Abstract
Growth hormone (GH) is an anabolic hormone produced by the pituitary gland. The action of growth hormone is not only to promote growth in children, but it has a significant effect on metabolism and body composition also in adults. Growth hormone deficiency (GHD) leads to physical impairment (worsen muscle strength, aerobic and anaerobic capacity) and altered body composition - with increased fat and reduced lean body mass, particularly reduced skeletal muscle mass. On the other hand, GH excess in patients with acromegaly impairs physical function, especially aerobic capacity and muscle strength irrespective of GH-dependent muscle hypertrophy. There is unclear data about GH impact on physical performance among healthy populations. Some studies showed improvement in anaerobic capacity during recombinant human GH (rh-GH) administration, others showed no significant difference. Muscle strength did not improve after rh-GH administration among healthy adults. However, recombinant GH is abused by professional and recreational athletes to improve their physical performance.
References
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2. Brinkman JE, Tariq MA, Leavitt L, et.al. Physiology, Growth Hormone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Mar 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482141/
3. Olarescu NC, Gunawardane K, Hansen TK, et.al. Normal Physiology of Growth Hormone in Adults. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000 [cited 2023 Mar 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK279056/
4. Vilar L, Vilar CF, Lyra R, et.al. Acromegaly: clinical features at diagnosis. Pituitary. 2017 Feb;20(1):22-32.
5. Lewiński A, Smyczyńska J, Stawerska R, et al. National Program of Severe Growth Hormone Deficiency Treatment in Adults and Adolescents after Completion of Growth Promoting Therapy. Endokrynol Pol. 2018;69(5):468-524.
6. Rubeck KZ, Bertelsen S, Vestergaard P, et.al. Impact of GH substitution on exercise capacity and muscle strength in GH-deficient adults: a meta-analysis of blinded, placebo-controlled trials. Clin Endocrinol (Oxf). 2009 Dec;71(6):860-866.
7. Birzniece V, Nelson AE, Ho KKY. Growth Hormone Administration: Is It Safe and Effective for Athletic Performance. Endocrinol Metab Clin North Am. 2010 Mar 1;39(1):11-23.
8. Chikani V, Ho KKY. Action of GH on skeletal muscle function: molecular and metabolic mechanisms. J Mol Endocrinol. 2014 Feb 1;52(1):R107-123.
9. Sjögren K, Leung KC, Kaplan W, et.al. Growth hormone regulation of metabolic gene expression in muscle: a microarray study in hypopituitary men. Am J Physiol Endocrinol Metab. 2007 Jul;293(1):E364-371.
10. Lange KHW, Larsson B, Flyvbjerg A, et al. Acute growth hormone administration causes exaggerated increases in plasma lactate and glycerol during moderate to high intensity bicycling in trained young men. J Clin Endocrinol Metab. 2002 Nov;87(11):4966-4975.
11. Hansen TK, Gravholt CH, ØRskov H, et.al. Dose dependency of the pharmacokinetics and acute lipolytic actions of growth hormone. J Clin Endocrinol Metab. 2002 Oct;87(10):4691-4698.
12. Russell-Jones DL, Weissberger AJ, Bowes SB, et al. Protein metabolism in growth hormone deficiency, and effects of growth hormone replacement therapy. Acta Endocrinol (Copenh). 1993 Jun;128 Suppl 2:44-47.
13. Lucidi P, Laureti S, Santoni S, et al. Administration of recombinant human growth hormone on alternate days is sufficient to increase whole body protein synthesis and lipolysis in growth hormone deficient adults. Clin Endocrinol (Oxf). 2000 Feb;52(2):173-179.
14. Healy ML, Gibney J, Russell-Jones DL, et al. High dose growth hormone exerts an anabolic effect at rest and during exercise in endurance-trained athletes. J Clin Endocrinol Metab. 2003 Nov;88(11):5221-5226.
15. Copeland KC, Nair KS. Acute growth hormone effects on amino acid and lipid metabolism. J Clin Endocrinol Metab. 1994 May;78(5):1040-1047.
16. Yarasheski KE, Zachweija JJ, Angelopoulos TJ, et.al. Short-term growth hormone treatment does not increase muscle protein synthesis in experienced weight lifters. J Appl Physiol Bethesda Md 1985. 1993 Jun;74(6):3073-3076.
17. Shi J, Sekhar RV, Balasubramanyam A, et al. Short- and long-term effects of growth hormone (GH) replacement on protein metabolism in GH-deficient adults. J Clin Endocrinol Metab. 2003 Dec;88(12):5827-5833.
18. Meinhardt U, Nelson AE, Hansen JL, et al. The effects of growth hormone on body composition and physical performance in recreational athletes: a randomized trial. Ann Intern Med. 2010 May 4;152(9):568-577.
19. Ehrnborg C, Ellegård L, Bosaeus I, et.al. Supraphysiological growth hormone: less fat, more extracellular fluid but uncertain effects on muscles in healthy, active young adults. Clin Endocrinol (Oxf). 2005 Apr;62(4):449-457.
20. Katznelson L. Alterations in body composition in acromegaly. Pituitary. 2009;12(2):136-142.
21. Abernethy P, Wilson G, Logan P. Strength and Power Assessment. Sports Med. 1995 Jun 1;19(6):401-417.
22. Kim H, Barton E, Muja N, et.al. Intact Insulin and Insulin-Like Growth Factor-I Receptor Signaling Is Required for Growth Hormone Effects on Skeletal Muscle Growth and Function in Vivo. Endocrinology. 2005 Apr 1;146(4):1772-1779.
23. Florini JR, Ewton DZ, Coolican SA. Growth hormone and the insulin-like growth factor system in myogenesis. Endocr Rev. 1996 Oct;17(5):481-517.
24. Cuneo RC, Salomon F, Wiles CM, et al. Histology of skeletal muscle in adults with GH deficiency: comparison with normal muscle and response to GH treatment. Horm Res. 1992;37(1–2):23-28.
25. Johannsson G, Grimby G, Sunnerhagen KS, et.al. Two years of growth hormone (GH) treatment increase isometric and isokinetic muscle strength in GH-deficient adults. J Clin Endocrinol Metab. 1997 Sep;82(9):2877-2884.
26. Janssen YJ, Doornbos J, Roelfsema F. Changes in muscle volume, strength, and bioenergetics during recombinant human growth hormone (GH) therapy in adults with GH deficiency. J Clin Endocrinol Metab. 1999 Jan;84(1):279-284.
27. Sartorio A, Narici MV. Growth hormone (GH) treatment in GH-deficient adults: effects on muscle size, strength and neural activation. Clin Physiol. 1994;14(5):527-537.
28. Widdowson WM, Gibney J. The effect of growth hormone (GH) replacement on muscle strength in patients with GH-deficiency: a meta-analysis. Clin Endocrinol (Oxf). 2010 Jun;72(6):787-792.
29. Svensson J, Sunnerhagen KS, Johannsson G. Five years of growth hormone replacement therapy in adults: age- and gender-related changes in isometric and isokinetic muscle strength. J Clin Endocrinol Metab. 2003 May;88(5):2061-2069.
30. Füchtbauer L, Olsson DS, Bengtsson BÅ, et.al. Muscle strength in patients with acromegaly at diagnosis and during long-term follow-up. Eur J Endocrinol. 2017 Aug;177(2):217-226.
31. Mastaglia FL, Barwich DD, Hall R. Myopathy in acromegaly. Lancet Lond Engl. 1970 Oct 31;2(7679):907-909.
32. Young JA, Zhu S, List EO, et.al. Musculoskeletal Effects of Altered GH Action. Front Physiol. 2022 May 19;13:867921.
33. Blackman MR, Sorkin JD, Münzer T, et al. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2282-2292.
34. Papadakis MA, Grady D, Black D, et al. Growth hormone replacement in healthy older men improves body composition but not functional ability. Ann Intern Med. 1996 Apr 15;124(8):708-716.
35. Hermansen K, Bengtsen M, Kjær M, et.al. Impact of GH administration on athletic performance in healthy young adults: A systematic review and meta-analysis of placebo-controlled trials. Growth Horm IGF Res Off J Growth Horm Res Soc Int IGF Res Soc. 2017 Jun;34:38-44.
36. Doessing S, Heinemeier KM, Holm L, et al. Growth hormone stimulates the collagen synthesis in human tendon and skeletal muscle without affecting myofibrillar protein synthesis. J Physiol. 2010 Jan 15;588(Pt 2):341-351.
37. Miescher I, Rieber J, Calcagni M, et.al. In Vitro and In Vivo Effects of IGF-1 Delivery Strategies on Tendon Healing: A Review. Int J Mol Sci. 2023 Jan 25;24(3):2370.
38. Campbell N, De Jesus S, Prapavessis H. Physical Fitness. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine [Internet]. New York, NY: Springer; 2013 [cited 2023 Mar 27]. p. 1486-1489. Available from: https://doi.org/10.1007/978-1-4419-1005-9_1167
39. Cuneo RC, Salomon F, Wiles CM, et.al. Growth hormone treatment in growth hormone-deficient adults. I. Effects on muscle mass and strength. J Appl Physiol Bethesda Md 1985. 1991 Feb;70(2):688-694.
40. Cuneo RC, Salomon F, Wiles CM, et.al. Growth hormone treatment in growth hormone-deficient adults. II. Effects on exercise performance. J Appl Physiol Bethesda Md 1985. 1991 Feb;70(2):695-700.
41. Bollerslev J, Hallén J, Fougner KJ, et al. Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial. Eur J Endocrinol. 2005 Sep;153(3):379-387.
42. Jørgensen JO, Pedersen SA, Thuesen L, et al. Beneficial effects of growth hormone treatment in GH-deficient adults. Lancet Lond Engl. 1989 Jun 3;1(8649):1221-1225.
43. Jørgensen JO, Thuesen L, Müller J, et.al. Three years of growth hormone treatment in growth hormone-deficient adults: near normalization of body composition and physical performance. Eur J Endocrinol. 1994 Mar;130(3):224-228.
44. Gullestad L, Birkeland K, Bjønerheim R, et.al. Exercise capacity and hormonal response in adults with childhood onset growth hormone deficiency during long-term somatropin treatment. Growth Horm IGF Res Off J Growth Horm Res Soc Int IGF Res Soc. 1998 Oct;8(5):377-384.
45. Widdowson WM, Gibney J. The effect of growth hormone replacement on exercise capacity in patients with GH deficiency: a metaanalysis. J Clin Endocrinol Metab. 2008 Nov;93(11):4413-4417.
46. Whitehead HM, Boreham C, McIlrath EM, et al. Growth hormone treatment of adults with growth hormone deficiency: results of a 13-month placebo controlled cross-over study. Clin Endocrinol (Oxf). 1992 Jan;36(1):45-52.
47. Nass R, Huber RM, Klauss V, et.al. Effect of growth hormone (hGH) replacement therapy on physical work capacity and cardiac and pulmonary function in patients with hGH deficiency acquired in adulthood. J Clin Endocrinol Metab. 1995 Feb;80(2):552-557.
48. Rodríguez-Arnao J, Jabbar A, Fulcher K, et.al. Effects of growth hormone replacement on physical performance and body composition in GH deficient adults. Clin Endocrinol (Oxf). 1999 Jul 1;51(1):53-60.
49. Liu H, Bravata DM, Olkin I, et al. Systematic review: the effects of growth hormone on athletic performance. Ann Intern Med. 2008 May 20;148(10):747-758.
50. Berggren A, Ehrnborg C, Rosén T, et.al. Short-term administration of supraphysiological recombinant human growth hormone (GH) does not increase maximum endurance exercise capacity in healthy, active young men and women with normal GH-insulin-like growth factor I axes. J Clin Endocrinol Metab. 2005 Jun;90(6):3268-3273.
51. Thomas SG, Woodhouse LJ, Pagura SM, et.al. Ventilation threshold as a measure of impaired physical performance in adults with growth hormone excess. Clin Endocrinol (Oxf). 2002 Mar;56(3):351-358.
52. Giustina A, Boni E, Romanelli G, et.al. Cardiopulmonary performance during exercise in acromegaly, and the effects of acute suppression of growth hormone hypersecretion with octreotide. Am J Cardiol. 1995 May 15;75(15):1042-1047.
53. Chikani V, Cuneo RC, Hickman I, et.al. Growth hormone (GH) enhances anaerobic capacity: impact on physical function and quality of life in adults with GH deficiency. Clin Endocrinol (Oxf). 2016;85(4):660-668.
54. Birzniece V, Nelson AE, Ho KKY. Growth hormone and physical performance. Trends Endocrinol Metab TEM. 2011 May;22(5):171-178.
55. Cahill BR, Misner JE, Boileau RA. The clinical importance of the anaerobic energy system and its assessment in human performance. Am J Sports Med. 1997;25(6):863-872.
56. Taaffe DR, Pruitt L, Reim J, et al. Effect of recombinant human growth hormone on the muscle strength response to resistance exercise in elderly men. J Clin Endocrinol Metab. 1994 Nov;79(5):1361-1366.
57. Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5;323(1):1-6.
58. Saugy M, Robinson N, Saudan C, et.al. Human growth hormone doping in sport. Br J Sports Med. 2006 Jul 1;40(suppl 1):i35-39.
59. Tan SH, Lee A, Pascovici D, et al. Plasma biomarker proteins for detection of human growth hormone administration in athletes. Sci Rep. 2017 Aug 30;7:10039.
2. Brinkman JE, Tariq MA, Leavitt L, et.al. Physiology, Growth Hormone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Mar 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482141/
3. Olarescu NC, Gunawardane K, Hansen TK, et.al. Normal Physiology of Growth Hormone in Adults. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000 [cited 2023 Mar 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK279056/
4. Vilar L, Vilar CF, Lyra R, et.al. Acromegaly: clinical features at diagnosis. Pituitary. 2017 Feb;20(1):22-32.
5. Lewiński A, Smyczyńska J, Stawerska R, et al. National Program of Severe Growth Hormone Deficiency Treatment in Adults and Adolescents after Completion of Growth Promoting Therapy. Endokrynol Pol. 2018;69(5):468-524.
6. Rubeck KZ, Bertelsen S, Vestergaard P, et.al. Impact of GH substitution on exercise capacity and muscle strength in GH-deficient adults: a meta-analysis of blinded, placebo-controlled trials. Clin Endocrinol (Oxf). 2009 Dec;71(6):860-866.
7. Birzniece V, Nelson AE, Ho KKY. Growth Hormone Administration: Is It Safe and Effective for Athletic Performance. Endocrinol Metab Clin North Am. 2010 Mar 1;39(1):11-23.
8. Chikani V, Ho KKY. Action of GH on skeletal muscle function: molecular and metabolic mechanisms. J Mol Endocrinol. 2014 Feb 1;52(1):R107-123.
9. Sjögren K, Leung KC, Kaplan W, et.al. Growth hormone regulation of metabolic gene expression in muscle: a microarray study in hypopituitary men. Am J Physiol Endocrinol Metab. 2007 Jul;293(1):E364-371.
10. Lange KHW, Larsson B, Flyvbjerg A, et al. Acute growth hormone administration causes exaggerated increases in plasma lactate and glycerol during moderate to high intensity bicycling in trained young men. J Clin Endocrinol Metab. 2002 Nov;87(11):4966-4975.
11. Hansen TK, Gravholt CH, ØRskov H, et.al. Dose dependency of the pharmacokinetics and acute lipolytic actions of growth hormone. J Clin Endocrinol Metab. 2002 Oct;87(10):4691-4698.
12. Russell-Jones DL, Weissberger AJ, Bowes SB, et al. Protein metabolism in growth hormone deficiency, and effects of growth hormone replacement therapy. Acta Endocrinol (Copenh). 1993 Jun;128 Suppl 2:44-47.
13. Lucidi P, Laureti S, Santoni S, et al. Administration of recombinant human growth hormone on alternate days is sufficient to increase whole body protein synthesis and lipolysis in growth hormone deficient adults. Clin Endocrinol (Oxf). 2000 Feb;52(2):173-179.
14. Healy ML, Gibney J, Russell-Jones DL, et al. High dose growth hormone exerts an anabolic effect at rest and during exercise in endurance-trained athletes. J Clin Endocrinol Metab. 2003 Nov;88(11):5221-5226.
15. Copeland KC, Nair KS. Acute growth hormone effects on amino acid and lipid metabolism. J Clin Endocrinol Metab. 1994 May;78(5):1040-1047.
16. Yarasheski KE, Zachweija JJ, Angelopoulos TJ, et.al. Short-term growth hormone treatment does not increase muscle protein synthesis in experienced weight lifters. J Appl Physiol Bethesda Md 1985. 1993 Jun;74(6):3073-3076.
17. Shi J, Sekhar RV, Balasubramanyam A, et al. Short- and long-term effects of growth hormone (GH) replacement on protein metabolism in GH-deficient adults. J Clin Endocrinol Metab. 2003 Dec;88(12):5827-5833.
18. Meinhardt U, Nelson AE, Hansen JL, et al. The effects of growth hormone on body composition and physical performance in recreational athletes: a randomized trial. Ann Intern Med. 2010 May 4;152(9):568-577.
19. Ehrnborg C, Ellegård L, Bosaeus I, et.al. Supraphysiological growth hormone: less fat, more extracellular fluid but uncertain effects on muscles in healthy, active young adults. Clin Endocrinol (Oxf). 2005 Apr;62(4):449-457.
20. Katznelson L. Alterations in body composition in acromegaly. Pituitary. 2009;12(2):136-142.
21. Abernethy P, Wilson G, Logan P. Strength and Power Assessment. Sports Med. 1995 Jun 1;19(6):401-417.
22. Kim H, Barton E, Muja N, et.al. Intact Insulin and Insulin-Like Growth Factor-I Receptor Signaling Is Required for Growth Hormone Effects on Skeletal Muscle Growth and Function in Vivo. Endocrinology. 2005 Apr 1;146(4):1772-1779.
23. Florini JR, Ewton DZ, Coolican SA. Growth hormone and the insulin-like growth factor system in myogenesis. Endocr Rev. 1996 Oct;17(5):481-517.
24. Cuneo RC, Salomon F, Wiles CM, et al. Histology of skeletal muscle in adults with GH deficiency: comparison with normal muscle and response to GH treatment. Horm Res. 1992;37(1–2):23-28.
25. Johannsson G, Grimby G, Sunnerhagen KS, et.al. Two years of growth hormone (GH) treatment increase isometric and isokinetic muscle strength in GH-deficient adults. J Clin Endocrinol Metab. 1997 Sep;82(9):2877-2884.
26. Janssen YJ, Doornbos J, Roelfsema F. Changes in muscle volume, strength, and bioenergetics during recombinant human growth hormone (GH) therapy in adults with GH deficiency. J Clin Endocrinol Metab. 1999 Jan;84(1):279-284.
27. Sartorio A, Narici MV. Growth hormone (GH) treatment in GH-deficient adults: effects on muscle size, strength and neural activation. Clin Physiol. 1994;14(5):527-537.
28. Widdowson WM, Gibney J. The effect of growth hormone (GH) replacement on muscle strength in patients with GH-deficiency: a meta-analysis. Clin Endocrinol (Oxf). 2010 Jun;72(6):787-792.
29. Svensson J, Sunnerhagen KS, Johannsson G. Five years of growth hormone replacement therapy in adults: age- and gender-related changes in isometric and isokinetic muscle strength. J Clin Endocrinol Metab. 2003 May;88(5):2061-2069.
30. Füchtbauer L, Olsson DS, Bengtsson BÅ, et.al. Muscle strength in patients with acromegaly at diagnosis and during long-term follow-up. Eur J Endocrinol. 2017 Aug;177(2):217-226.
31. Mastaglia FL, Barwich DD, Hall R. Myopathy in acromegaly. Lancet Lond Engl. 1970 Oct 31;2(7679):907-909.
32. Young JA, Zhu S, List EO, et.al. Musculoskeletal Effects of Altered GH Action. Front Physiol. 2022 May 19;13:867921.
33. Blackman MR, Sorkin JD, Münzer T, et al. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2282-2292.
34. Papadakis MA, Grady D, Black D, et al. Growth hormone replacement in healthy older men improves body composition but not functional ability. Ann Intern Med. 1996 Apr 15;124(8):708-716.
35. Hermansen K, Bengtsen M, Kjær M, et.al. Impact of GH administration on athletic performance in healthy young adults: A systematic review and meta-analysis of placebo-controlled trials. Growth Horm IGF Res Off J Growth Horm Res Soc Int IGF Res Soc. 2017 Jun;34:38-44.
36. Doessing S, Heinemeier KM, Holm L, et al. Growth hormone stimulates the collagen synthesis in human tendon and skeletal muscle without affecting myofibrillar protein synthesis. J Physiol. 2010 Jan 15;588(Pt 2):341-351.
37. Miescher I, Rieber J, Calcagni M, et.al. In Vitro and In Vivo Effects of IGF-1 Delivery Strategies on Tendon Healing: A Review. Int J Mol Sci. 2023 Jan 25;24(3):2370.
38. Campbell N, De Jesus S, Prapavessis H. Physical Fitness. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine [Internet]. New York, NY: Springer; 2013 [cited 2023 Mar 27]. p. 1486-1489. Available from: https://doi.org/10.1007/978-1-4419-1005-9_1167
39. Cuneo RC, Salomon F, Wiles CM, et.al. Growth hormone treatment in growth hormone-deficient adults. I. Effects on muscle mass and strength. J Appl Physiol Bethesda Md 1985. 1991 Feb;70(2):688-694.
40. Cuneo RC, Salomon F, Wiles CM, et.al. Growth hormone treatment in growth hormone-deficient adults. II. Effects on exercise performance. J Appl Physiol Bethesda Md 1985. 1991 Feb;70(2):695-700.
41. Bollerslev J, Hallén J, Fougner KJ, et al. Low-dose GH improves exercise capacity in adults with GH deficiency: effects of a 22-month placebo-controlled, crossover trial. Eur J Endocrinol. 2005 Sep;153(3):379-387.
42. Jørgensen JO, Pedersen SA, Thuesen L, et al. Beneficial effects of growth hormone treatment in GH-deficient adults. Lancet Lond Engl. 1989 Jun 3;1(8649):1221-1225.
43. Jørgensen JO, Thuesen L, Müller J, et.al. Three years of growth hormone treatment in growth hormone-deficient adults: near normalization of body composition and physical performance. Eur J Endocrinol. 1994 Mar;130(3):224-228.
44. Gullestad L, Birkeland K, Bjønerheim R, et.al. Exercise capacity and hormonal response in adults with childhood onset growth hormone deficiency during long-term somatropin treatment. Growth Horm IGF Res Off J Growth Horm Res Soc Int IGF Res Soc. 1998 Oct;8(5):377-384.
45. Widdowson WM, Gibney J. The effect of growth hormone replacement on exercise capacity in patients with GH deficiency: a metaanalysis. J Clin Endocrinol Metab. 2008 Nov;93(11):4413-4417.
46. Whitehead HM, Boreham C, McIlrath EM, et al. Growth hormone treatment of adults with growth hormone deficiency: results of a 13-month placebo controlled cross-over study. Clin Endocrinol (Oxf). 1992 Jan;36(1):45-52.
47. Nass R, Huber RM, Klauss V, et.al. Effect of growth hormone (hGH) replacement therapy on physical work capacity and cardiac and pulmonary function in patients with hGH deficiency acquired in adulthood. J Clin Endocrinol Metab. 1995 Feb;80(2):552-557.
48. Rodríguez-Arnao J, Jabbar A, Fulcher K, et.al. Effects of growth hormone replacement on physical performance and body composition in GH deficient adults. Clin Endocrinol (Oxf). 1999 Jul 1;51(1):53-60.
49. Liu H, Bravata DM, Olkin I, et al. Systematic review: the effects of growth hormone on athletic performance. Ann Intern Med. 2008 May 20;148(10):747-758.
50. Berggren A, Ehrnborg C, Rosén T, et.al. Short-term administration of supraphysiological recombinant human growth hormone (GH) does not increase maximum endurance exercise capacity in healthy, active young men and women with normal GH-insulin-like growth factor I axes. J Clin Endocrinol Metab. 2005 Jun;90(6):3268-3273.
51. Thomas SG, Woodhouse LJ, Pagura SM, et.al. Ventilation threshold as a measure of impaired physical performance in adults with growth hormone excess. Clin Endocrinol (Oxf). 2002 Mar;56(3):351-358.
52. Giustina A, Boni E, Romanelli G, et.al. Cardiopulmonary performance during exercise in acromegaly, and the effects of acute suppression of growth hormone hypersecretion with octreotide. Am J Cardiol. 1995 May 15;75(15):1042-1047.
53. Chikani V, Cuneo RC, Hickman I, et.al. Growth hormone (GH) enhances anaerobic capacity: impact on physical function and quality of life in adults with GH deficiency. Clin Endocrinol (Oxf). 2016;85(4):660-668.
54. Birzniece V, Nelson AE, Ho KKY. Growth hormone and physical performance. Trends Endocrinol Metab TEM. 2011 May;22(5):171-178.
55. Cahill BR, Misner JE, Boileau RA. The clinical importance of the anaerobic energy system and its assessment in human performance. Am J Sports Med. 1997;25(6):863-872.
56. Taaffe DR, Pruitt L, Reim J, et al. Effect of recombinant human growth hormone on the muscle strength response to resistance exercise in elderly men. J Clin Endocrinol Metab. 1994 Nov;79(5):1361-1366.
57. Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5;323(1):1-6.
58. Saugy M, Robinson N, Saudan C, et.al. Human growth hormone doping in sport. Br J Sports Med. 2006 Jul 1;40(suppl 1):i35-39.
59. Tan SH, Lee A, Pascovici D, et al. Plasma biomarker proteins for detection of human growth hormone administration in athletes. Sci Rep. 2017 Aug 30;7:10039.
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