Initiating and Managing Growth Hormone Therapy in Adults

This episode explores how adult GH therapy is initiated, adjusted over time, and evaluated for clinical impact — with a focus on quality of life as the primary outcome measure.

Dr. Agrawal explains that in adults, GH therapy is individualized based on etiology, severity of deficit, and patient comorbidities. She starts all patients low and titrates upward based on symptom response, side effects, and IGF-1 levels. Quality of life questionnaires — specifically the AGHDA (Adult Growth Hormone Deficiency Assessment) — are used to track meaningful clinical change. Unlike in pediatrics, where growth velocity is the clearest efficacy signal, adults must rely on more subjective endpoints.

Dr. Garcia echoes the importance of quality of life as the most tangible treatment outcome. He notes that body composition changes — though statistically significant in trials — can be difficult for individual patients to perceive, especially since body weight may not change even as lean mass increases and fat mass decreases. He advocates for a minimum treatment trial of 3 months to 1 year before concluding non-response.

A key adult-specific consideration is the impact of oral estrogen (e.g., birth control pills) on GH dosing. Women on oral estrogen may require double the usual GH dose due to hepatic GH resistance. This adjustment is unnecessary if they are using transdermal estrogen or progestins alone.

The panel also discusses what to do when treatment response is inadequate. If quality of life scores fail to improve meaningfully, Dr. Agrawal reduces or discontinues GH rather than treating a lab number in isolation. Dr. Garcia confirms that the same approach applies — treatment should produce a clinically meaningful difference, not just normalization of IGF-1.

In the next episode, “Long-Acting Growth Hormone Analogs —Benefits and Safety Considerations,” the panel examines the three approved weekly GH analogs, their mechanisms, comparative IGF-1 profiles, and the theoretical and practical safety considerations for clinicians.