By Shimon Herman, Science and Technology Editor
Human growth hormone (HGH) was once one of the most tightly controlled substances in medicine. Today, it has taken a very different role. In a world obsessed with optimization — stronger bodies, sharper minds, longer lives — growth hormone has quietly moved from being a highly regulated medical treatment to something far more mainstream.
HGH is not an inherently controversial treatment. It is a natural hormone released by the pituitary gland that plays a vital role in growth, metabolism and repair. It helps with regulating muscle development, bone density and in managing blood sugar levels. For individuals who have deficiencies that prevent them from producing enough growth hormone, treatment simply restores what is missing. It is not an enhancement but a correction. However, the last 10 years have seen an enormous increase in growth hormone usage, and it is not due to more people being diagnosed with growth hormone deficiency.
To make sense of this surge in use, it helps to look at how HGH entered medicine in the first place. The first time HGH was used was in the early 1950s, when it was extracted from human cadavers in order to treat those with severe deficiencies. However, years later it was determined that using growth hormone from cadavers led to Creutzfeldt–Jakob disease, a fatal, incurable brain disorder. This prompted the creation of a new biosynthetic growth hormone that was far more promising.
In 1985, the U.S Food and Drug Administration (FDA) approved biotechnology company Genentech’s synthetic methionyl Growth Hormone for the therapy of severe childhood growth hormone deficiency. At this point, medical growth hormone usage was extremely limited, and the hormone was difficult to get hold of. Only those with Turner syndrome, chronic renal insufficiency or growth hormone deficiency were prescribed HGH.
However, in 2003 the FDA approved HGH use for Idiopathic Short Stature (ISS), which essentially means that an individual is shorter than the mean for their age and sex. By expanding eligibility to include individuals who are shorter than average, the number of potential patients that qualified for HGH increased drastically.
Data shows that the growth hormone market has increased every single year over the last decade. Similarly, a South Korean report stated that growth hormone usage has tripled in the last four years. Another supporting study found that while the amount of children receiving growth hormone has increased drastically, insurance companies’ total cost per patient has gone down 25% in the last ten years. What is even more interesting is that while insurance rates decreased, out-of-pocket costs went up 163% during the same timeframe. This points to an increase in HGH usage that is not covered by insurance; in other words, the amount of people using growth hormone has gone up but the usage has become more broad and not what insurance companies would deem as “real medical problems.”
This is particularly striking given the strict diagnostic criteria required for true growth hormone deficiency. Diagnosis involves failure to respond to multiple hormone stimulation tests and numerous blood tests that are performed in order to record important markers such as Insulin-like growth factor 1 (IGF-1) and Insulin-like growth factor-binding protein 3 (IGFBP-3) hormone levels. On paper, this kind of screening should reserve HGH prescriptions for people who clearly need it. However, because of the FDA’s expanded approval, doctors are able to prescribe HGH even though they are not meeting an insurance company’s strict approval requirements. Because insurance companies independently determine whether a treatment meets their criteria for coverage, this creates a growing gap between prescription practices and insurance approval. As a result, many patients are being forced to pay out of pocket to obtain growth hormone.
Recently, growth hormone has been promoted for self-improvement rather than for medical treatment. It has been branded as a way to improve muscle development, reduce fat, speed up recovery and even slow signs of aging. This has driven significant demand, particularly among individuals who do not meet strict medical criteria. However, no data currently points to human growth hormone as having anti-aging benefits and the FDA has not approved non-medical usage. That being said, there are physicians who operate under the assumption that prescribing HGH remains legally defensible as long as the patient’s hormone levels test below a certain threshold, making them “low” — compared, for example, to a robust 25-year-old. This is what insurance companies fear are examples of framing normal age-related hormone decline as a “deficiency.” Since HGH exists in this gray area, insurance companies often adopt narrow definitions of “medical necessity” and enforce strict criteria in order to control costs. Even when a physician believes the treatment is appropriate, insurance providers may deny coverage if the patient doesn’t meet their exact thresholds.
In medical contexts, HGH remains a critical and highly effective treatment, helping improve linear growth, increase bone density and enhance overall quality of life. It is only its efficacy in non-medical contexts that is in question.
Ultimately, the rise of growth hormone use may reflect a broader shift in modern medicine, one from treating disease to enhancing the human body. The continued uptick in HGH usage raises questions about what the definition of medical necessity is. As demand continues to grow, the challenge will be to balance medical value with the risks and ethical concerns that arise from pushing the use of human growth hormone beyond traditional medical boundaries.
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