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MACIMORELIN A NEW DIAGNOSTIC TOOL FOR DIAGNOSING ADULT GROWTH HORMONE DEFICIENCY


Written by Dr. Welsh, Article reviewed and edited by Dr. Fine M.D..
Published on 22 July 2021

Adult growth hormone deficiency is not the easiest condition to test for and diagnose accurately. Doctors cannot just take a blood sample and see how much growth hormone is in your blood because growth hormone is released in pulses throughout the day. Thus, the concentration in the blood stream will vary widely over the course of 24 hours. In addition, other symptoms need to be taken into consideration, such as decreased muscle mass and chronic fatigue.

Doctors will take a blood sample and test for the concentration of insulin-like growth factor-1 (IGF-1) which is a protein that is produced via growth hormone stimulation by the liver and other tissues. In addition, doctors would diagnose adult-onset growth hormone deficiency via an insulin tolerance test (IST) or glucagon stimulation test (GST). These tests involve the use of a needle, which many people are not fans of, and thankfully, there is a new diagnostic test available that involves ZERO needles. The new product is Macrilen (macimorelin acetate), developed by Aeterna Zentaris, and is taken orally in order to make administration of the drug easier for patients and providers, alike.

Macimorelin Acetate: Oral Formulation for Ease of Diagnosis

In 2017, macimorelin acetate was approved by the Food and Drug Administration as a method of diagnosing growth hormone deficiency. Technically, macimorelin acetate is a synthetic growth hormone secretagogue receptor agonist. The acetate salt causes the release of growth hormone from the pituitary gland. Chemically, macimorelin acetate is known as: D-Tryptophanamide, 2-methylalanyl-N-[(1R)-1-(formylamino)-2-(1H-indol-3-yl)ethyl]-acetate. Good luck wrapping your head around that and prayers to the scientists who study and work with this stuff!

As stated previously, the diagnosis of adult-onset growth hormone deficiency can be challenging and it needs to be confirmed with a growth hormone stimulation test (GHST). This test, GHST, is labor intensive and can cause severe hypoglycemia. Because of this, the test itself is not recommended for many patients. Macimorelin acetate seems to be a much better form of testing because it is an orally active growth hormone secretagogue and once taken, the stimulated growth hormone levels can then be tested via a blood test afterwards. Simple as that!

How to Take Macimorelin for Adult-Onset Growth Hormone Diagnosis

In order to take macimorelin acetate to find out whether you are suffering from adult-onset growth hormone deficiency, you first need to get the go-ahead from your doctor. He or she needs to know whether you have ever had a hormone, thyroid or hypothalamus disorder before, and whether or not you are pregnant or breastfeeding.

One week before your growth hormone test, stop taking any growth hormone medication, if you are currently taking anything. Macimorelin acetate oral administration requires a fasting period of 8 hours prior to the test, with no food or drink except water.

Only one dose of macimorelin acetate is given and it will be mixed in with a drink that you must consume within 30 seconds. Your blood will then be drawn at 30 minutes, 45 minutes, 60 minutes and 90 minutes later.

Side Effects of Macimorelin

The side effects of taking macimorelin acetate are minimal. However, there is always the risk of an allergic reaction. Tell your doctor immediately if you experience hives, swelling of the face, lips, tongue or throat and/or you have difficulty breathing.

Other serious side effects include and should be reported right away: light-headedness, slow heartbeats, shortness of breath or fast/pounding heartbeats in conjunction with dizziness like you might pass out.

Common side effects include:

  • headache; dizziness
  • nausea, hunger, diarrhea
  • increased sweating/feeling hot
  • feeling tired
  • changes in sense of taste
  • symptoms that are similar to a cold: stuffy nose, sore throat, sinus pain

A Simple Diagnostic Tool Available Now

Despite the possible, but rare side effects, macimorelin acetate is a simple and effective way to diagnose adult-onset growth hormone deficiency. In addition, you are super safe because youll be in the doctors office for a long time after the dose is taken in order to take blood tests. You can report any adverse side effects to the doctor right away and get treated right away.

The treatment of adult-onset growth hormone deficiency is fairly straight-forward and simple, especially when overseen by a qualified hormone specialist or endocrinologist. And now, the diagnosis of the condition is easier than ever before!

Typically, growth hormone deficiency is treated with growth hormone injections or sermorelin acetate injections. The patient can choose which treatment is best for them based on personal preference, finances, safety concerns, etc.

Hormone Imbalance is Simple to Treat Once Diagnosed

The occurrence of adult-onset growth hormone deficiency is on the rise, especially in the United States. This is due to the fact that as we age, its much easier for our hormones to become imbalanced and certain lifestyle factors certainly play a role in this. If you havent been taking care of your health properly over the last 30-60 years or so, you may be paying the price now with hormone imbalance, including adult-onset growth hormone deficiency.

The only way to know for sure is to get tested. See if those annoying symptoms such as increased belly fat, low libido, chronic fatigue and/or low muscle mass are due to hormone imbalance. Contact our clinic to get tested as soon as possible! Give us a call today! We will answer any questions you might have about macimorelin acetate as a diagnosis tool and hormone replacement therapy (HRT) in general.


PRESENCE OF SPECIFIC GENETIC ALLELE INFLUENCES RESPONSE TO GROWTH HORMONE THERAPY


Written by Dr. Welsh, Article reviewed and edited by Dr. Fine M.D..
Published on 15 July 2021

For some people, human growth hormone (HGH) replacement therapy works wonders and for other people, it can take a long time to see any results. We know that everyone is different and everyone reacts differently to medicines, procedures and therapy, but in terms of growth hormone therapy, we now know why some people respond better than others. Not surprisingly, the answer lies in our genes, or genetics.

Growth Hormone Genotype Influences Response to Therapy for Adults

For adults that are suffering from adult-onset growth hormone deficiency, what determines how well they respond to therapy, or the level of response over the course of five years, is partly determined by the presence or absence of a specific growth hormone receptor allele in their genes, according to recent research published in the Journal of Neuroendocrinology. An allele is one of two or more alternative forms of a gene that are found at the same place (locus) on the chromosome. Alleles can occur in pairs and different alleles can affect the expression of a particular trait. In this case, the presence of a certain allele influences an adult’s response to growth hormone therapy.

An author of the study, Laura De Marinis, MD, from the Catholic University School of Medicine in Rome, stated, “In adult GH [deficiency], only a few studies have investigated the GH receptor polymorphism. These observations demonstrate, in some cases, an increased response to GH in patients carrying the GH allele, but with conflicting and not-conclusive data. Moreover, in some studies, an improvement in lipid metabolism or a worsening of glucose tolerance has been observed.” Hmm, it appears that the presence of these alleles makes things pretty complicated, according to scientists.

By “polymorphism,” De Marinis is describing the fact that there is more than one allele that is occupying that location on the gene. An easy way to understand how this works, is a simple example. On our genes, there are multiple locations of specific genetic code, called alleles. If a rat has an allele that codes for grey hair, then that rat will have grey-colored hair. Another rat might have a totally different allele that happens to code for white hair – therefore, that rat has white hair. The same goes for the alleles in this instance. If a certain type of allele is present at that location on the gene, the better  or worse a patient will respond to growth hormone (GH) therapy.

Determination of Genetic Influence on Response to GH Therapy

In the study, 69 adults with growth hormone deficiency were studied, both before and after treatment. The therapy used a low-dose protocol (typical for growth hormone replacement therapy treating adult GH deficiency) that was based on the patient’s body weight and monitored via insulin-like growth factor-1 (IGF-1) blood tests. Whether the patient had the GH receptor genotype of interest or not was determined from blood samples as well.

The patients were split up into three separate groups: homozygous carriers of the full-length GH receptor; heterozygous carriers of the exon 3-deleted (d3) GH receptor; and homozygous carriers of the d3 GH receptor.

After six full months of low-dose growth hormone therapy, all metabolic parameters remained the same between groups. However, by 12 months, there were significant differences observed. In the d3 carrier patients, there was significant improvement in LDL cholesterol and body composition, as observed by decreased fat mass.

There was five years of follow-up with the patients in this study. Over the course of these five years, HbA1c increased across all groups (the higher the HbA1c level, the more likely you have diabetes) but LDL cholesterol and fat mass decreased in both d3 GH receptor carriers.

In addition, the patients that had the d3d3 GH receptor demonstrated higher IGF-1 levels at 6 and 12 months of therapy, but not by five years.

Presence of d3 Allele Related to More Effective Response to GH Replacement Therapy

Based on their results, the researchers stated, “The presence of the d3 GH [receptor] appears to be related to a more effective response in terms of reduction of LDL, fat mass and improvement in blood pressure. The presence of the d3 GH [receptor] in homozygosity is associated with a significant IGF-1 increment at 6 and 12 months of GH replacement therapy.”

However, there are probably other genetic factors involved in IGF-1 response to growth hormone therapy and more research is needed, of course.

The scientists believe that their results, “confirm that the d3 GH [receptor] genotype may influence some metabolic effects during short- and long-term follow-up of low dose GH replacement therapy…”

What is Adult-Onset Growth Hormone Deficiency?

Both children and adults can suffer from a growth hormone deficiency, when the body is not producing enough growth hormone. Children need it in order to grow to their ideal height and adults need it in order to maintain cellular regeneration, metabolism and muscle mass. In recent years, it has been confirmed that adults can experience a deficiency of growth hormone as they age that is greatly influenced by lifestyle, diet and exercise.

Symptoms of deficiency include chronic fatigue, unexplained weight gain (especially in the belly area), low libido or sex drive, erectile dysfunction, low bone mineral density, low muscle mass leading to sarcopenia and thinning skin/hair. A deficiency is determined via a blood test, testing for the patient’s level of IGF-1 in the blood stream, a metabolite of growth hormone.

Most of the time, if an adult is suffering from a deficiency, they’ll need to undergo a low-dose growth hormone replacement therapy program, just like the patients in this study. The goal is to find the dose that provides just the right amount of growth hormone – not too much and not too low. The only option at this time, for treatment, is HGH injections and sermorelin acetate injections. Pills or sprays will not work for treatment – the hormones must be injected subcutaneously.

If you suspect that you are suffering from a growth hormone deficiency, it’s best to get your blood tested as soon as possible. This is something simple to do and once done, you’ll have the peace of mind knowing whether you really have a hormone imbalance or not. Contact our clinic to discuss the process of a comprehensive hormone panel and how hormone replacement therapy works. We offer free consultations! Call us today!

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EVERYTHING TO KNOW ABOUT ANDROGEL


Written by Dr. Welsh, Article reviewed and edited by Dr. Fine M.D..
Published on 10 July 2021

If youre looking for a convenient method of treating low testosterone, or hypogonadism, Androgel is a real possibility for you. Currently, there are multiple ways to treat low testosterone: injections (with various types), gels, patches and creams. In this article, well be discussing one of the more well-known gels on the market, Androgel. This is a topical gel that men can use to treat testosterone deficient, a growing issue in the male population of the United States.

Androgel: Synthetic Testosterone to Treat Low-T

Androgel is a clear, topical medication, meaning that it is rubbed onto the skin, almost like a lotion. You can get a pump dispenser or a gel packet. The pump dispenses a single dose of 12.5 or 20.25 mg with one pump. The gel packets are available in 20.25, 25, 40.5 and 50 mg dose packets. To apply, you rub one dose per day to the shoulders, upper arms or abdomen. You use the palm of your hand to massage it in. Sounds super easy, right? So much more convenient than injections and needles! However, there is one downside...

Be Aware of Drug Transference to Others

Unfortunately, with testosterone gels and creams, it is possible to transfer the hormone to others, if youre not careful or aware. This can happen by touching another person after applying the gel. If you are going to have skin-to-skin contact with someone, be sure that the application site is washed with soap and water beforehand. It is especially important not to transfer the hormone to women and children. Testosterone is a potent sex hormone as well as an anabolic steroid. It can cause harmful physical and psychological effects on people who are not used to or do not need large amounts of this hormone. Women who come into contact with exogenous testosterone may develop acne and male characteristics, including body and facial hair. Children who are routinely exposed to Androgel may exhibit aggressive behavior or even experience early puberty or swelling of the genitals. Please be mindful and VERY CAREFUL around others when using Androgel.

Side Effects of Androgel

All testosterone replacement treatments can cause side effects, with most of them being the same. Some are mild and will go away on their own once your body gets used to the hormone. One of the most common side effects is skin irritation at the application site, especially if you have sensitive skin. Other mild side effects include:

  • increased acne
  • headaches (mostly at the beginning of treatment)
  • increased blood lipids (get tested regularly!)
  • diarrhea (mostly at the beginning of treatment)
  • muscle aches or back pain
Some of the more serious side effects to be on the lookout for are:

  • hypertension (high blood pressure)
  • irritability
  • mood swings/changes
  • breathing problems/allergy to the drug
  • swelling of the ankles or legs (possible blood clot or circulatory issue)
  • blood clots
  • long-lasting or frequent erections
  • issues urinating
To avoid any other issues while taking Androgel, its best to avoid these three prescription drugs: Insulin: testosterone can lower blood sugar and this will affect the amount of insulin your body needs to produce. Blood thinners: testosterone can increase the effect of blood thinners. Steroids: the interactions between testosterone and steroids can cause fluid buildup, especially if you are dealing with heart, kidney or liver disease

The Benefits of Androgel

Now that weve discussed the potential side effects of Androgel and what to cautious with, lets look at the amazing benefits of Androgel. If you are suffering from low testosterone, Androgel has been proven to be an effective medication in increasing testosterone levels, as cited by the Food and Drug Administration (FDA). Not only is the use of Androgel as effective as testosterone injections, the way hypogonadism patients were treated in the old days, but it can be much more convenient for most patients. This is due to the fact that it can be easily rubbed into the skin like a lotion and not injected using a needle. Most people do not like dealing with needles and injections are usually more time-consuming in terms of prep, sterilization and disposal of needles than just rubbing on a gel, especially when this hormone needs to be administered on a daily basis. However, with injections, there is no worry about transferring the hormone to someone else. The health benefits of Androgel, when treating low-T, include:

  • improved mood
  • increased muscle mass
  • more confidence
  • decrease in body fat
  • increased libido
  • more energy
When a man is experiencing low testosterone, it can feel like his world has turned upside down. Hormone imbalance is no joke and can lead to serious effects like depression, anxiety, sexual issues and weight gain. Its not wonder so many men are turning to treatments such as Androgel. Thankfully, treating low testosterone is a pretty easy fix, when it is diagnosed and treated by an endocrinologist or hormone doctor. There are so many choices on the market today in terms of treatment and Androgel is just one of them. After learning a bit more about how Androgel works and how it compares to other treatment methods on the market, we hope that the knowledge has helped you to decide which method is right for you. Contact our clinic if you are interested in getting started on a testosterone replacement therapy program today or would like to learn more! We are always available for free consulation.


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If your doctor only prescribes testosterone by itself, you will probably have a rough ride. The tendency is for you to feel great the first couple months, while you increase testosterone levels, followed by a slow deterioration, once your estrogen creeps up.

High estrogen negates a lot of the positives from testosterone therapy, resulting in the same symptoms of low testosterone you had in the first place!

The solution is to add a drug called Arimidex. It's called an aromatase inhibitor, which essentially blocks the conversion of testosterone to estrogen. It has the effect of increasing testosterone levels, while keeping your estrogen low.

Once you have your testosterone and estrogen solved, it's time to stop the next inevitable decline? Shrinking testicles.

This is where HCG (human chorionic gonadotropin) comes in. It prevents both infertility and testicle shrinkage. Your testicles shrink because your body thinks it doesn't need to make testosterone anymore.

For some, small testicles may seem like just a cosmetic problem. But HGC does more than increase testicle size, it also increases adrenal function, which can have positive effects on well-being, libido, and energy.





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