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For proof that the drug works, marketers turn to images like the memorable one of pot-bellied septuagenarian Dr. Jeffry Life, supposedly transformed into a ripped hulk of himself by his own program available at the upscale Las Vegas-based Cenegenics Elite Health. (He declined to be interviewed.)

These promoters of HGH say there is a connection between the drop-off in growth hormone levels through adulthood and the physical decline that begins in late middle age. Replace the hormone, they say, and the aging process slows.

“It’s an easy ruse. People equate hormones with youth,” said Dr. Tom Perls, a leading industry critic who does aging research at Boston University. “It’s a marketing dream come true.”

Some scientific studies of HGH have found modest benefits: some muscle and bone building, as well as limited fat loss, but nothing like the claims of the anti-aging industry. And some of the value credited to HGH may instead come from testosterone, which is routinely provided with HGH by anti-aging doctors and sports suppliers.

Endocrinologists say it’s natural for the body to produce less growth hormone as people age beyond their early 20s, because they aren’t growing anymore. Only a tiny number of adults with extraordinarily low HGH levels _ perhaps several thousand of them _ are believed to suffer real deficiencies that can properly be treated with the hormone.

Still, anti-aging doctors routinely diagnose otherwise healthy middle-aged people with an HGH deficiency, simply because their levels are lower than in young adults. “Basically anyone going through midlife,” can benefit from the drug, declared one prescriber, Dr. Howard Elkin, of Whittier, Calif., who has himself competed as a bodybuilder.

Dr. Kenneth Knott, of Marietta, Ga., said HGH helps his older patients feel “more vibrant” and look “more alive.”

Like many anti-aging doctors, he diagnoses patients by testing for a blood component called insulin growth factor, which is indirectly tied to HGH. Endocrinologists use a more authoritative test that stimulates the pituitary gland to make HGH itself. Nearly all insurers insist on this stimulation testing, and that’s why clinic patients almost always pay for HGH out of their own pockets.

Bob Vitols, a 50-year-old lab assistant at a veterinary medicine company in Lincoln, Neb., is a rare exception. His unusually generous health plan isn’t allowed to challenge a doctor’s prescription.

Four years ago, Vitols began feeling run down. So he Googled his symptoms on the Internet, decided he had a hormone deficiency, and sought out a clinic.

One doctor put him on testosterone replacement therapy. A second clinic added HGH after diagnosing him with osteopenia, a mild bone thinning common in aging adults. It is not, however, a condition that can properly be treated with HGH.

Despite the diagnosis, the treatments _ which can cost $10,000 per year _ have been covered by his health insurance, he said. He takes Genotropin, the HGH made by Pfizer. His prescriptions are filled via mail order by CVS Caremark Corp., one of the largest dispensers of prescription drugs in the U.S.

Vitols said the drug changed his life: his mood is better, and he isn’t burning out every day at 2 p.m. “I feel like I could walk outside and just walk through a fence _ and come out fine on the other side,” he said.

His experiences with the drug haven’t all been positive, though. Vitols said he initially developed elevated liver enzymes and went to a specialist, who told him to stop taking hormones immediately.

Instead, Vitols said, he adjusted his dosage, and the problem disappeared.

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