More Reasons Not to Worry about HGH in Baseball

With the Mitchell Report supposedly being released this Thursday, I wanted to post some links to more studies of the performance-enhancing effects human growth hormone (HGH). You can read more here and here.

Short-Term Administration of Supraphysiological Recombinant Human Growth Hormone (GH) Does Not Increase Maximum Endurance Exercise Capacity in Healthy, Active Young Men and Women with Normal GH-Insulin-Like Growth Factor I Axes

Annika Berggren, Christer Ehrnborg, Thord Rosén, Lars Ellegård, Bengt-Åke Bengtsson and Kenneth Caidahl

The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 6 3268-3273

CONTEXT: Despite the fact that the use of GH as a doping agent in sports is widespread, little is known about its short-term effects. OBJECTIVE: The objective was to study the effects of GH on exercise capacity. DESIGN: A double-blind, placebo-controlled study was used, with a treatment period of 28 d. SETTING: Subjects from general community studied ambulatory at a university hospital. PARTICIPANTS: Thirty healthy active young normal volunteers (15 women and 15 men) were recruited by local announcement, and all completed the study. INTERVENTION: All subjects were randomized to receive a low GH dose (0.033 mg/kg.d or 0.1 IU/kg.d), a high GH dose (0.067 mg/kg.d or 0.2 IU/kg.d), or placebo. MAIN OUTCOME MEASURES: Power output and oxygen uptake on bicycle exercise were the main outcome measures. Results: We found no effect of the low or high dosages of GH on maximum oxygen uptake during exercise (mean +/- se for placebo, 45.2 +/- 1.6 to 45.2 +/- 2.1 ml/kg.min; GH low dose, 42.8 +/- 1.6 to 42.8 +/- 1.6 ml/kg.min; GH high dose, 44.8 +/- 3.4 to 44.8 +/- 2.2 ml/kg.min; not significant by two-way ANOVA). Neither was there any effect on maximum achieved power output during exercise or on blood pressure, heart rate, or the electrocardiographic ST level at rest or during exercise. GH significantly increased total body weight (P = 0.028), an effect predominantly ascribed to fluid retention (increased extracellular water volume), whereas muscle mass (as indicated by intracellular water volume) did not change. However, changes in the latter correlated to changes in physical performance, possibly due to different training efforts. CONCLUSION: Administration of supraphysiological recombinant human GH during a period of 4 wk does not improve power output or oxygen uptake.

Supraphysiological growth hormone: less fat, more extracellular fluid but uncertain effects on muscles in healthy, active young adults

Ehrnborg C, Ellegård L, Bosaeus I, Bengtsson BA, and Rosén T.

Clinical Endocrinology, Volume 62 Issue 4 Page 449-457, April 2005

OBJECTIVES: To study the effects on body composition after 1 month’s administration of supraphysiological doses of growth hormone (GH) in healthy, active young adults with normal GH-IGF-I axis. SUBJECTS AND METHODS: Thirty healthy, physically active volunteers (15 men and 15 women), mean age 25.9 years (range 18-35), participated in this study, designed as a randomized, double-blind, placebo-controlled, parallel study with three groups (n = 10: five men and five women in each group). The groups comprised the following: placebo (P), GH 0.1 IU/kg/day [0.033 mg/kg/day] (GH 0.1) and GH 0.2 IU/kg/day [0.067 mg/kg/day] (GH 0.2). RESULTS: In the pooled group with active GH treatment (n = 20) the results showed significant increases: IGF-I increased by 134% (baseline vs. after 1 month), body weight by 2.7%, fat free mass by 5.3%, total body water by 6.5% and extracellular water (ECW) by 9.6%. Body fat decreased significantly by 6.6%. No significant change in intracellular water was detected. The observed increase in fat free mass by 5.3% was explained by the ECW increase, indicating limited anabolic effects of the supraphysiological GH doses. Changes were noticeable in both genders, although more prominent in the male subjects. Fluid retention symptoms occurred in the majority of individuals. CONCLUSIONS: This is, to our knowledge, the first placebo-controlled trial to show the effects of supraphysiological GH doses on body composition and IGF-I levels in physically active and healthy individuals of both genders; the results indicate limited anabolic effects of GH with these supraphysiological doses. The role of GH as an effective anabolic doping agent is questioned.

This paper summarizes the findings of several studies.
Ergogenic aids: human growth hormone.

Stacy JJ, Terrell TR, and Armsey TD.

Current Sports Medicine Reports 2004 Aug;3(4):229-33.

Human growth hormone (GH) has a number of accepted medical uses, but has quickly become a popular ergogenic aid among athletes. The issue of performance-enhancing substances such as anabolic steroids and GH has drawn the attention of athletes, their parents, and politicians. On almost a daily basis, headlines about the status of doping in professional, international, and amateur sports seem to be more pervasive. The supraphysiologic effects of GH lead to lipolysis, with increased muscle volume. Due to the ethical limitations of studying the use of high doses of GH in isolation or combined with anabolic steroids, the scientific literature has not produced compelling results on its efficacy. GH has potential as an anti-aging drug and does lead to some improved athletic performance in isolated studies. Despite the lack of compelling data, GH seems to have developed a reputation among athletes for enhancing performance. The detection of illegal doping with GH has been the focus of a concerted international effort by the International Olympic Committee. A number of promising detection techniques may allow the detection of illicit GH use. This review on GH as an ergogenic aid includes a discussion of the basic physiology of GH and its actions, the accepted medical indications for its use, the results of scientific studies that assess whether it improves exercise performance or work capacity, and the scientific techniques under development to detect ergogenics with strong abuse potential.

From this same study, here is what the authors conclude regarding the ergogenic properties of growth hormone.

There is no current study that has demonstrated a significant increase in workload capacity in response to human GH administration in healthy adults. The studies that have addressed the impact of GH on muscle mass and athletic performance do not show consistently favorable results. For instance, patients with acromegaly do have greater muscle volume than normal individuals, but they do not show an increase in strength or performance. No controlled study to our knowledge has shown a beneficial effect of supraphysiological doses of human GH on muscle strength in trained athletes.

Also, I would like to clarify my motivation for highlighting the evidence regarding the ergogenic impacts of growth hormone. The main reason is that I want to point out where the media has dropped the ball. And, I’m not one of those “it’s the media’s fault” conspiracy nuts. I love the media. Both my parents are former journalists, and my dad was a newspaper editor for over 30 years. I spent a lot of time in The Charlotte News and The Charlotte Observer newsroom(s) as a kid, and I have a lot of respect for what journalists do. Journalism has its share of jerks and hacks, but I suspect it’s no different than in any other profession. This isn’t meant to be a personal indictment of these people.

The reporting on performance-enhancing drugs in baseball has been as much of a black mark on journalism as the actual substances have been for the game, and not because reporters may have given players a pass many years ago. Guys like Brady Anderson and Luis Gonzalez have been accused of using performance-enhancing drugs based solely on a bump in performance, which is outrageous. This is the type of claim that columnists shouldn’t have written and editors shouldn’t have allowed, as there are many alternative explanations for sudden changes in performance.

The reporting on growth hormone has been beyond bad. There has been a grand total of two articles on the scientific evidence regarding the performance-enhancing effects of the drug in the the midst of this latest drug scandal. When home runs didn’t fall after testing started, it was too convenient to say, “well, there is still HGH, and there is no test for that yet.” Yet, few stopped to check to see if the drug had any more effect than eating chicken, pre-game dance routines, or jumping foul lines when running to and from the dugout. Steroids do improve athletic performance, HGH does not.

This isn’t a harmless mistake either. The first question I get asked when I point out the non-effect of HGH is, “why do players take it, then?” These guys read the papers, too. Members of the media who have reported on HGH being a performance enhancer are as much to blame for the use of HGH as the trainers and athletes themselves. When the first whispers of HGH in the clubhouse were heard, reporters should have been calling exercise physiologists and searching PubMed. Instead, some struggling fourth outfielder gets tired of being a spare part, goes to an online pharmacy, and before he knows it his wrists hurt and he isn’t playing any better.

Right now, MLB is paying researchers to develop a urine test for HGH. This is a colossal waste of resources. Instead, MLB should institute a campaign summarize the scientific findings and present them to the players. I would also remove the ban on HGH to take away some of the “forbidden fruit” magnetism. If it remains illegal, then some players may think that it must work. If you want carpal tunnel syndrome, a swollen head, smooshed internal organs, a dangerous blood profile, etc., then that is your business.

4 Responses “More Reasons Not to Worry about HGH in Baseball”

  1. JEC says:

    I don’t disagree with your conclusions about the media’s rush to judgment. But a four-week study of the lack of effects of HGH is hardly a conclusive one. Creatine doesn’t “work” in four weeks (little to no noticeable changes). Does that mean it doesn’t work? Exercise in general doesn’t do much in just four weeks. Many medications can take months to work, such as ones for HIV or over-active thyroids. Stating that there are no athletic benefits to long-term consumption of HGH (which is what these players are doing – players like Paul Byrd are reported to have been getting it prescribed for YEARS) based on a short-term study is as mis-represented as the articles touting its benefit which you rail against.

  2. dfc says:

    I agree that a 4-week study doesn’t seem terribly likely to reach a strong conclusion. And that’s why I agree that we should stop just banning such things in sports. Let the athletes take whatever they want, just require a doctor’s supervision. That way, fans can make their own judgments about the players, and there will be a lot more information available about the health effects.

    As a side note, while this isn’t the first I’ve heard about HGH having no effect on grown people, is there any kind of study about effects on people still growing? Say, high school athletes?

  3. RJB says:

    Well, I think there are a couple more points to think about. A lot of athletes take much higher doses of HGH than what the doctors are “ethically” allowed to test. Also, most athletes tend to use it combination with steroids. Steroids help increase muscular performance and the HGH helps enlarge supporting tissues like ligaments and bones. This allows the body to withstand the increased force created by larger muscles. It seems that the HGH is also key in recovery so that athletes can train longer and harder than normal. All this would lead to increased performance on the playing field.

  4. Justin says:

    I agree with your column and the comments from other readers, too, but I think it needs to be mentioned that HGH and steroids are both largely used for injury recovery and/or stamina over long periods of time and not explicitly as magical drugs that can make anyone into an All-Star (see: Jeremy Giambi).

    It wasn’t a coincidence that most everyone who has been named in the performance-enhancing drug stories over the years is over 30 years old and was over 30 when they reportedly purchased the drugs.

    Guys who were borderline big leaguers go for steroids or HGH to keep up with younger, more talented players and to ensure they keep getting paid; guys like Bonds or Clemens want to keep playing but struggle with health issues and so turn to steroids or HGH to help recovery time and whatnot.