GH - (ed verses eod)

I was doing 4iu ed and had to back off to 2 iu ed because of joint and water problems. His suggestion in my case would be 4iu eod. hmm, will have to see if there is any other supporting data.

jb

Posted by: jboldman

I was doing 4iu ed and had to back off to 2 iu ed because of joint and water problems. His suggestion in my case would be 4iu eod. hmm, will have to see if there is any other supporting data.

jb

I seen a similiar read awhile back based on a shorter study, I'll see if I can locate it.

I swear by this method now, I remember when the study was first posted hear so I changed from 3iu's ED to 6iu's EOD and after a few weeks I dropped all the excess water and no longer got any of limb numbness.

Professional sprinters use 2.5iu EOD.

quote:

---

Professional sprinters use 2.5iu EOD.

---

mathematitian bastard mode /on:

used at least untill 2000 when someone gave uo the program.
now its most likely different with igf and ngf and stuff...

and they used it synergisticaly with insulin after morning weights to be able to pull off speed at the evening

Posted by: Wicked Design

I swear by this method now, I remember when the study was first posted hear so I changed from 3iu's ED to 6iu's EOD and after a few weeks I dropped all the excess water and no longer got any of limb numbness.

Interesting. Anyone else experiment with this protocol, and what were the results - mainly in terms of body composition?

I wonder if a lower dosage eod would be just as efficient, though - such as 6IUs eod instead of 4IUs ed.

Lot of BB's I know use eod GH, they say it works better, and I am sure they have not read that study.

But better in terms of what? This study was on growth rate in children, didn't say anything about fat loss.

I'd be interested in hearing results and dosages in terms of fat loss, where 3-4IUs per day (so in this case 6-8IUs eod) seems to give the best cost:benefit ratio.

I found these studies supporting the eod dosing:

J Endocrinol Invest. 2003 May;26(5):420-8.

Three weekly injections (TWI) of low-dose growth hormone (GH) restore low normal circulating IGF-I concentrations and reverse cardiac abnormalities associated with adult onset GH deficiency (GHD).

Pincelli AI, Bragato R, Scacchi M, Branzi G, Osculati G, Viarengo R, Leonetti G, Cavagnini F.

University of Milan, IRCCS San Luca Hospital, Italian Auxologic Institute, Milan, Italy.

GH replacement therapy given 3 times weekly (TWI) and adjusted to allow serum IGF-I concentrations in the mid-normal range for sex and age has been shown to be as effective as the daily regimen in improving lipid profile, body composition, bone mass and turnover in adult GH deficient (GHD) patients. Only one study has investigated so far the short-term (6 months) effect of a fixed weight-based TWI dosing schedule on heart structure and function in childhood onset (CO) GHD patients, whereas such a schedule in adult onset (AO) GHD patients has not been studied as yet. Aim of this study was to investigate whether a 1-yr low-dose titrated TWI GH-replacement regimen aimed at achieving and maintaining IGF-I levels within the low normal limits for age and sex is able to affect cardiovascular and heart parameters in a group of AO GHD patients. Eight adult patients (4 women and 4 men, age 35.8 +/- 3.37 yr, body mass index, BMI, 28.7 +/- 2.62 kg/m2) with AO GHD were included in the study, along with 10 healthy subjects, matched for age, sex, BMI and physical activity (6 women and 4 men, age 35.2 +/- 4.05 yr, BMI 28.4 +/- 2.34 kg/m2). M- and B- mode ecocardiography and pulsed doppler examination of transmitral flow were performed in GHD patients at baseline and after 3 and 12 months of GH therapy (mean GH dose 6.7 +/- 0.8 microg/kg/day given thrice a week), while normal subjects were studied once. Treatment with GH for 1 yr induced a significant increase in left ventricular (LV) diastolic and systolic volumes (+11.1 and +16.5%, respectively). Systolic LV posterior wall thickness and LV mass were increased (+10.2 and +7.7%, respectively) by GH administration. Systemic vascular resistance was significantly decreased by 1-yr GH therapy (-13.8% after 1 yr), while stroke volume, cardiac output and cardiac index were increased (+9.4, +11.6 and + 11.9%, respectively). LV end-systolic stress was decreased at the end of GH therapy (-11.2%). E and A wave, significantly reduced at baseline, were increased by 1 yr of GH therapy (+23.3% and +28.1%, respectively); likewise, the abnormally high E peak deceleration time was partially reversed by GH administration (-10.7%). Our study, though conducted in a small sample size, demonstrates that a TWI GH treatment schedule is able to reverse the cardiovascular abnormalities in AO GHD patients and to improve body composition and lipid profile. The maintenance of circulating IGF-I concentrations within the low normal range allows to avoid most of the side-effects reported with higher GH doses while being cost-effective and improving the patient's compliance.

J Clin Endocrinol Metab. 2000 Oct;85(10):3720-5.

Recombinant growth hormone (GH) therapy in GH-deficient adults: a long-term controlled study on daily versus thrice weekly injections.

Amato G, Mazziotti G, Di Somma C, Lalli E, De Felice G, Conte M, Rotondi M, Pietrosante M, Lombardi G, Bellastella A, Carella C, Colao A.

Institute of Endocrinology, Seconda Universita of Naples, Italy. [email protected]

Currently, replacement recombinant GH (rGH) therapy in GH-deficient (GHD) adults is performed in daily injections. This modality of treatment is not complied with by the totality of GHD patients, who are supposed to receive life-long replacement. The aim of our study was to compare daily vs. thrice weekly (TIW) rGH injection effects on lipid profile, body composition, bone metabolism, and bone density in 34 GHD patients (13 women and 21 men; median age, 39 yr; range, 30-55 yr) randomly assigned to different therapeutic regimens. Group A included 18 patients receiving daily rGH injections, and group B included 16 patients receiving TIW injections of rGH. The starting dose of rGH was 10 microg/kg x day in both groups. Subsequently, the dose was adjusted to maintain serum insulin-like growth factor I (IGF-I) concentrations in the normal age-adjusted range. IGF-I levels were assessed before and after 1, 3, 6, and 12 months of rGH treatment, and lipid profile, body composition, bone metabolism, and bone density were evaluated before and after 6 and 12 months of treatment. Thirty-four healthy subjects served as controls. In the basal condition, lipid profile, body composition, bone metabolism, and bone density were significantly different in patients compared to controls. Conversely, patients included in groups A and B had similar serum IGF-I levels, lipid profile, body composition, bone metabolism, and bone density. After 3 months of rGH treatment, IGF-I levels were normalized in 15 of 18 patients (83.3%) in group A and in 7 of 16 patients (43.7%) in group B (chi2 = 4.21; P = 0.04). At this time point, serum IGF-I levels in patients in group A (202+/-57.5 microg/L) were significantly higher than those in patients in group B (155+/-45.1 microg/L; P = 0.001). After 6 months of therapy, serum IGF-I levels were normalized in all patients and were similar in both groups (223+/-35.2 vs. 212+/-41.4 microg/L, A vs. B, respectively). IGF-I levels remained normal until the 12-month follow-up. After 6 months of rGH replacement, total cholesterol, low density lipoprotein cholesterol, triglycerides, bioelectrical impedance, and body fat mass were significantly reduced, whereas high density lipoprotein cholesterol levels and lean body mass were significantly increased in both groups of patients, without any difference between them. No further change in lipid profile and body composition was observed after 12 months of treatment. Serum bone GLA protein and procollagen III levels were significantly increased after 6 months, and a downward trend was observed after 12 months of rGH replacement. However, a slight, but significant, increase in bone mineral density was observed in both groups only after 12 months (P = 0.0001). All patients in group B had good compliance to the TIW treatment, whereas 5 patients in group A had poor compliance to the treatment (chi2 = 3.2; P = 0.07). In conclusion, our randomized, prospective, and controlled study confirmed that rGH therapy with TIW injection regimen is effective in normalizing IGF-I levels and improving lipid profile, body composition, bone metabolism, and bone density. It also demonstrated that this efficacy is comparable to that observed in patients treated with daily rhGH therapy, with few side-effects and good compliance.

There's also these, where many studies use eod injections of GH: http://www.ncbi.nlm.nih.gov/entrez/...=ExternalSearch

Oh, and this article, if you scroll down to the chapter on lipodystrophia, it refers to a study (couldn't access the abstract) where the treatment group starting off with ed injections then switching to eod injections had better results than all the other groups: http://www.thebody.com/sfaf/winter03/hgh.html

Good post Blade

JohnnyB

I know I've been in and out lately, so I've may have missed something, but it's nice to see you back around posting, Blade!

hmm, i had forgotten this thread. i think we should put this puppy in the archives. i think it was big willy that was doing 10iu's eod and said he was having great results. i would like to try this to avoid the sodium retention.

any more studies?

jb

i posted this one, some time ago:

Clin Endocrinol (Oxf). 1995 Aug;43(2):143-9.

Which adults develop side-effects of growth hormone replacement?

Holmes SJ, Shalet SM.

Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK.

OBJECTIVE: Although the nature of the side-effects of GH replacement in adults are well described, the factors influencing their development are ill understood. The aim of this study was to determine whether there were any characteristics of adults with GH deficiency that predicted whether or not they developed side-effects of GH replacement. DESIGN: A 12-month study (double blind placebo controlled for the first 6 months and open for the second 6 months) of GH replacement (0.125 IU/kg/week for the first month and 0.25 IU/kg/week thereafter) in adults. PATIENTS: Sixty-three adults (27 men, 36 women, aged 34.9 +/- 1.4 (mean +/- SE, range 20.1-59.5 years)) with GH deficiency (peak serum GH response to provocative testing of less than 10 mU/l) who took part in a 12-month study of GH replacement. Twenty-five patients (40%) did not develop side-effects, 19 patients (30%) developed side-effects which did not necessitate a reduction in dose of GH, and 19 patients (30%) required a reduction in dose of GH because of side-effects. MEASUREMENTS: The three groups of patients were compared according to age, height, weight and body mass index (BMI) at entry into the study and to pretreatment peak serum GH response to provocative testing. They were also compared according to serum concentration of insulin-like growth factor (IGF)-I and IGF binding protein-3, and age-adjusted serum IGF-I standard deviation score (SDS), at entry into the study and by change in these measurements after 6 months of GH replacement. The patient's sex, whether GH deficiency was of childhood or adult onset, estimated duration of GH deficiency, presence or absence of additional pituitary hormone deficiencies, underlying pathological disorder and previous therapeutic interventions were also compared in the three groups of patients. RESULTS:Those patients who required a reduction in dose of GH because of side-effects were more likely to have a peak serum GH response of greater than 1 mU/l (P = 0.005) and to have adult onset GH deficiency (P = 0.04) than those who did not develop side-effects or who did not require a reduction in dose of GH because of side-effects. In addition, those who needed a reduction in GH dose were older (P = 0.002), heavier (P = 0.04) and had a greater BMI (P = 0.003) than those who did not develop side-effects. Those who developed side-effects but did not require a reduction in dose of GH had a greater increment in IGF-I SDS after 6 months of GH replacement than those who did not develop side-effects (P = 0.03). CONCLUSION: Side-effects of GH replacement are more likely to occur in older patients, in those with a peak serum GH response to provocative testing of greater then 1 mU/l, in those with a greater increment in serum IGF-I SDS whilst receiving GH replacement, in those with greater weight and BMI, and those with adult onset GH deficiency.

--------------------------------

Titrating, can make a difference.

--------------------------------

J Clin Endocrinol Metab. 2007 Mar 13;

IGF-based Dosing of GH Therapy in Children:A Randomized Controlled Study.

Cohen P, Rogol AD, Howard CP, Bright GM, Kappelgaard AM, Rosenfeld RG.

Context: Weight-based dosing of GH is the standard-of-care for short-children, although IGF-I is thought to be the main mediator of GH-actions on growth. Objective: To test whether IGF-I levels achieved during GH therapy are determinants of the growth-responses to GH-treatment. Design: Two-year, open-label, randomized, IGF-I concentration-controlled-trial. Prepubertal short-children (n=172, mean age=7.53 yrs, mean height-SDS [HT-SDS]=-2.64) with low IGF-I levels (mean IGF-I SDS=-3.56) were randomized to receive one of two GH dose-titration arms in which GH-dosage was titrated to achieve an IGF-I SDS at the mean (IGF(low) group, n=70), or the upper-limit of the normal-range (+2 SDS, IGF(high) group, n=68) or to a comparison-group of conventional-GH-dose of 40 microg/kg/d (n=34). Setting: Multi-center, outpatient. Primary-Outcome-Measure: Change in HT-SDS over 2-years. Results: 147 patients completed the trial. Target IGF-I levels were achieved in the dose-titration arms within 6-9 months. The changes in HT-SDS were +1.0, +1.1 and +1.6 for conventional, IGF(low), and IGF(high), respectively, with IGF(high) showing significantly greater linear-growth response (P<0.001 compared to the other two groups). The IGF(high) arm required higher doses (>2.5 times) than the IGF(low) arm and these GH doses were highly variable (20-346 mcg/kg/day). Multivariate-analyses suggested that the rise in the IGF-I SDS significantly impacted height-outcome along with the GH-dose and the pretreatment peak stimulated-GH level. Conclusion: IGF-I-based GH-dosing is clinically-feasible and allows maintaining serum-IGF-I concentrations within the desired target-range. Titrating the GH-dose to achieve higher IGF-I targets results in improved growth-responses, although at higher average GH doses.

--------------------

Endocr J. 2006 Dec;53(6):853-8.

Growth hormone (GH) effects on central fat accumulation in adult Japanese GH deficient patients: 6-month fixed-dose effects persist during second 6-month individualized-dose phase.

Chihara K, Shimatsu A, Kato Y, Kohno H, Tanaka T, Takano K, Irie M.

Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Japan.

Both Japanese and Caucasian adults with GH deficiency (GHD) have pronounced abdominal obesity, which is associated with increased risk of cardiovascular complications. We investigated the effects of GH treatment in 27 adult Japanese GHD patients, 15 with adult onset (AO) and 12 with childhood onset (CO) GHD. Patients initially received GH titrated to 0.012 mg/kg/day for 24 weeks in a double-blind design and the dose was then individualized for each patient according to IGF-I for a further 24 weeks. Dual-energy x-ray absorptiometry (DXA) data were evaluated for percentages of trunk fat, total body fat and lean body mass. Serum IGF-I and lipid concentrations were determined at a central laboratory. There were 25 patients who completed 48 weeks of treatment, with 7, 6 and 12 patients then receiving GH at 0.003, 0.006 and 0.012 mg/kg/day, respectively. With the reductions in dose when individualized between weeks 24 and 48, mean serum IGF-I level was reduced and excessively high values, observed in AO patients on the fixed GH dose, were no longer seen. The decrease from baseline in trunk fat was similar at week 24 (-3.8 +/- 3.3%, p<0.001) and week 48 (-3.1 +/- 3.7%, p<0.001), and the difference between changes was not significant. Total cholesterol was decreased from baseline by -24 +/- 28 mg/dl (p<0.001) at week 24 and -17 +/- 28 mg/dl (p = 0.007) at week 48. Two patients had elevated HbA1c levels: one continued GH treatment after a dose reduction and the other discontinued due to persistent impaired glucose tolerance. Therefore, excessively high IGF-I levels can be avoided by individualized dosing during long-term GH treatment. Individualized dosing maintains the decrease in abdominal fat in adult Japanese GHD patients and should reduce the cardiovascular risk.