Growth Hormone Is Tempting to Athletes

And there seems to be little doubt, therefore, that chronic administration of exogenous human growth hormone also will produce a human giant, and perhaps a giant athlete with gargantuan abilities! --Dr. William N. Taylor

The use of anabolic steroids has been a fact of life for some athletes for more than a decade, but in the last few years something new has found its way into the medicine cabinets.

The substance is human-growth hormone, and it has some athletes and physicians convinced it could lead to a world in which sprinters run the 100 meters in less than 8 seconds, and 308-pound William Perry is too small to play professional football.

Human-growth hormone is used almost exclusively to treat children with dwarfism, a condition that occurs when the pituitary gland fails to produce enough of the hormone naturally. Only since October, when a mass-produced synthetic form of the hormone was approved for use, has it begun to be used in research.

Those athletes using it, doctors say, are under the impression that they will gain height (depending on their age) and lean-muscle mass and will better utilize fat. Athletes, who obtain growth hormone mainly through the black market, are also attracted to it because, as of now, there is no test to detect it.

Still, because there has been no definitive research completed on the hormone’s effects--beneficial or harmful--there is considerable disagreement among doctors and others close to the issue as to whether there is any beneficial effect for athletes.

Some are convinced that use of growth hormone could lead to the day that, instead of cheering for The Fridge, fans would be yelling for three-bedroom colonials. Others aren’t so sure. And some experts say they think growth hormone should be classified as a controlled substance until those questions are answered.

Taylor, a Tucker, Ga., physician with an emphasis on sports medicine, has studied and written about the misuse of steroids and growth hormone by athletes. Of growth hormone he said, “I’m convinced it will enhance height and muscular strength.”

“There’s no question that it’s been used by a lot of athletes,” said Terry Todd, a former weightlifter who is a professor of physical education at the University of Texas, where he was the host of a seminar on the subject earlier this year.

Taylor attended the seminar, as did Robert B. Kerr, a southern California physician who said he has prescribed growth hormone for about 100 athletes, though not in the last two years; and Don H. Catlin, chief of clinical pharmacology at UCLA Medical Center and director of drug-testing during the 1984 Los Angeles Summer Olympics, who said he would never prescribe growth hormone for athletic-performance reasons.

“I don’t think the use of growth hormone is a widespread problem in the sense of anabolic steroids,” Catlin said. “Sure, some have tried it to see, but the magnitude is probably low. I don’t know that, but I deduce the amount is low, because I’ve talked to athletes one-on-one and . . . I asked them, and some would say, ‘Well, maybe I tried it but it doesn’t work.’

“I’m not surprised that it doesn’t; though, again, it’s not knowing the facts. But the amount taking it is really quite small. In my opinion, which comes from my knowledge of internal medicine, endocrinology and the study of growth hormone, I don’t see any beneficial effect.

“The only evidence is Dr. Kerr’s articles in muscle magazines and anecdotes. I know of no scientific evidence that it works. But I also know of no evidence that it doesn’t work.”

Kerr said the hormone is used extensively in Europe, and “I believe it is an anabolic agent.” He said he no longer prescribes it, because athletes, particularly body-builders, don’t follow his instructions.

“I used to think that because so many were taking black-market anabolic steroids . . . if the physician gave a little guidance and said to them that a little will give them the gains they want without taking the other things, it would be better,” Kerr said. “But they take what I prescribe and supplement it with five or six other things. I’ve changed my mind. You can’t trust athletes.”

The possible side effects include diabetes, hypertension and a condition known as acromegaly. The condition, which results from an oversupply of growth hormone, can leave a person with Neanderthal-like facial features, larger hands and feet, thicker skin, heart disease and shorter life expectancy.

Kerr said that the amounts he gave were small.

“When you take large amounts, you’re going to see acromegaly,” Kerr said. “What I was using in adults was one-fifth of what they use in an 8-to-10-year-old.”

Normally, growth hormone is produced by the pituitary gland and is responsible for triggering growth, either directly or by activating other chemicals in the body, during the growth years which end at about age 17.

However, the Human Growth Foundation in Bethesda, Md., estimates that in the United States there are 10,000 to 15,000 children whose pituitary glands don’t produce enough of the hormone.

If the disease, referred to as dwarfism, isn’t treated, the children may reach adult heights of substantially less than 5 feet.

Until the synthetic human-growth hormone was approved for use by the Food and Drug Administration, the only source of the hormone was through extraction from the pituitary glands of human cadavers.

According to the company producing the synthetic hormone, it took 50 human cadavers to keep one child supplied with the hormone for one year. That meant two things: the supply was extremely low, and the cost was extremely high, upward of $20,000 a year.

However, in the spring of 1985, the natural hormone was taken off the market when it was linked to four deaths from Creutzfeldt-Jakob disease, an extremely rare brain infection.

But the purity problem and the supply barriers may be lessened now that Genentech Inc. of South San Francisco has been allowed to market its synthetic human-growth hormone, which has a trade name of Protropin.

Although the greater supply will mean a happier future for children with dwarfism, it also will increase the likelihood that the hormone will find its way to athletes through a doctor’s prescription or the black market.

A Genentech spokesperson, acknowledging the possibility of misuse by athletes, said the company would distribute the synthetic hormone only through hospital pharmacies to about 500 pediatric endocrinologists and 500 adult endocrinologists who also treat children.

The spokesperson added, “There is no clinical study that indicates any advantage to an adult in taking growth hormone.”

Because of the short supply, and the ethical problems involved with doing tests on humans, there has not been a thorough scientific study done to measure what effect human growth hormone has on normal adults or normal children, and what the side effects are for those two groups. That leaves only anecdotal evidence, theory and more questions than answers.

“It’s not OK to make superficial dogma based on no research,” Taylor said. “It gets you into trouble every time.”

He proposes that the hormone be registered as a controlled substance. Currently human-growth hormone is available through prescription.

Even with all the questions, Dr. Rebecca Kirkland, a professor of pediatrics specializing in endocrinology at Baylor University, said she gets several calls a week from parents inquiring about growth hormone for their children.

“They think the growth hormone will give their child an added advantage,” said Kirkland, who added that she usually persuades them to wait. Not all parents are so easily persuaded. Taylor recalled the father of a 16-year-old, 6-foot-6 basketball player coming into his office with his own supply of growth hormone.

“The father came in and said, ‘How much do I give him?’ ” Kerr said. “He had obtained it from a Florida health club.”

As more companies produce the synthetic hormone, Taylor thinks it’s “only a matter of time” before it becomes readily available to athletes.

Kerr said, “When you have an overabundance, there is a greater likelihood of it getting on the black market. There’s also a lot of fake products on the black market, and people pay fantastic prices for them.”

Taylor, Todd, Kerr and Dr. Robert Voy, chief medical officer for the U.S. Olympic Committee, favor making the hormone a controlled substance.

“The drug ought to be controlled to give research scientists five to 10 years to work with it,” Taylor said. “We have no clue what it really does. It does have potential to increase height and the potential for abuse.

“If a doctor is willing to write down the (Drug Enforcement Administration) number for a drug, he’s saying it’s for a legitimate purpose. Now, if he wants to write it for 50 athletes . . . it’s like penicillin--it’s difficult to follow.”

Dr. Richard P. Bowles, a family practitioner with an interest in sports medicine, would like to see human growth hormone classified as a Schedule II controlled substance.

Schedule II, the second most tightly controlled of the five classes, includes cocaine. (Schedule I includes drugs such as heroin for which there is no acceptable medical use, according to the DEA.)

Substances on Schedule II cannot be prescribed by phone, cannot be refilled, must be stored in a vault or safe and must be carefully recorded. The DEA also has a computerized method for tracking Schedule II drugs.

Misuse of a controlled substance can bring stiff criminal penalties and, depending on the classification, can include physicians losing their licenses if the substance is prescribed illegitimately.

“It is both wonderful and fearsome,” Bowles said of the hormone’s capabilities. And of the effort to have it controlled, he said, “That way it would still be available and it still can be prescribed. But it can give a severe sting for abusers, enough so that the use in that regard would be curtailed.”

Dr. John Gueriguian, an FDA supervising medical officer who was involved with the Genentech case, said, “We have to count on the medical integrity of the doctors who should prescribe it for legitimate purposes. People would have to be immensely stupid to take it if they didn’t need it. It doesn’t work (to build muscle), it costs too much, it’s detrimental to yourself and may be illegal.”

Others aren’t so sure that will keep all athletes from trying it.

“We’ll bury our heads in the sand and forget about it,” Taylor said. “It’s a major cancer in the fitness revolution. It’s only been since ’84 that the medical profession said steroids were effective. Before that we said it was a placebo. That is the most ridiculous scenario and it got us into the problem with steroids, and I think it’s unprofessional-hear no evil, speak no evil, see no evil, and don’t stir up any trouble.”

Todd said, “It’s somewhat similar to the position people took on anabolic steroids until they became laughingstocks.”

Like steroids, the use of human-growth hormone is one more attempt at better performance through chemicals.

“That tells you about the value system and competitive motivation of some athletes,” Todd said. “They want to win awfully bad.”