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Bodybuilding Pharmacology: GH and the Anabolic Cocktail

Bodybuilders who?ve used GH alone swear by its fat-reducing properties. That makes sense, since GH is known to spare muscle glycogen stores in the body while promoting the use of fat as a fuel source.

Human growth hormone, or GH, has attained an almost mythological status in athletic circles. Perhaps it’s because the name itself implies massive growth. One reason people believe that GH has great anabolic potential is the fact that extremely tall people get that way through extra growth hormone release at certain critical points. The accepted notion is that GH is so potent, it makes you grow everywhere.

Is that really true? Few people realize that hormones work best in balance with other hormones. Practical experience shows that GH works best when combined with testosterone or other anabolic steroids and possibly with insulin. Insulin appears to correct some of the side effects that occur with high-dose GH use, such as elevated blood glucose levels, that might otherwise impose enough stress on the pancreas to bring on diabetes in people who are genetically predisposed to it.

Some athletes aren’t thrilled about the notion of engaging in polypharmacuetical experimentation. There’s no published research evaluating the athletic or health effects of combining anabolic hormones, such as GH, anabolic steroids and insulin; however, since that combination has become particularly popular in bodybuilding, some previously rare side effects have emerged.

A notable example is the paradoxical appearance of what look like beer bellies on otherwise highly muscular athletes. Debate continues as to the precise cause of such anatomical anomalies as a protruding gut on a person who simultaneously displays deep abdominal-muscle definition and is virtually fat-free. On the other hand, organs in the gut are known to contain growth receptors that rapidly respond to large doses of insulin and IGF-1, which is elevated with GH use.

How anabolic is GH on its own? That’s a pertinent question. Numerous over-the-counter food supplements claim to be capable of promoting GH release in the body. Under certain circumstances GH is without doubt anabolic, specifically with individuals who are genetically lacking in GH production or who previously had normal GH synthesis but are now deficient, such as many older people.

Yet studies of such patients show that while providing the missing GH in injection form does appear to increase muscle size considerably, it doesn’t proportionately increase strength. The usual explanation for the discrepancy is that GH does not increase the muscle contractile proteins that are responsible for strength increases but instead increases noncontractile portions of muscle, such as connective tissue. Other studies show that GH does what steroids were once thought to do: induce a potent water-retention effect. That’s underscored by the fact that any gains made with GH rapidly evaporate when the trainee stops using the drug.

But won’t taking huge doses of GH lead to greater muscle gains? Excess GH results in a disease called acromegaly. It’s caused by a small tumor in the pituitary gland (where GH is synthesized), and people who are afflicted with it are usually quite tall, often giants, who often have large muscles when they’re young. But those muscles gradually weaken, especially in the extremities. Eventually, the disease progresses to full myopathy, or full-blown muscle-weakness disease. In one notable case, Robert Wadlow, recognized as the tallest human ever at 8’11’, had to wear leg braces because his leg muscles were too weak to support his 400-pound-plus bodyweight. The braces eventually led to an infection that killed him at a young age in the 1940s.

Studies of athletes show that GH doesn’t seem to improve either muscle size or strength. On the other hand, many such studies used doses of GH that were far smaller than those typically used by professional athletes. Some bodybuilders, for example, are rumored to inject as much as 16 units of GH a day, while the dose used to treat GH deficiency is about one unit daily or every other day. In other cases subjects used GH for only short periods.

Another problem with GH use, besides the considerable financial cost, is that it must be balanced with other hormones. Many athletes on GH have quickly noted changes in thyroid hormone. In some cases GH produces a signal that appears to turn off thyroid-stimulating hormone (TSH) in the pituitary gland. TSH controls thyroid-hormone production in the thyroid gland, but without sufficient thyroid output, it doesn’t work well. For that reason many athletes also add a thyroid drug, such as Cytomel, to their anabolic regimens.

Used alone, GH isn’t very anabolic in muscle. For reasons that are unclear, that changes dramatically when the hormone is combined with testosterone injections. Some theorize that testosterone promotes greater muscle protein synthesis, while GH may promote anticatabolic, or breakdown-inhibiting, effects in muscle.

Bodybuilders who’ve used GH alone swear by its fat-reducing properties. That makes sense, since GH is known to spare muscle glycogen stores in the body while promoting the use of fat as a fuel source. GH may also offset the potent fat-promoting effects of insulin, which is often used in conjunction with GH and testosterone.

I interviewed a top competitor at the 1990 Mr. Olympia contest, which remains to this day the only fully drug-tested Mr. Olympia, and he told me off the record that he was using GH to circumvent the drug-testing procedures for steroids that were in place that year. There was no test for GH in 1990, and there still isn’t. This man’who successfully evaded the drug net imposed that year’said he felt that GH did nothing to increase his muscle size but did seem to ‘freeze’ the size he had acquired from his previous training and drug use, which included several anabolic steroids. He also felt that GH promoted considerable fat loss, which is significant, since this particular bodybuilder was well-known for his dramatic muscular definition.

So GH does appear to offer significant anabolic effects for bodybuilding purposes when used in a stack that also features testosterone and possibly insulin. When used alone, it helps preserve acquired muscle. At least, that represents the consensus of athletes who are currently on the drug. As yet no published research confirms those opinions.

Next month in this column I’ll discuss the research on growth hormone’s fat-burning effects.

What Factors Determine Steroid-induced Muscle Gains?
Athletes vary in their responses to anabolic steroid drugs. In an effort to understand the underlying factors that predict individual responses to steroids, a group of researchers designed a study with the goal of figuring out models for predicting anabolic steroid responses in men.1

Fifty-four healthy young men took a drug that suppressed their natural testosterone production. After that they got various doses of testosterone enanthate, an injectable, long-acting form of testosterone. The subjects got 25-, 50-, 125-, 300- or 600-milligram injections each week for 20 weeks. They were also subjected to regular body-composition tests throughout the course of the study.

As you might expect, the primary factor that influenced the anabolic effects of testosterone was the dose, with the highest dose producing the most potent anabolic effect in all subjects. Even so, subjects’ responses to even the largest testosterone doses were varied. Factors such as body composition, muscle size and muscle morphology, or structure, didn’t affect how any man would respond to the drug. That’s a bit surprising, since popular opinion holds that men who are already naturally muscular will become more so with the use of steroids.

The study only looked at androgen-receptor response. Other factors that could play a role in determining individual responses to steroids include other genetically based mechanisms known to influence muscular size, such as myostatin genes, angiotensin-converting enzyme (known to be higher in champion endurance athletes), IGF receptors and growth hormone receptors that interact with androgens.

What all that means is that two men can use the same training program, identical diets and even precisely the same drug regimen yet experience totally different results. I’ve witnessed that time and again over the years with bodybuilding champions. Their training partners train with them, eat like them and take the same drugs, yet their physiques look nothing alike. Not even close. What makes those men champions is a cumulative effect, influenced by many interposing factors, such as diet, training, drug use and’most of all’genetics.

Is Gyno a Prelude to Cancer?
A common side effect experienced by anabolic steroid users is gynecomastia, or ‘male breasts,’ also known as ‘bitch tits.’ Gyno results from an imbalance between testosterone and estrogen in men, where estrogen levels rise above normal. When that happens, any estrogen-sensitive tissue responds. Men always produce some estrogen, mainly from the natural conversion of free testosterone in the blood by way of the ubiquitous aromatase enzyme, which is located in numerous tissues, particularly fat.

Male breast tissue is normally dormant, since men usually have far greater levels of testosterone than estrogen. As estrogen levels rise, though, the dormant breast tissue responds, leading to what appears to be increased tissue mass just below the nipple. For a graphic example of gynecomastia, you need look no further than photos taken at any major professional bodybuilding contest. Some cases are more apparent than others.

How obvious each case is depends on a man’s genetic response to estrogen; that is, how many estrogen breast receptors the bodybuilder inherited from his mother. Theoretically, if allowed to continue unabated, gyno would eventually provide a man with a pair of breasts that closely resemble his mother’s, giving new meaning to the term breast man.

Although many types of drugs can produce gyno, in athletes it almost always arises from their using drugs prone to aromatization, or conversion into estrogen, such as testosterone injections of any type. Growth hormone may also promote gyno, especially when used in conjunction with testosterone injections, a common practice among pro bodybuilders. For that reason bodybuilders and other athletes often use such drugs as Nolvadex or Arimidex to counteract increased estrogen levels. Nolvadex blocks estrogen receptors, while Arimidex inhibits the aromatase enzyme that converts testosterone into estrogen. The worst thing about gyno is the cosmetic disfigurement. No red-blooded man wants to walk around with pecs that resemble teenage female breast buds. In the early stages of gyno simply getting off all drugs that predispose one to the condition often causes the incipient breast tissue to recede. Some suggest that using topical creams based on dihydrotestosterone may help speed the reduction process. Once the glandular tissue becomes fibrotic, or hard, however, the only recourse is surgery.

Although it’s usually thought of as a benign condition, the worst effects of which are cosmetic and psychological, a recent study presents an ominous possible future for those with gyno.2 The researchers followed 446 men, all of whom underwent surgery for gyno between 1970 and 1979. They were looking for any connection between gyno and subsequent onset of breast cancer in men, which is far rarer than in women but does happen.

They found that having gyno didn’t increase the subjects’ overall risk for most types of cancer over that of men who’d never had gyno, except for testicular cancer. Contrary to expectations, having gyno didn’t increase any risk of breast or prostate cancer in men. It did, however, increase the risk of squamous-cell skin cancer, which is usually benign when diagnosed early. The researchers had no explanation for the increased prevalence of skin cancer in former gyno patients. Some patients also showed a slightly increased risk for esophageal cancer, but that related to gyno induced by alcoholism. Another mystery was the finding that having gyno leads to a decreased risk of rectal cancer. On the other hand, women show a decreased risk of that type of cancer, so it may have something to do with elevated estrogen levels.

Why would having gyno lead to an increased risk of testicular cancer? Again, it may relate to higher-than-normal estrogen levels. When estrogen is produced in too high a quantity for too long, it’s known to promote changes in cells that may predispose to cancer, which could be the mechanism. As to why having gyno would lead to skin cancer, that awaits further research.

1 Woodhouse, L.J., et al. (2003). Development of models to predict anabolic response to testosterone administration in healthy young men. Amer J Physiol. In press.
2 Olsson, H., et al. (2002). Male gynecomastia and risk for malignant tumors: a cohort study. BMC Cancer. 2:26. IM

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