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.)
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
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
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
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.
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.
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.