Excellent idea about if the hormone levels are low, then correct them. Testosterone is easy. Just test the total testosterone, the sex hormone binding globulin and the albumin, plug the values into the calculator and...voila! presto chango! you have the bioavailable testosterone and NOONE can dispute the value. Docs may disagree as to what is the actual level when replacement begins, but we would all agree WHAT the bioavailable testosterone value represents.
NOW, what about HGH? What value do you want to use? IGF-1? What level? Less than 100? Less than 200? What would be considered "Human Growth Hormone Deficiency Disorder"? Some would argue that the IGF-1 is worthless and that you need to do a "challenge" test to the pituitary to get the functioning of the anterior pituitary tested. But WHICH test? IV Arginine? Some experts say it is okay and others say it is not. ALL would agree that the insulin-hypoglycemic test is the "gold standard" but it requires hospitalization and it can actually be very dangerous to do...so the risks outweigh the benefits and no one wants to do the "gold standard" test. So, unlike testosterone (or thyroid or cortisol or estradiol or progesterone) testing, which is pretty cut and dried, the testing for HGH deficiency is ill-defined.
So what, you ask? If my doctor thinks I am low in HGH because of age, etc., and he/she thinks it is most beneficial that I get it, then he can prescribe it and all will be well with the world...and you would be WRONG. HGH is the ONLY medication on the US Pharmacopeia that cannot be written for "off label" and thus the diagnosis MUST be made of a deficiency (or you have AIDS wasting syndrome OR you are a pituitary dwarf OR you have complete pituitary failure, e.g., Sheehan's Syndrome) or the doc would be illegally prescribing it to you. Remember that YOU won't take the hit...the doc will. So those of you getting HGH from your doc and you aren't one of the cut and dried diagnoses, then eat, drink and be merry for sometime tomorrow you COULD be cut off of your HGH.
As to why the FEDS are involved...simple, Congress back in the 1970's classified HGH in the same category as steroids since it was being abused by bodybuilders (imagine that!) and athletes and docs did not have a real understanding of the importance of HGH replacement therapy at therapeutic levels (not the idiotic high doses of abusers). CONGRESS made docs jump through hoops for HGH. Thus the feds are involved.
Now for YEARS it was basically ignored/overlooked by the feds as long as it wasn't thrown in their faces or flaunted by yahoo doc trying to be a martyr and make a point. However, recently there have been a number of pharmacies being shut down and owners/pharmacists being indicted for distributing HGH to virtual docs who prescribe oodles of HGH without a good faith exam. I actually have worked with some of these pharmacies in the past for the small number of patients I had on HGH at the time. But they are now out of business and I now work with a compounding pharmacy in FL who does not sell/service virtual docs but only those who are "brick and mortar" docs, i.e., have offices that they actually see patients in (remember those kind?).
So as you know, fecal matter, like water, always wants to find its lowest poin and will thus roll down hill. So the Feds have started to notify state medical boards to start looking over and investigating docs who write for HGH. Remember that any scripts written by docs are monitored so they know when a doc is writing for it. The biggest question for the doc writing it is..."How big do I appear on the State Medical Board radar screen?" If they write for a lot of Rx of HGH then they are a big and juicy target but if they only have a few then it is unlikely to be a problem.
This is the reality of the situation and this is where "good" medicine and "legal" medicine part company. No amount of your justification of "well, my doc feels I need it so he is authorized to give it..." thinking will work unless you have had one of the verifiable tests. Now, if you are one of a FEW patients the doc has on HGH then he will probably not be bothered. However, if he is treating celebrities OR has a large number, then he will be spotted and he will get his pee pee whacked hard. Thus, Sermorelin is the obvious alternative that can be written for "off label" and maintains the negative feedback loop.
Hope this long-winded answer helps you understand the frustration that anti-aging docs go through everyday. I think I get more flak from my colleagues for starting people on adrenal replacement hormones vs HGH...but that's just me.
Dr. Work
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Don't cave in to what Congress thinks...they are idiots.. and not trained in medicine... you are. It is your job to make things right in the human body...what would happen if insulin became the next "bad boy" drug???? You going to prescribe sugar tablets?? NO... we need more Doctors to stand up and say enough is enough... Leave the Medicine business out of Congress...... You took the oath Doc.... now do the right thing and prescribe human growth hormone - somatropin - to those that need it.... Don't let your patients suffer because of some jackass Congressmen want to get re-elected.
