Friday Tidbits: DHEA and HGH

As a child I had normal human growth hormone...

In the past, I've described several tests that can help doctors, as well as patients with fibromyalgia and/or Chronic Fatigue Syndrome (CFIDS/ME/CFS), to better understand the medical problems that are all too common, yet may be overlooked.  Some tests, like the sed rate (Erythrocyte Sedimentation Rate), white blood cell count and thyroid hormone levels do not vary with age.  That is, a young adult and an octogenarian would be expected to have levels that fall within a certain range, regardless of age.  However, this isn't true for two very important hormones: DHEA and growth hormone (HGH).  

DHEA (mentioned before), also known as Dehyrdroepiandrosterone, is a natural hormone that is made by both men and women and is necessary for optimal body function.  It's made in the adrenal glands, which are glands that lay above each kidney.  If a person doesn't have enough DHEA, he/she is more prone to:

• infection, low energy
• decreased libido 
• muscle weakness 
• poor muscle tone. 

The highest levels occur, not surprisingly, when a person is between 20 and 30-years of age and the levels decrease as an individual ages.  A graph in the book, DHEA: A Practical Guide by Ray Sahelian, MD illustrates this very clearly. (Unfortunately, the book is out of print so why do I bring it up?  Because rheumatologists, endocrinologists and others who work with these hormones still love it!)  This is important because the DHEA level that is obtained for any given patient must be interpreted in the context of the sex and age of the patient.  

However, it's easy to misinterpret the DHEA level by referring to the normal range provided by the laboratory. The normal range encompasses the levels of DHEA from healthy individuals of all age groups.  For example, a forty-year-old woman should have a level of about 200 and an 80-year old woman should have a level of about 50.  Both values, i.e., 200 and 50, are in the normal range.  However, if a 40-year-old fibromyalgia and CFS sufferer has a level of 50, it may be in the normal range for the general population but certainly not the right level for the 40-year old.  This is an extremely important point as a patient may be incorrectly reassured that he/she does not have a DHEA problem when in fact the patient is dire need of DHEA supplementation. 

The same principal holds true for growth hormone.  This is a hormone that's made by the pituitary gland of the brain, typically during deep sleep.  (Ah! Therein lies the rub for the fibro and/or CFS patient: sleep deprivation!)  The highest levels are made by children.  Once they reach adult stature, they still need to produce this hormone, albeit in smaller quantities, in order for wound healing and normal metabolism to occur.  For an adult, the summary phrase for the role it plays might be "helps maintain tissues and organs throughout life."  Dr. Robert Bennett described growth hormone deficiency in fibromyalgia patients as early as 1992 in the journal, Arthritis and Rheumatism.  It is important to understand that a normal hormone secretion for a 40-year old is going to be a lot more than that of an 80-year old.  As in the above example, if a 40-year old has a level appropriate for an 80-year old, that patient has a REAL problem.

(The role of HGH level production has not been described in CFS/ME patients but many rheumatologists who deal with fibromayalgia patients also see HGH insufficiency in their CFS patients as well.  Mine certainly does.)

 Adult Growth Hormone deficiency can cause the metabolism to slow down, resulting in: 

• weight gain, particularly around the mid-section
• decreased stamina
• altered body composition (more fat, less lean muscle mass)
• muscle and bone growth (spine and disc erosion may occur)
• sugar and fat metabolism (slows down)
• possibly heart function
• many other unpleasant symptoms (including depression, anxiety, decreased sweating, thermoregulation, changes in memory - processing and attention included, social isolation)

Again, this deficiency may be overlooked if the test results are misinterpreted.  

Therefore, if you have fibro or CFS/ME then 

• have your DHEA level checked
• have your Growth Hormone level checked by getting a test for its byproduct known as IGF-1 -- insulin dependent growth factor-1, otherwise known as Somatomedin-C 
• make sure that the tests are interpreted correctly since both tests are dependent on the patient's age.

If deficiencies are identified and addressed, many symptoms will go away completely or become more manageable.  Believe it or not, DHEA deficiency or growth hormone deficiency are more common than thought and are eminently treatable. 

I'll address the reimbursement issues in a future post.

As always, hoping all are doing their best, only better.  Ciao and paka!


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