How can I safely increase growth hormone (GH) levels?

How to Safely Increase Growth Hormone Levels

Growth hormone (GH) should only be increased through medically supervised recombinant human GH therapy when specific diagnostic criteria are met, as self-administration or use without proper indication carries significant risks and is not recommended for healthy individuals.

Who Qualifies for GH Therapy

GH therapy is FDA-approved only for specific medical conditions, not for general enhancement in healthy individuals 1, 2:

• Pediatric indications: GH deficiency, chronic kidney disease, Turner syndrome, idiopathic short stature, small for gestational age without catch-up, Prader-Willi syndrome, SHOX gene haploinsufficiency, and Noonan syndrome 1, 2
• Adult indication: Documented GH deficiency with multiple (≥3) pituitary hormone deficiencies, history of pituitary surgery, radiation therapy, traumatic brain injury, or childhood-onset GH deficiency 3

Diagnostic Requirements Before Starting GH

You cannot simply "increase" GH without proper medical evaluation. The following must be documented 4, 5, 3:

• Stimulation testing is required in most cases, using insulin, glucagon, GHRH-arginine, or macimorelin to prove GH deficiency 3
• IGF-1 levels must be measured, though low levels alone are insufficient for diagnosis 4, 3
• Thyroid function (TSH, free T3/T4) must be normal, as hypothyroidism causes similar symptoms 4, 5
• Bone age assessment via left wrist radiograph to confirm open growth plates in children 4, 6

Critical Pre-Treatment Optimization

GH therapy should never be initiated until these factors are corrected 4, 5:

Nutritional Status

• Achieve adequate caloric intake (130 kcal/kg/day in infants) and protein (4 g/kg/day) 5
• Correct vitamin D deficiency (maintain 25-hydroxyvitamin D3 >30 ng/ml) 4
• Address malnutrition through enteral feeding if necessary 4

Metabolic Control

• Correct metabolic acidosis (serum bicarbonate ≥22 mEq/l) 4
• Manage electrolyte disturbances, particularly in kidney disease 4, 5
• Control secondary hyperparathyroidism to CKD-stage-dependent targets 4

Hormonal Assessment

• Exclude or treat hypothyroidism 4, 5
• Evaluate pubertal status in patients >10 years old 4

FDA-Approved Dosing Regimens

Pediatric dosing (subcutaneous injection) 1:

• GH deficiency: Up to 0.3 mg/kg/week (0.045-0.05 mg/kg/day) 5, 1
• Chronic kidney disease: Up to 0.35 mg/kg/week 1
• Turner syndrome: Up to 0.375 mg/kg/week 1
• Pubertal patients: Up to 0.7 mg/kg/week 1

Adult dosing 1, 7:

• Non-weight-based: Start 0.2 mg/day (range 0.15-0.3 mg/day), increase by 0.1-0.2 mg/day every 1-2 months 1, 7
• Weight-based: Start ≤0.006 mg/kg/day, maximum 0.025 mg/kg/day (age ≤35) or 0.0125 mg/kg/day (age >35) 1
• Maintenance dose should not exceed 1.0 IU/m²/day (ages 40-60) or 1.5 IU/m²/day (ages 20-40) 7

Absolute Contraindications

GH must not be used in the following situations 4:

• Active malignancy or tumor 4
• Closed epiphyses (no growth potential remaining) 4
• Uncontrolled diabetes mellitus 4
• Pre-existing papilledema or intracranial hypertension 4
• Known hypersensitivity to GH or its components 4

Mandatory Monitoring During Treatment

Quarterly assessments 6:

• Height measurements every 3 months to calculate growth velocity 5, 6
• Adequate response defined as >2 cm/year increase over baseline 4

Every 6 months 6:

• IGF-1 levels to prevent supraphysiological dosing 4, 6

Annually 4, 6:

• Bone age radiography (left wrist) to monitor for accelerated maturation 4, 6
• Pubertal staging (Tanner stages) in patients >10 years 4

Every 3 months in CKD patients 4:

• Renal function monitoring (eGFR, creatinine) 4

When to Stop GH Therapy

Discontinue immediately if 4, 8:

• Height velocity drops below 2 cm/year 4, 8
• Epiphyseal closure evident on radiography 4
• No adequate response after 6 months of therapy 4
• Genetic target height achieved 4
• At time of renal transplantation 4
• Severe adverse effects, illness, or trauma occur 4

Critical Safety Warnings

Common pitfalls to avoid 4, 8:

• Higher doses are not more effective and increase side effect risk 4
• Accelerated pubertal development may occur, requiring dose reduction or discontinuation 4, 8
• Slipped capital femoral epiphysis risk requires immediate bone radiographs if hip/knee pain develops 4
• Papilledema can develop, causing vision loss if untreated 4
• Non-adherence is a common cause of treatment failure 4

Natural Methods Are Insufficient

While sleep, exercise, and nutrition influence endogenous GH secretion 9, these lifestyle modifications cannot meaningfully increase GH levels in individuals with true deficiency or approved indications. Recombinant human GH therapy remains the only effective treatment for documented GH deficiency 10, 9.

The key message: GH therapy is a prescription medication requiring rigorous diagnostic criteria, careful monitoring, and should never be used for enhancement in healthy individuals. Attempting to increase GH without medical supervision carries significant health risks including diabetes, joint problems, carpal tunnel syndrome, and increased cancer risk 10.