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Thursday, June 8, 2006
Updated: June 19, 2:08 AM ET
Anti-aging movement fuels interest in HGH

By Tom Farrey and Shaun Assael
ESPN The Magazine

One of the more intriguing things that Arizona Diamondbacks pitcher Jason Grimsley allegedly told federal agents when they served a search warrant on his home in April is that major league players might be getting human growth hormone through the fast-spreading national network of anti-aging clinics.

Grimsley, according to recently unsealed court records, remarked that a player "told him of a doctor in Florida that he was using at a 'wellness center' to obtain human growth hormone." He alleged that the player, whose name is blacked out in the document released publicly, told him: "If you are going to do this, you should do it right."

Call it a gesture of care, or brazen cheating. Just don't call it rare among Americans.

FAQ on HGH

What is human growth hormone?
• Growth hormone is a powerful anabolic hormone that occurs naturally in the human body. It is produced by the pituitary gland in the brain and stimulates the growth of muscle, cartilage and bone.
• A body produces growth hormone throughout its entire life, but produces more of it during youth.
• HGH was initially isolated in 1956. By 1959, it was starting to be used on children suffering from stunted growth.
• Originally, prior to genetic engineering, the only source of HGH was human corpses. The pituitary glands were removed from cadavers, processed and the hormones made available in injectable form. However, synthetic HGH can now be made in unlimited quantities in the laboratory. The International Olympic Committee's medical commission banned HGH in 1989.

Why would an athlete take HGH?
• To increase muscle size. Because there is a correlation between muscle size and strength, competitors in events that require power and short bursts of explosive strength would be most likely to benefit. It also allows tired muscles to recover faster -- allowing you to train harder and more often.

Are there any side effects?
• If a body has too much HGH, a condition can result called acromegaly, a disease where the hands become spade-like in appearance as they get bigger. Growth of the facial bones causes the face to change shape too.
• Organs such as the heart, liver and kidneys also undergo excessive growth, leading to potentially life-threatening problems.
• Accelerated cell growth also increases the risk for cancers.

SOURCE: ESPN Research Department and BBC.co.uk

The dispensing of growth hormone by doctors for controversial reasons has become increasingly common over the past decade. Many of these wellness -- more often called anti-aging -- physicians belong to a group called the American Academy of Anti-Aging Medicine (A4M), a trade organization that claims to have trained 30,000 practitioners around the world, up from 12 when the organization was formed in 1993.

The industry was initially driven by baby boomers approaching retirement. But recently, growing numbers of physicians have been willing to push the envelope and start prescribing HGH to clients in their 40s. In some cases, clients are as young as their mid-30s are being treated with hormones. In a book called "Grow Young with HGH," Ronald Klatz, the president of the anti-aging academy, wrote: "Once we hit 30, it's all downhill. The lean body mass of all our organs starts to shrivel while the adipose mass, or fat mass, increases." In another section of the best-selling book, he writes that "the body-building action of HGH has been shown in many different groups, including athletes."

Grimsley, 38, was released by the Diamondbacks on Wednesday, a day after his home was searched by federal agents conducting an investigation into steroid use by athletes. Grimsley had admitted using human growth hormone, steroids and amphetamines, according to a search warrant affidavit filed April 18 in Arizona District Court by the Internal Revenue Service. In an interview with IRS agent Jeff Novitsky on the day the warrant was served at his Arizona home, the Diamondbacks pitcher also allegedly said he knew of other players who used growth hormone. The names of those players are blacked out in the document released by the U.S. prosecutor's office.

The record does not identify the source of Grimsley's HGH or those of other players, although the pitcher told investigators that he personally did not get his from a doctor. The drug also can be purchased on the black market. He said that among the reasons he took the drugs was to heal rapidly from injuries.

The spread of anti-aging clinics has been a growing source of concern to the Food & Drug Administration, which opened 55 criminal cases into illegal importation and distribution in 2005. A spokesperson declined to comment on the specifics of the Grimsley search, which involved the FDA's Office of Criminal Investigation. But she said that the agency considers the use of HGH in "anti-aging clinics, bodybuilding and pro sports to constitute a violation of the Food Drug and Cosmetic Act."

Rob Manfred, baseball's executive vice president, told ESPN that he's especially concerned by the prospect that baseball's drug problem could be overlapping with the spread of anti-aging clinics.

"The notion that it is possible to get a prescription for a banned substance is troubling to us, given the limits of the testing," he said. But Manfred also called the issue "a societal problem."

Currently, the only available test involves the use of a blood sample -- which baseball's collective bargaining agreement forbids players from giving. Critics have attacked the sport for this loophole. Manfred said that the test is so new that it is not widely available due to shortages of a particular antibody.

"Even if we wanted to do it, we couldn't get a kit," he said.

Growth hormone, as a controlled substance under federal law, can be prescribed or dispensed only for a "legitimate medical purpose," such as dwarfism in children and wasting in AIDS patients. Doctors in the anti-aging movement take an expansive view of what constitutes a legitimate medical condition, contending that aging itself is a form of disease, in that the body breaks down and becomes vulnerable to sickness unless hormone levels are managed.

Athletes seek growth hormone for its possible recuperative powers. At an anti-aging conference in Chicago last August, one Los Angeles doctor discussed his treatment of a 44-year-old professional motocross athlete who had injured his hip; he soon returned to competition with the use of growth hormone and testosterone. The doctor also claimed to treat a 35-year-old heavyweight boxer who returned to the ring only eight months after he ruptured his Achilles tendon. Other doctors at the conference also spoke of treating unnamed professional athletes.

But the line between sports medicine and performance enhancement is muddy, and open to abuse. A 2004 report by the International Olympic Committee concluded that human growth hormone is becoming a bigger problem than steroids. James Shortt, the South Carolina doctor at the center of the Carolina Panthers scandal, claimed that he gave growth hormone and steroids to athletes to help prevent and recover from injury. He ultimately lost his medical license for, and pled guilty to, prescribing the drugs in a medically inappropriate manner.

Doctors in the "wellness" movement argue that athletes, like other patients, should be supplemented only to their "optimal" level, meaning the hormone level akin to a young person. Yet athletes using black-market steroids often take supra-natural amounts, far in excess of what most doctors would prescribe for any medical condition.

Some experts argue that no professional athletes, even those in their late 30s and 40s, should be candidates for growth hormone prescriptions.

"There are repair benefits but is it legitimate and medically necessary?" said Dr. Karlis Ullis, a UCLA professor and expert on hormone supplementation. "These people don't have medical disorder, like polio or AIDS. They have self-imposed medical issue that is created by the demands of their sport. Theirs is the result of voluntary activities in which they are being paid."

Still, baseball's leaders have permitted the use of a banned, muscle-building drug when deemed medically appropriate. Manfred told ESPN that it is "theoretically possible" that a player could be allowed to use testosterone under a doctor's orders. He declined, however, to say whether any players have received these waivers, which are based on the "Therapeutic Use Exemptions" pioneered by the World Anti-Doping Agency.

With the major leagues now testing for some forms of steroids, the appeal of using human growth hormone has grown. According to the affidavit filed in connection with the search of Grimsley's home, he "stated that since Major League Baseball began its drug testing for steroids and amphetamines [in 2004], the only drug that he has used is human growth hormone." Greg Anderson, the steroids dealer and personal trainer of Barry Bonds, allegedly bought growth hormone from AIDS patients in San Francisco even earlier, before the feds' raid of his home in September 2003. One bar has been the cost. Federal investigators who subpoenaed bank records from July 2004 found that Grimsley paid $3,200 for two "kits" of HGH -- roughly enough to last a season. But last month, the FDA approved a generic version of HGH made by the drug company Sandoz. That could drive the cost down significantly and further increase its allure.

Tom Farrey and Shaun Assael are senior writers for ESPN The Magazine.