Serostim Growth Hormone:
How Much Muscle Does It Really Build?
by Michael Mooney (March 1, 1999 - Updated April, 2000)

Q. I am confused. You say that Serostim growth hormone is not very anabolic, but it seems like everyone else thinks it is. It's supposed to be something that is used when steroids don't work for someone who has AIDS, so it must be more powerful as an anabolic hormone.

A. This is incorrect. Let's dig a little deeper and get to the truth. Serostim growth hormone is promoted by its manufacturer to address wasting in HIV. Since wasting is the loss of lean body mass that precedes death, this is an important effect. And growth hormone does increase lean body mass, but exactly what does this mean? Don't assume that lean body mass means muscle.

Several studies of HIV(-) subjects indicate that growth hormone does not increase the portion of the lean body mass (LBM) that is known as muscle, even though growth hormone does increase "lean body mass". Note that LBM describes several compartments of tissue that include muscle, connective tissue, bone, organs, and water, too. These studies found that the increase in LBM with growth hormone in HIV(-) subjects consists of tissue other than muscle. Actually the increase in LBM appears to be mostly water, with perhaps a little connective tissue, and some organ tissue, too. (It should be underlined that organ tissue, like muscle tissue, wastes in HIV, and rebuilding of organ tissue by growth hormone could be an important effect that may improve overall health and survival.)

Summaries:

1. Effect of growth hormone and resistance exercise on muscle growth in young men. Yarasheski KE; Campbell JA; Smith K; Rennie MJ; Holloszy JO; Bier DM. Am J Physiol, 262(3 Pt 1):E261-7 1992 Mar
In this study GH given at 2 to 4 times normal physiological levels (9 IU per day) did not produce significant muscle growth in HIV(-) young men who lifted weights. While there was an increase in LBM, this study showed that the LBM that was gained was basically not muscle, but water or other tissue.

Note that studies with anabolic steroids do show considerable muscle growth when given in doses that are this much higher than normal physiological doses. (See: Bhasin, S, et al. The effect of supraphysiological doses of testosterone on muscle size and strength in normal men. N Engl J Med (1996) 335(1):1-7, and Friedl, KE, et al. Comparison of the effects of high dose testosterone and 19-nortestosterone to a replacement dose of testosterone on strength and body composition in normal men. J Steroid Biochem Mol Biol (1991) 40(4-6):607-612.

2. Effect of growth hormone and resistance exercise on muscle growth and strength in older men. Yarasheski KE; Zachwieja JJ; Campbell JA; Bier DM. Am J Physiol, 268(2 Pt 1):E268-76 1995 Feb
In this study there was also a lack of effect on muscle tissue, but in older men who lifted weights. The authors said: "The greater increase in fat free mass (FFM) with GH treatment may have been due to an increase in noncontractile protein and fluid retention." Note that "contractile protein" tissue is muscle, so "noncontractile" tissue could mean connective tissue like ligaments, or organs like kidneys.

3. Growth hormone effects on metabolism, body composition, muscle mass, and strength. Yarasheski KE. Exerc Sport Sci Rev, 22():285-312 1994
In this one the author said, "On the basis of the similar increases in muscle protein synthesis, muscle cross-sectional area, and muscle strength observed in placebo and GH-treated exercising young adults, it is doubtful that the nitrogen retention associated with daily GH treatment results in an increase in contractile protein, improved muscle function, strength and athletic performance."

While some people would question the validity of applying data gleaned from studies on HIV(-) subjects to HIV(+) subjects thinking that they must have very different responses to GH, anabolic response to GH in HIV(+) subjects has been described as being "comparable" to the HIV(-) subjects in her study by highly-respected Dr. Kathleen Mulligan of San Francisco General Hospital. (See: Anabolic effects of recombinant human growth hormone in patients with wasting associated with human immunodeficiency virus infection. Mulligan K, et al, J Clin Endo & Metab 1993;77(4): 956-962.)

GH's Real Value

In HIV(+) subjects we do have a somewhat different metabolism than the "normal" metabolism of someone who is HIV(-), and there is weak indication in some of the published data that a perhaps little of the LBM growth caused by growth hormone might actually be muscle growth in some HIV(+) subjects, but this has not been investigated in more depth, so this is still quite unclear.

Note that Serono, the manufacturer of Serostim has not allowed any study to be done of Serostim GH with exercising subjects. I assume that this is because they do not want people to know the truth -- they are trying to keep the issue of muscle growth confused so that they can sell more GH to people who have a false impression that Serostim increases muscle tissue or the effects of weight training on muscle tissue.

During the next two years we should see the publication of some studies with wasting HIV(+) people that will carefully analyze what kind of LBM is gained. The first information released from one of them did show that there was no muscle gained in HIV(+) people over 12 weeks. Read it at: HIV Study Shows No Muscle Growth From Serostim Growth Hormone.

While this might surprise some people because they believe that they have seen significant changes in the muscle tissue of friends who have used GH, consider that it is possible that GH's effect may actually only be that the person's muscle tissues hold more water so they look fuller, while the GH caused some loss of bodyfat, so the person's muscle have a better appearance. However, for its cost, these effects still don't make GH seem like an equitable compound.

It could also be that GH increases organ tissue, which may be a critical role that would improve survival in HIV. This needs to be studied though, and Serono has not funded any study that details this, perhaps important aspect.

If GH is shown to have little or no effect on muscle tissue growth or organ tissue under any circumstances, this wouldn't mean that GH has absolutely no value, as GH's effect on lipid oxidation (fat burning) may be its most important effect. But if it was proven to be true that GH promotes little or no muscle growth, then it shouldn't be used to try to grow muscle; anabolic steroids are proven to do that much more effectively.

GH should be used for GH replacement purposes, which means it should be part of the hormone "cocktails" that can address wasting or lipodystrophy (bodyfat redistribution syndrome). For someone who has wasted severely, sometimes growth hormone can effect a miraculous improvement that has been described as "life-saving." But this kind of effect can be caused by several things including improved hydration (water) in the muscles and the body, better burning of fat for energy, and an improvement in the health of organ tissues that are critical for overall health, like the kidneys or the heart.

It seems likely that GH would be better used in a lower replacement dose in combination with testosterone and perhaps an anabolic steroid, with the idea that these hormones could complement each other and become a "cocktail" that might have a better effect than any one of them alone could.

GH's place in addressing lipodystrophy appears to be mostly related to its role in adipocyte (fat cell) metabolism, which is an important part of possible treatments or treatment combinations for lipodystrophy. So consider GH for this use, but do not put your money on it doing what steroids can do to help you build up your arms, legs, or butt if they have wasted. Also consider that for whatever problem GH is used to address, the 4, 5, and 6 mg daily doses that Serono currently recommends cause side effects like joint aches and carpal tunnel syndrome in a majority of HIV(+) people because the doses are too high. (Most professional bodybuilders are cautious about using doses of GH greater than about 1.4 mg (~ 4 IU) because they know that they might suffer from severe joint aches.)

We have reports that HIV(+) people are experiencing a reduction in lipodystrophy symptoms like protease paunch with doses as low as 1 mg per day up to 3 mg per day without problems. Finding an appropriate dose is highly individual, though, so ask your doctor to help you find a lower dose that is effective but doesn't cause side effects.

Case Study
Richard - A Seemingly Dramatic Response to hGH

We have also seen a few HIV-positive individuals who have a seemingly tremendous anabolic response to the use of high dose growth hormone, and much more so than they do to anabolic steroids. This can be deceptive.

For instance, one of the my close friends, Richard, who is 56 years old and has been extremely progressed in AIDS (several times near death), is an example of a person who appears to have a significant resistance to the effects of anabolic steroids, as steroids have not helped him gain as much lean body mass as some people do. In an attempt to help him gain weight his doctor put him on Serostim growth hormone and two weeks after he had started Serostim we were surprised to find that he had gained 18 pounds. (I even thought that I might have to re-assess my somewhat critical position on growth hormone.)

However, a few days into his third week he began to be overwhelmed by the problems he was having with side effects. He admitted that in his high hopes that growth hormone would be the magic bullet that it is advertised as he had down-played the fact that he had been experiencing extreme swelling and pain in his hands and other joints, numbness in his hands and arms when he slept, difficulty breathing when he climbed stairs and he was unable to sleep on his back because he felt like he was suffocating.

On examination his doctor found that most of the weight he had gained was water and determined that he was suffering from severe pulmonary edema (water in the lung tissues), so she immediately took him off of Serostim and admitted him to the hospital. After several critical medical procedures while he was in the hospital (he was almost given open-heart surgery) he recovered to live another day. His doctor said that it is unlikely that she would prescribe Serostim again.

I assert that this kind of situation can result from the use of the currently recommended 4, 5, and 6 mg doses that for most people are over-doses of growth hormone, and the fact that there is no preservative in Serostim's formulation, which deters people from lowering their dose to reduce the side effects. During the later part of 1998 we have had numerous reports of people solving this problem by mixing Serostim with Abbott bacteriostatic water instead of the sterile water that comes with Serostim. When bacteriostatic water is substituted, I am told that growth hormone will last for two weeks in the vial instead of 24 hours, as when the sterile water is used. Then the individual can ration out a lower daily growth hormone dose; one that does not produce side effects, but still produces beneficial effects. Ask your doctor to consider giving you a prescription for bacteriostatic water, and work with your doctor to find a dose that works for you.

Disclaimer: This article is provided for educational purposes only, and is in no way a substitute for the advice of a qualified medical doctor or a recommendation to do other than your doctor determines is best for you. You should present this information to your doctor for their analysis because appropriate medical therapy and the use of pharmaceutical compounds like anabolic steroids should be tailored by a knowledgeable doctor for the individual as no two individuals are alike. I do not recommend self-medicating with any pharmaceutical drug as you should consult with a qualified medical doctor who can determine your individual situation. If you use the information I present without the approval of your doctor, you do so strictly at your own risk and no responsibility is implied or intended on my part.