Human Growth Hormone (HGH) 

HGH, produced by the pituitary gland, spurs growth in children and adolescents. It also helps to regulate body composition, body fluids, muscle and bone growth, sugar and fat metabolism, and possibly heart function. Produced synthetically, HGH is the active ingredient in a number of prescription drugs and in other products available widely over the Internet.

Growth hormone and exercise

The effect of acute exercise on production of GH in the body has been widely described in the literature.7 The concentration of hGH in blood increases with time for a given work intensity and can increase 10‐fold during prolonged moderate exercise. During more intensive exercise (with accumulation of lactate at 70% Vo2 max for a short term period such as 10-20 minutes) hGH will increase by 5-10‐fold.8 With short exercise durations, levels of GH will generally peak at 15-30 minutes after the exercise. Furthermore, it appears that hGH response is more closely related to the peak intensity of exercise than the total work output.9 Endurance training generally amplifies the pulsatile release of growth hormone, elevating the GH amplitude. This appears evident when the training is very hard and above the aerobic threshold.10

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Apart from exercise related increase, hGH secretion can be affected by other factors-for example, GH secretion is increased in hypoglycaemia, increased temperature, and stress, whereas it decreases in obesity, or with a carbohydrate‐rich diet and intake of β2 adrenergic agonists. Thus, it is hard to differentiate between the physiological increase in hGH levels seen in exercise and what can be from external hGH administration (as in doping). This problem makes the purely quantitative approach of measuring directly the total circulating GH not feasible in case of doping, except if the conditions of collection of biological samples are well controlled.

Adverse effects of hGH

The long term risks of hGH use are not well known since epidemiological data regarding this type of treatment in healthy sportsmen are unavailable. Acromegaly, which results from a pathological increase in endogenous production of GH, is often cited as one of the major risks associated with excessive use of hGH. The major symptoms are swelling of the hands and feet, coarsened facial appearance, dentition problems, arthralgias, fluid retention, and excessive sweating. Acromegalic patients have an increased risk for diabetes mellitus and hypertension that can lead to premature mortality from cardiovascular diseases.26 It can be argued that long term hGH doping with high dosages will probably result in misusers experiencing symptoms of fluid retention and increased risk of development of diabetes mellitus and hypertension. There is also a risk of cardiomyopathy, osteoporosis, menstrual irregularities, and impotence. Some of these side effects are reversible after withdrawal of the drug. Furthermore, hGH misuse can disturb the lipid profile with decreased high density lipoprotein (HDL)‐cholesterol.

As hGH is administered by injection, if syringes are non‐sterile or contaminated, there is a risk of cross‐infection, such as HIV/AIDS and hepatitis. Even though cadaveric GH is now rare in the black market, its use is associated with a high risk of developing Creutzfeldt-Jakob disease, which is characterised by slowly progressive dementia.