What are your thoughts on the use of peptides, such as somatropin (growth hormone), for therapeutic benefits like hormone regulation, wound healing, or anti-aging in adults?

Opinion on Peptide Therapeutics

For therapeutic peptides like growth hormone (somatropin), use should be strictly limited to FDA-approved indications with documented deficiency or specific medical conditions—not for anti-aging, general wellness, or performance enhancement in healthy adults. 1

Evidence-Based Therapeutic Uses

Approved Medical Indications Only

Growth hormone therapy has legitimate, FDA-approved uses in specific populations where benefits clearly outweigh risks:

• Growth hormone deficiency (GHD) in both children and adults with documented deficiency 1, 2
• Chronic kidney disease in children with growth failure 3
• Short bowel syndrome (SBS) with intestinal failure, though teduglutide (a GLP-2 analog) is preferred over growth hormone as first-line therapy 3
• Specific genetic conditions including Turner syndrome, Prader-Willi syndrome (with strict safety criteria), Noonan syndrome, and SHOX gene haploinsufficiency 1, 2

Critical Safety Concerns That Limit Use

Growth hormone carries serious, potentially life-threatening risks that contraindicate its use outside approved indications: 1

• Increased mortality in acutely ill patients—a 42% mortality rate versus 19% in placebo groups during critical illness 1
• Sudden death risk in pediatric patients with Prader-Willi syndrome who have obesity, upper airway obstruction, or sleep apnea 1
• Active malignancy is an absolute contraindication—growth hormone increases risk of malignancy progression and second neoplasms, particularly meningiomas in patients previously treated with cranial radiation 1
• Significant side effects including edema, joint pain, carpal tunnel syndrome, and glucose intolerance 3

The Anti-Aging and "Wellness" Peptide Problem

No Evidence for Functional Benefit in Healthy Adults

The disconnect between muscle mass and actual function is critical: 4

• Growth hormone increases lean body mass but does not improve strength, exercise capacity, or functional outcomes 4
• In COPD patients, growth hormone increased lean mass by 2.3 kg but the 6-minute walk distance actually decreased significantly, indicating functional impairment despite increased muscle mass 4
• The American Thoracic Society/European Respiratory Society concluded growth hormone "cannot be recommended" based on this mass-function disconnect 4

Hormonal Therapies Not Recommended for Heart Failure

Multiple cardiology guidelines explicitly state that growth hormone and other hormonal therapies should not be used: 3

• Randomized trials have failed to demonstrate benefit for routine hormonal supplementation in heart failure 3
• No clinical trials have demonstrated improved survival with nutritional or hormonal therapy 3
• Until more data are available, hormonal therapies are not recommended for treatment of heart failure 3

Short Bowel Syndrome: The Exception With Caveats

Teduglutide Preferred Over Growth Hormone

When growth factors are indicated for intestinal rehabilitation in SBS, teduglutide (GLP-2 analog) is the first choice over growth hormone: 3

• Growth hormone has more frequent systemic adverse effects compared to teduglutide's primarily gastrointestinal side effects 3
• High-dose growth hormone may improve wet-weight absorption but is associated with significant side effects 3
• Effects of growth hormone are mainly in SBS patients with colon in continuity, with limited effects in jejunostomy patients 3

Strict Requirements for Any Growth Factor Use

Growth factors in SBS should only be prescribed under highly controlled conditions: 3

• Only by experts experienced in SBS management with facilities to objectively evaluate benefit versus risk 3
• Patients must be carefully informed about probability of reducing parenteral nutrition needs, quality of life improvement, duration of treatment, effects after cessation, adverse effects, cost-effectiveness, and monitoring requirements 3
• Life-long treatment is required as effects quickly vanish after stopping 3
• Careful patient surveillance for cancer risk must be performed 3

Alternative Approaches That Actually Work

Resistance Training: The Gold Standard

For muscle growth and functional improvement in healthy individuals, resistance training vastly outperforms any peptide: 4

• Training 2-3 times per week with 3-4 sets of 7-10 repetitions per exercise effectively promotes muscle growth 4
• Progressive overload with adequate protein intake (1.6g/kg body weight or higher) optimizes results 4
• This approach increases both muscle mass AND strength, unlike pharmacological interventions 4

The Quality Over Quantity Principle

Studies consistently show that increases in lean body mass without corresponding strength gains do not translate to: 4

• Improved daily function 4
• Reduced fall risk 4
• Enhanced quality of life 4

Emerging Peptide Therapeutics: Limited Clinical Data

GHRH Analogs and Secretagogues

Newer growth hormone secretagogues have theoretical advantages but lack robust clinical evidence: 5, 6

• Different mechanisms of action between tesamorelin and ipamorelin require consideration of potential side effects 5
• Glucose metabolism must be closely monitored due to effects on insulin sensitivity 5
• IGF-1 levels require assessment during monitoring 5
• Ghrelin and GHRH act synergistically in vivo but only additively in vitro, suggesting complex regulatory mechanisms 6

Peptides as Drug Class: Promising but Context-Dependent

Peptides have legitimate pharmaceutical applications when properly developed: 7, 8

• Approximately 140 peptide therapeutics are in clinical trials, recognized for high selectivity and efficacy 7
• Peptides can effectively disrupt protein-protein interactions and mimic natural ligands 8
• However, stability and delivery remain significant challenges requiring peptidomimetics, carrier systems, or protein transduction domains 8

Bottom Line for Clinical Practice

Do not prescribe growth hormone or related peptides for: 1, 3

• Anti-aging purposes
• General wellness or "optimization"
• Athletic performance enhancement
• Muscle building in healthy individuals

Only consider peptide therapy when: 3, 1

• FDA-approved indication is present
• Documented deficiency or specific medical condition exists
• Patient has been thoroughly counseled on risks versus benefits
• You have expertise in managing the specific condition
• Facilities for objective monitoring are available
• Malignancy has been ruled out and patient is not acutely ill

The cost-effectiveness and risk-benefit ratio must be carefully considered, as these treatments are expensive and effects cease upon discontinuation, requiring potentially life-long therapy. 3