Growth hormone use in young athletes: a ‘black box’ of information

Research about the effects of growth hormone used to gain athletic advantages lags behind steroid research.

While research on steroids, steroid precursors or other ergogenic drugs has been widespread and well-documented, research on the effects of growth hormone use in athletes and competitive sports is lacking, and the research that has been done is inconclusive.

“The problem with growth hormone is that it’s sort of this black box right now,” said Ryan Calfee, MD, clinical instructor of orthopedics and chief resident in the orthopedic surgery department at Brown University Medical School.

Calfee and colleague Paul Fadale, MD, wrote a review in Pediatrics of current literature regarding the use, effects, risks and legal standing of anabolic steroids, steroid precursors, nutritional supplements, ephedrine and growth hormone.

“It’s a hard thing for health care providers and physicians to say ‘we know exactly how growth hormone will affect you.’ People are using growth hormone based on the promises they see in advertising saying it will make you stronger or perform better, but the available scientific data do not support these claims,” Calfee said.

Risks of use

“There are well-documented risks and health problems associated with growth hormone use,” he said. Beyond the risks of disease transmission via nonsterile needles is the potential for premature physeal closure, jaw enlargement, hypertension and slipped capital femoral epiphysis.

More rare but severe risks include papilledema with intracranial hypertension.

Despite these documented risks, a 1992 study in Clinical Pediatrics by researchers in the department of pediatrics at the University of Arkansas for Medical Sciences found that 10 (4.5%) of 224 high school boys surveyed reported use of growth hormone specifically to improve athletic performance.

A separate 2001 study by the National Collegiate Athletic Association of over 21,000 collegiate athletes found that 3.5% had taken growth hormone in the 12 months prior to the survey.

A first question may be: If not by prescription, where can an athlete get growth hormone?

The Internet would seem like the primary option. A search for “growth hormone” returns a number of sponsored links to web sites touting its use for a variety of reasons: longevity, rejuvenation, increased vitality and athletic performance. Some sites herald the benefits of growth hormone spray or liquid noninjectable formulations, seemingly obvious scams.

“It’s almost impossible to say how the availability of growth hormone on the Internet plays a factor,” Calfee said. “There are hundreds of websites that claim to have it, but there is no proof that these advertisements accurately reflect the content of their products.”

Alternatively, research has shown that getting growth hormone by other means may depend more on a teenaged athlete’s connections within their community more than anything else: Peers and coaches, parents, team physicians or other physicians are passing it along. Calfee said that it’s less likely that a young athlete would get the money and purchase growth hormone on a completely independent basis.

“It’s going to depend on who athletes are around more than anything,” Calfee said.

Emulating the pros

“In most surveys, there are a small percentage of people actually using ergogenic drugs, but a large percentage of peers in that group that know of or see these people using them,” Calfee said.

In the University of Arkansas study, 31% of the boys surveyed knew of a peer using growth hormone. In a way, this may reflect the nature of competition and sports in the United States, “how competitive sports have become and what even young athletes believe it takes to succeed,” Calfee said.

When an athlete sees another more successful athlete using ergogenic drugs, then using the drugs may not only become justifiable, but the first athlete may think success will come only by emulating this behavior themselves.

This works on a peer-to-peer level, but also on a role-model level when younger athletes look to elite professionals.

“In anecdotal reports and highly publicized incidents of younger athletes admitting use of these drugs, these athletes have referenced professional athletes. They are seeing some of their idols use drugs — whether it is steroids, growth hormones or other drugs — and it definitely has an impact,” Calfee said.

Lagging behind

So why does growth hormone seemingly lag behind steroids in terms of its use and research into its effects?

Calfee cited three reasons why its use is not widespread.

“It’s not as easily available to as many people. This might not be true for the elite athlete, but in younger people, it’s easier to get their hands on steroids or alternative ergogenic substances,” Calfee said.

A second reason is that growth hormone is currently only available in injectable forms. There is no option of an oral agent, such as with steroids. “It’s a lot easier if you can take a pill,” Calfee said.

“A third reason would be that the costs are prohibitive. When you look at acquiring medicinal growth hormone, you’re talking $1,000 to $5,000 for a one-month supply,” he said.

From a research perspective, the contrast between steroid research and growth hormone research is apparent.

There is a consensus about anabolic steroids. “These drugs do increase athletic measures with objective gains in strength and fat-free mass,” Calfee and Fadale wrote. In contrast, “nearly 30% of steroid users experience mild subjective adverse effects,” they wrote.

“As far as I can tell, no study has shown any significant athletic measure or performance gain for growth hormone, although researchers have been able to document adverse effects,” Calfee said.

This may, however, provide a means of convincing athletes not to use growth hormone.

“Hopefully, educational programs would at least steer people away from substances that are known to be dangerous without benefit,” Calfee said. “There are a lot of drugs out there such as growth hormone that are touted as having benefits that haven’t been born out.”

Educational programs stressing the risks of steroid use are effective; programs stressing the lack of benefit of and associated risks of growth hormone may be even more effective. “If we can make these effects more public, hopefully we will turn people away from putting themselves at risk,” Calfee said.

Means of prevention

Beyond stressing the risks, other preventive measures can be taken to keep athletes from using growth hormone.

Educational initiatives that model successful anti-steroid programs may be effective. These programs are designed for both athletes and coaches to participate in, and they include role-playing, examining literature to learn how to analyze claims made in advertisements, and how to independently search for more reliable information.

“Those seem to be effective in terms of steroid use. Initiatives modeled in this way are probably going to be the best, most wide-reaching programs,” Calfee said.

Another aspect of prevention incorporates physician involvement. “Opening people’s eyes to the risk is the big thing for young athletes, because they are only focused on potential gains in the short-term,” Calfee said.

Physicians can educate athletes about the apparent lack of benefits and the risks involved, and can be prepared to talk to them during preparticipation physicals. “If the athlete has questions, physicians can have an open and educated exchange, which would hopefully sway them from using the drug,” Calfee said.

Recent popular media coverage of testing for steroids in high school athletes has brought the concept of testing to the forefront as another form of prevention.

“The problem with growth hormone, and one of the reasons some people have turned to it, is that there isn’t a commercial test to detect it in athletes,” Calfee said. “So another preventive measure would be developing a test for growth hormone,” he said.

Although increasingly advanced tests can screen for designer steroids, without a test to screen for growth hormone — regardless of a lack of proven benefit — people are trying it anyway. – by Evan Young

For more information:

• Calfee R, Fadale P. Popular ergogenic drugs and supplements in young athletes. Pediatrics. 2006; 117:e577-e589.
• Rickert VI, Pawlak-Morello C, Sheppard V, et al. Human growth hormone: a new substance of abuse among adolescents? Clin Pediatr (Phila). 1992;31:723-736.
• NCAA study of substance use habits of college student-athletes; 2001. Available at http://www.ncaa.org/library/research/substance_use_habits/2001/substance_use_habits.pdf