HGH and Wound Repair (gasolo)

Discussion in 'Fibromyalgia Main Forum' started by Slayadragon, Mar 22, 2007.

  1. Slayadragon

    Slayadragon New Member

    Gary,

    You got me interested in the topic of HGH and wound repair, and so I did a really fast Web search tonight.

    Here is a Medscape summary. (The site requires a login and so I'm including the text below.)

    http://www.medscape.com/viewarticle/407543_14

    And here are a bunch of articles on HGH (some of which are related to wound/surgical healing) from PubMed:

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&itool=abstractplus&dopt=pubmed_pubmed&from_uid=11955392


    I went through them very fast, but my conclusions would be the following:

    * There's a fair amount of support for the idea that HGH can help in burn healing, and some support that it could help with other kinds of trauma and wounds.

    * The measured effects for other kinds of trauma seem (I think) to be more related to post-operative fatigue and muscle deterioration during healing. I didn't see many studies on whether it helps wounds to heal faster per se, but I was looking quickly.

    * Geriatric patients have been studied more frequently and seem to be at least somewhat responsive.

    * Some of these studies use large doses of HGH, creating hyperglycemia that needs to be tempered with insulin.

    * The studies don't seem to give a good sense of what sort of dose would be effective (without being overly stressful) clinically. (For what it's worth, my doctor said that he used up to 1 mg per day after his hernia operation, which seems to be a lot less than researchers in many of these studies use. My little syringes--which are filled with the lowest recommended amount for ordinary use--are .2 mg.)

    * For some reason, a good number (but still less than 25%) of these articles are from Chinese journals. I'm not sure why the Chinese are interested in this particular topic, or how well-regarded their research is in the American medical community.



    On another note: considering how much I value research, there's some irony in having a disease that has little or no useful research available.....

    Best, Lisa


    ***

    The Stress Response to Injury and Infection...
    from Wounds

    Rationale for Use of Anabolic Agents

    Overview[33,34]
    The successful correction of PEM and prevention of a severe protein deficiency in the presence of catabolic illness require the restoration of the normal protein partitioning process (to restore lean body mass and wound healing). However, the process means the use of protein for protein synthesis, not energy. Restoration of the key components of nutrition is essential before considering an anabolic agent (Table 8).

    A limiting factor to restoration of lean mass and improving wound healing is the output of the protein synthesis pathway, which is dependent on adequate substrate plus an anabolic stimulus. Body composition studies during correction of PEM have demonstrated that a significant portion of weight gain after unintentional weight loss from catabolic disease represents the addition of body fat and extracellular fluid, not added protein mass due to decreased anabolic activity. Even in the recovery phase, endogenous anabolic activity remains depressed. This is especially true in elderly patients, those with chronic illness, or patients with a significant involuntary weight loss. Adequacy of substrate (1.5g/kg/d protein) may not be sufficient to jump-start a rapid restoration of lean body mass.

    The action of all anabolic agents currently in clinical use is twofold. First, amino acids are driven into the protein synthesis pathway. Second, catabolic activity is decreased (Figure 6). Anabolic hormones are being used with increasing frequency in populations with lean mass loss or existing PEM, along with optimal nutrition and the added anabolic stimulus of resistance exercise. The most commonly used anabolic agents are described.

    Figure 6. (click image to zoom) Comparison of lost lean mass and rate of lean mass restoration in burn patients using optimum nutrition alone versus the addition of human growth hormone or oxandrolone. Both anabolic agents decreased by over half the amount of lean mass lost and increased by four fold the rate of lean mass restoration.

    Human growth hormone (HGH)[35-40]
    HGH is a potent anabolic hormone that has a host of metabolic effects, some due to direct hormone activity on tissues, especially in the liver. Other effects are due to the release of insulin-like growth factor-1, which has potent wound healing effects. The primary stimuli for HGH release are starvation and intense exercise. The plasma HGH level is decreased after severe injury or sepsis, thereby decreasing normal anabolic activity. Numerous studies of exogenous HGH use in patients with trauma or burns and other injuries have demonstrated its efficacy for improving anabolism and the wound-healing rate. The mechanism for improved outcomes appears to be related to maintenance of lean body mass. The average dose of HGH used is 0.1 to 0.2mg/kg of body weight, or about ten times the normal endogenous production. A number of complications have been reported; the most common is hyperglycemia, due to anti-insulin activity. Increased insulin is often required in addition.

    Testosterone
    Testosterone levels are decreased immediately after severe trauma or critical illness and throughout the recovery period, eliminating another anabolic stimulus during a period of catabolism. Exogenously administered (oral or parenteral) testosterone is rapidly metabolized in the liver, resulting in a half life of approximately ten minutes, which is not practical for clinical use.

    Oxandrolone[41-45]
    Oxandrolone (Oxadrin®, Bio-Technology General Corp., Iselin, NJ) is an orally administered 17beta-hydroxy-17alphamethyl ester of testosterone and is cleared primarily by the kidney. Hepatotoxicity is minimal. Oxandrolone is the only steroid in which a carbon atom within the phenanthrene nucleus has been replaced by oxygen. This alteration appears to be responsible for its potent anabolic activity, which is five to ten times that of methyltestosterone. In addition, its androgenic activity is considerably less than testosterone, minimizing this complication common to other testosterone derivatives.

    Oxandrolone is the only oral anabolic steroid that is FDA approved for restoration of weight loss after severe trauma, major surgical procedures, or infections. Weight gain is primarily lean body mass.

    Clinical trials have shown benefit in a variety of patient populations. Benefits on wound healing have also been shown (Figure 7). Lean mass gains with anabolic agents are four times that seen with optimum nutrition alone. As with other anabolic agents, adequate calorie and protein intake is necessary for an optimum effect.

    http://www.medscape.com/viewarticle/407543_14
  2. gasolo

    gasolo New Member

    Thanks for the info and reference. I have used anabolic steroids in para and quadriplegic to help with poor appetite and weight loss. The results have been favorable. It is interesting that hgh and anabolic steroids in the general wound care population is rarely used. Most of these patients have co-morbid condition such as diabetes, renal failure, cancer, radiation injury or auto immune disease. I probable need to revisit the use of these drugs in the above population of patients to see if they might benefit.

    Gary