his testing center (ETLA). For more information about testing for GH deficiency, please go to
Treatment with GH
Once a physician has proven GH deficiency, he or she will begin the patient on GH and if needed, the dose will be increased until a final maintenance dose is reached. Dr. Friedman begins with 0.2 mg a day for men and elderly patients and 0.4 mg for women. Estrogens decrease the effect of GH, which is thought to be the reason why females need more GH. The
of growth hormone; values which are too high prompt a lower dose. Dr. Friedman likes to see the IGF-1 in the upper-normal range. Once a final dose is established, the blood tests will continue approximately every 4 to 6 months. The symptoms of GH excess include muscle or joint pain, retention of fluid (called edema) and carpal tunnel, which consists of pain and/or numbness in the hands. If these symptoms occur, it is likely that the dose is too high.
In that case, Dr. Friedman will have you get an IGF-1 level, stop your GH for a few days, then restart at a lower dose.
Oral estrogens, such as birth control pills, premarin and oral estrace all block the action of GH at the liver. This leads to high GH (which can cause diabetes) and low IGF-1, both of which are detrimental. Estrogen applied to the skin (creams or patches) does not cause this effect.
Patients on oral estrogens will often need two to three times the dose of GH.
For these reasons, all patients taking GH should not take oral estrogens.
There are other ways the physician will monitor GH therapy.