Growth Hormone Deficiency and IGF-1: How Anti-Aging Peptides like Sermorelin work

Keeping growth hormone levels normal is important as men age like with optimal testosterone levels.  As men age, growth hormones begin to decrease by 1-2% from starting at age 30, similar to decreasing testosterone levels. Low growth hormone or GH deficiency is a medical condition that speeds up the aging process reducing energy production and liveness impacting muscle health by lengthens cell recovery regardless if you are working out or not. Peptides like sermorelin can help increase insulin-like growth factor (IGF-1) back to optimal levels.

GH (growth hormone) production starts in the pituitary gland signaling down to the liver to produce insulin-like growth factor 1 (IGF-1).

In men over 30, healthy IGF-1 levels help the body keep the metabolic process flowing as it should from processing and digesting food, recovering and building muscle, and promoting restful sleep. All of these metabolic flows help keep your body alert and energized.

Like with low Testosterone (secondary hypogonadism), the pituitary gland is responsible for kicking off the production of growth hormone, which in turn stimulates the liver to produce insulin-like growth factor 1 (IGF-1).

In our article about fitness over 40, men’s hormones rely on an axis of critically timed events and signals between the brain, liver, and testicles. If the hypothalamic-pituitary-growth hormone axis is off and reduced with age, hormone imbalance can occur and throw off the body’s “day-to-day” engine leading to some unpleasant symptoms.

• Reduced muscle mass
• Drops in energy, feeling lethargic & fatigue
• Increase in fat around the belly, gut, and waist
• Anxiety & moodiness
• Aging skin, wrinkles
• Low sex drive / libido
• Difficulty concentrating / loss of mental clarity
• Slowed metabolism

If you are familiar with HCG therapy for secondary low T, our providers prescribe sermorelin to stimulate the natural release of Growth Hormone (GH).

What is Sermorelin?

Sermorelin is a bioidentical protein-peptide called a Growth Hormone Releasing Hormone (GHRH) not growth hormone (HGH) nor an anabolic steroid (illegal). The hormone promotes secretion of growth hormone increases the level of IGF-1 aka growth hormone.

A more in-depth scientific look at “what is sermorelin” centers around this amino peptide’s response inside the body’s metabolism. The first 29 amino acids of sermorelin are just as effective as the full 44 amino acid structure.

Sermorelin is referred to as a Modified GRF (1-29) or modified growth releasing factor with amino acids 1 to 29. Researchers found that GH deficiency naturally increased when normalizing these releasing hormones in the pituitary gland. Sermorelin binds to the growth-hormone-releasing hormone receptor (GHRHR) on cells in the anterior pituitary stimulating the production of GH.

Unlike HGH therapy, sermorelin does not suppress the natural production of HGH. If the body’s IGF-1 levels are below normal, sermorelin helps normalize GH back to optimal range. HGH therapy elevates IGF-1 to higher levels than they need to be. Elevating GH levels will only benefit men to a certain extent. Anything beyond normal may lead to diabetes or lead to joint issues.

We will cover why some need full HGH replacement later on in this article.

Optimizing testosterone and growth hormone levels has proven to be more beneficial than HGH elevating levels past a normal threshold. Muscle recovery is the cornerstone for the development of healthy muscle tissue. “Juicing” GH levels have proven to be unnecessary for many men but keeping GH levels optimized with sermorelin peptides is very effective.

Yes, some men may not respond well to GHRH treatment and if that is the case, our providers will look for alternative treatment options. It’s well established that High IGF-1 levels are associated with a higher risk of cancer and low IGF-1 levels with an increased risk for cardiovascular disease. In a review of 12 studies in 2011 on cancer and heart issues, 14,906 participate confirmed the low and high of IGF-1 association for the cause of death.

What Are Peptides?

Peptides are similar to proteins but they serve a specific function for the body – Looking back at sermorelin’s 1-29 of the 50 amino acids, the shorter amino acids in peptides make it easier for the body to absorb than proteins. A good example is collagen protein – our partner Frog fuel makes a liquid protein that is predigested so you feel the positive effects in 10-15 minutes.

The word peptide is derived from the Greek word: peptós, which means “digested.” If you needed an ah-ha moment, there you go.

Amino acids are the building blocks for cell regeneration and hormone stabilization within the body. Peptides like sermorelin play a specific role in how the hormone IGF-1 regains its normal level because the amino peptides have their own unique structure and code.

The 29 amino acid code make up within sermorelin directly mimics the effects of growth hormone-releasing hormone (GHRH).

Once injected, the central nervous system responds to this GHRH amino and begins to start a series of events that leads to the release of growth hormone thus increasing IGF-1.

How does sermorelin help with muscle mass?

Sermorelin helps the body elevate deficient IGF-1 and growth hormone (GH) levels back to normal allowing the healing process to continue within muscle tissue. Low levels of IGF-1 can lead to slow recovery or weakened muscles as the body does not have the right level of hormones to repair and reenergize muscle fibers.

Treating low GH with supplemental HGH can elevate GH past optimal levels and lead to chronic issues in the joints and impact the body’s natural ability to produce growth hormone. When exercising, muscles in the body break down so the body naturally releases hormones and nutrients to repair the stressed-out muscles. This is why nutrition and balancing hormones are important as men get older to reduce the risk of injury.

What is Growth Hormone Releasing Hormone?

Growth hormone-releasing hormone or GHRH is a hormone produced in the hypothalamus and plays a critical role in the axis of growth hormone production. Like Low T and HCG, the main role of growth hormone-releasing hormone is to alert the pituitary gland to produce and release growth hormone (GH) into the bloodstream sending this repairing growth hormone (GH) to nearly every tissue of the body controlling energy production via metabolism and growth of healthy muscle tissues.

What does IGF 1 do to the body?

Insulin-like growth factor (IGF-1) is primarily produced by the liver and behaves “like” insulin in that the hormone creates muscle fibers similar to how insulin converts blood sugar to energy. IGF-1 helps regulate growth hormone (GH) production in the pituitary gland and also works with growth hormones (GH) to promote the development of bone and muscle tissue.

How does sermorelin help improve energy?

This IGF-1 hormone also works in tandem with insulin to keep energy production stable specifically regulating carbohydrate and lipid (cholesterol) metabolism.

The body uses growth hormone (GH) in protein metabolism by helping with the growth and nerve tissue response combating a continuous cycle of muscle breakdown (trophic effect). Growth hormone (GH) and its mediator, IGF-1, have an antagonistic effect on insulin and some aspects of lipid metabolism. Insulin burns to stoke energy while GH produces to regrow tissue.

Many tissues in the body rely on growth hormone (GH) by way of energy consumption and product within the metabolic effect all the way down at the cellular level.

Growth hormone (GH) binds to cells to regenerate bodily tissue.

Growth hormone (GH) increases lipolysis

Lipolysis occurs in the liver where the enzyme creates new tissue for the liver and muscles.

Lipolysis reduces cholesterol levels and increases “lipid droplets” keeping the body’s metabolism burning fat. Testosterone and growth hormones (GH) fire off a series of actions to promote a rapid decrease in bad cholesterol and an increase in lipid droplet cholesterol.

Reduces glucose and protein oxidation

Glucose oxidation breaks down glucose and protein to create energy. Growth hormone (GH) decreases glucose oxidation sending glucose down a different route in the body stimulating growth vs. energy consumption. Reference, Reference

The effects of growth hormone (GH) triggered by IGF-1 can be thought of as “anabolic” (compound building) like insulin. Anabolic is commonly thought of in a negative light namely performance-enhancing drugs or anabolic steroids, but anabolism is simply the antithesis of metabolism whereas our body builds rather than burns.

Growth hormones ask the body to start building through protein synthesis and carbohydrate oxidation.

The building process through the conversation of protein and carbs helps with skeletal growth, muscle strength, bone density, heart function. IGF-1 is the regulator telling the body to release growth hormone (GH) to heal and improve these areas. Many outside factors can impact the production of growth hormones (GH) like stress, exercise, nutrition, and sleep but without proper IGF-1 or GH balance, the compounding effects of stress can hurt the body. Reference, Reference, Reference, Reference

How does sermorelin help lose fat?

IGF-1, insulin, and metabolism work closely together inside the body. Using sermorelin to stabilize the body’s IGF-1 production will increase the body’s ability to increase muscle mass and burn fat. As we discuss in our articles, increasing the development of lean muscle fibers will help improve the body’s shape and figure. While bodyweight may not reduce, the development of lean healthy muscle is also burning away fat. When IGF-1 is normal the body can convert fat into muscle and helps reveal your true fit self.

In a study of 3,354 adults, low and high levels of IGF-1 were both associated with insulin resistance. Researchers found that optimal levels of IGF-1 were more effective in weight management rather than increasing the levels of HGH. Reference

How does sermorelin slow aging and wrinkles?

Maintaining optimal levels of IGF-1 can slow the inevitable aging process by keeping skin and other organs from aging too quickly. Chronically low levels of IGF-1 leads to cognitive decline, risk of heart disease, weaker grip strength, and negatively impacts the immune system.

IGF-1 can influence fibroblast function (cell creation), which tells the body to release collagenases enzymes to break up and remove dead skin then produce collagen to regenerate healthy skin.

Why? The hormones IGF-1, glucose, and cortisol all impact skin health. Without proper balance and excess cortisol, the skin will not have enough GH or collagen to repair stressed skin cells leading to skin aging and wrinkling.

IGF-1 deficiency can increase the risk for cardiovascular disease because cardiac activation of the IGF-1 receptor protects people from heart attacks. These receptors activate pathways through their tyrosine kinase activity and coupling to a heterotrimeric G protein. Simply put, IGF-1 helps the body produce a healthy blood plasma membrane and keeps cell structure in the heart arteries.

A decrease in IGF-1 is related to cognitive decline and dementia. IGF-1 promotes neuron growth, dendritic arborization, and synaptogenesis… Simply put, healthy levels of IGF-1 keep the central nervous system primed and ready to tell parts of the body to repair, regenerate, and recover. IGF-1 plays an anabolic (GH) and neuroprotective role in the brain.

Inside the body, there is a balancing act between cell proliferation and differentiation in many physiological functions. Simply put, the body is constantly creating cells and these cells are changing to meet the needs of the body. In the skin, the maintenance process is cell creation and the changing cycle is extremely important for skin creation and development. IGF-1 is a major regulator of cellular proliferation and differentiation. Reference, Reference, Reference, Reference, Reference, Reference, Reference

How does sermorelin improve sex drive?

Like with low testosterone, low libido is also associated with GH deficiency. Stabilizing IGF-1 back to normal levels will help restore sex drive in both men and women. The role of IGF-1 and growth hormone (GH) centers around erectile stimulation and arousal. A solid erection begins with proper vascular blood flow. When erectile dysfunction occurs and IGF-1 levels are low, this could mean that the endothelial lining of blood vessels is no generating enough cells. IGF-1 and growth hormone (GH) help stimulate the process for cell growth in the penis and in turn potentially reverse ED. Reference

How does sermorelin improve concentration?

Cognitive decline is common with increasing age, but studies have shown that keeping IGF-1 levels stable can improve mood and cognitive performance as people age.

Studies among Traumatic Brain Injury (TBI) or post-traumatic stress disorder (PTSD) patients have proven that stabilizing IGF-1 levels help synthesize tissues including neurons, glia, and vascular cells within the brain allowing the patient to feel better. TRT has similar alleviating effects on TBI and PTSD as well.

For years, TBI researchers believed that that the cognitive declines in executive functioning, memory, and information-processing speed, were due to diffuse axonal injury (extreme concussion) and structural injuries to the frontal and temporal lobes.

After studying GH deficiency and TBI, researchers were “intrigued” to find that patients may benefit from the replacement of IGF-1 and growth hormone (GH) to help the brain regenerate cells and bring some relief to an uncomfortable life. Reference

How does sermorelin stabilize the sleep?

Sermorelin has shown to improve sleep cycles in men struggling to stay asleep. Things like sleep apnea or insomnia can disrupt your life and greatly impact mental function as the body relies on sleep to heal and reset the body and brain.

Quality of sleep decreases with age so with less time in deep or REM cycles the body cannot keep up. By stabilizing the IGF-1 and promoting healthy growth hormone (GH) leads to an improvement in sleep. The body naturally releases growth hormone (GH) during sleep so it’s imperative to get restful sleep to allow the body to recover. Sermorelin (GHRH) therapy can help with that.

It’s well documented that growth hormone (GH) secretes during deep, slow-wave sleep. Growth hormone (GH) begins its journey at the beginning of sleep and is supervised by growth hormone-releasing hormone (GHRH).

Once you enter sleep, the body tells the inhibiting hormone (somatostatin) to stop holding back growth hormone (GH) which also is associated with an increased level of circulating ghrelin. Ghrelin regulates appetite and acts on the hypothalamic-pituitary axis to simulate a feeling of hunger, desire to eat, and actually kicks off the first step of sleepiness.

When a person sleeps, leptin levels rise to reduce appetite reassuring the brain that there is enough energy in circulation for the night.

A deeper look at sleep shows that GHRH neurons need to fire off at the same time to start the first stage of sleep and pituitary growth hormone (GH) release.

Without proper GHRH function, this sequence of events will be held back leading to wakefulness and fatigue. This is where sermorelin therapy can actually stimulate this first stage of sleep allowing the GHRH neurons to fire off as they should in the brain leading to restful sleep and the necessary production of growth hormone (GH). Reference, Reference, Reference, Reference, Reference, Reference

Another issue could be Sleep apnea or snoring.

What causes GH Deficiency?

Similar to secondary hypogonadism (Low T), low growth hormone centers around the pituitary gland where the brain fails to signal the liver to produce growth hormone. These signals are IGF-1 coming up to the brain from the liver. In secondary low T, the pituitary gland fails to tell the testicles to produce testosterone.

The lack of production can range from natural aging to traumatic brain injury. Most men fail to produce enough growth hormone because they do not produce enough IGF-1 due to age. Tumors or radiation or more severe examples.

When your pituitary gland doesn’t produce enough growth hormone, the body’s natural recovery or rebuild is impacted.

While growth hormone (GH) deficiency can develop at a young age, when you’re an adult, you acquire growth hormone deficiency.

Issues like:

• A severe head injury
• A tumor in your head or a history of pituitary tumors
• Brain surgery
• TBI/PTSD
• An infection
• Radiation treatments to your brain
• Hormonal problems related to the hypothalamus-pituitary axis or pituitary gland (Low T, hypothyroidism, excess estrogen, elevated cortisol)
• Lack of blood supply entering the pituitary gland

How do I know if I have GH deficiency?

A diagnosis of GH deficiency can be made through blood work to check your IGF-1 levels. Our providers will order IGF-1 alongside testing as part of the normal low T work up at your first visit.

Studies have confirmed a “U-shaped” risk association where low or high IGF-1 levels are harmful to the body.

Several population-based studies have defined the following age to IGF-1 level reference range:

Age/Average Serum IGF-1 (ng/ml)

21-30: 158-230

31-40: 135-220

41-50: 121-193

51-60: 98-150

61-70: 85-140

71-80: 85-95

80+: 85-90

Our partner lab’s Reference range shows:

Age/Average Serum IGF-1 (ng/ml)

25-29 Years     63-373

30-39 Years     53-331

40-49 Years     52-328

50-59 Years     50-317

60-69 Years     41-279

70-79 Years     34-245

80+ Years        34-246

Our providers reference 200 ng/ml or below should be evaluated for low IGF-1. One European study found an average serum IGF-1 level of 200-210 ng/ml.

Several studies confirm that the daily secretion of growth hormone undergoes a decrease with age around 14% per decade after puberty. As a consequence of natural aging and these physiologic imbalances, IGF-1 levels can begin to decline to a point where 30% of nonobese men are at an IGF-1 level below the lowest serum concentration of 16 ng/ml. Reference, Reference, Reference

 

How does GH deficiency treatment work?

Research studies concerning adult GH replacement have consistently shown significant beneficial effects. GH replacement reduces total body fat and in particular fat around the abdomen. It also increases lean body and muscle mass, which improves strength and exercise tolerance. Commonly reported side effects are muscle aches, joint discomfort, headaches and swelling, and inflammation.

Everyone’s body responds differently to GHRH therapy, which is why our providers do not use a cookie-cutter protocol during treatment. While these side effects need attention, most people report that the side effects subside after the body adjusts to the therapy, but an immediate reduction in sermorelin dose with guidance from our providers is typically the first step.

Side effects are usually mild usually related to fluid retention but if you feel moderate to severe side effects, call 911 immediately.

What are the symptoms of GH deficiency?

Growth hormone (GH) plays a role in muscle growth, recovery, and density.

When levels are low, fat begins to accumulate around the waist and unusual areas commonly called problem areas.

Yes, diet and lifestyle impact fat gain but low levels of IGF-1 and growth hormone can compound the effect of poor nutrition. IGF-1 is a partial regulator of HDL and LDL lipoproteins in our cholesterol levels and bone density helping the body burn fat and produce testosterone as it releases growth hormone (GH) from the pituitary gland. Low levels of IGF-1 impact the brain’s natural production of growth hormone to help with normal brain function. Symptoms are closely aligned with low testosterone so if you’re feeling off, blood work could help our providers determine what the root cause is driving these signs and symptoms.

Symptoms / Signs

Increasing fat in unusual areas / Excess weight, protruding beer gut

Decrease energy and motivation / Brain fogginess, that 3 pm feeling but it’s 6 pm

Dehydration, poor nutrition / Skin wrinkling & dryness

Reduced strength / Decreased muscle mass and stamina, unusual soreness

Depressed moods & anxiety / Negative thoughts and moodiness

Low sex drive / Erectile dysfunction or lack of urge and readiness

Poor sleep / Wakefulness late at night

Once IGF-1 and growth hormone (GH) levels stabilize, working out should feel less of a burden and your physical fitness will likely improve with the balance found in treatment, specifically with cardiovascular function.

Reduced bone density is tricky to identify but crackly joints are a sign of low or excess of abnormal IGF-1 and GH.

Guys with growth hormone (GH) deficiency can experience an excess of LDL (low-density lipoproteins) or bad cholesterol over HDL (high-density lipoproteins) or good cholesterol, which can impact blood vessel health. Learn more about cholesterol in men here.

When is the best time to take Sermorelin?

It’s best to take sermorelin before bedtime as growth hormone production occurs during sleep.

So taking a dose before bed should improve sleep and help the body recover and repair as it should.

How is Sermorelin therapy administered?

Sermorelin hormone therapy is a prescription in a multi-dosed, injectable vial. Each prescription contains a powder that contains Sermorelin Acetate and a vial of bacteriostatic water. Our staff can mix it for you or we can train you on the mixing process. It’s fairly simple.

Sermorelin is typically self-administered but our staff can help with treatment in our clinics. Injections are done subcutaneously (sometimes called subQ) just under the skin in a fatty area like your stomach or love handles using a small insulin needle. Intermuscular injections are unnecessary for GHRH therapy like sermorelin as the amino peptides absorb better through fat. Our providers will prescribe a frequency for the sermorelin therapy during your consult but shots are typically prescribed for 6 days per week or 2-3 times a week.

how long does it take for sermorelin to work?

Patients typically report noticing improved sleep within the first few weeks of therapy. Improved sleep will lead to increased energy and stabilized mood.

Most men will see noticeable physical effects after 3-6 months of therapy, similar to TRT, the body needs time to get used to the restored hormone levels. Body composition, lean muscle gains, and thinner waist are commonly reported during these first 6 months.

After 6+ months of GHRH therapy, patients should see improvements in skin tone.

There are several things to look forward to during the first 6 months.

1-3 Months:

Guys may experience vivid dreams, sound sleep, weight loss, a positive attitude, and an improvement in aerobic stamina. Sexual performance should start to turn around for the better between 1-2 but results will vary.

Some men may experience immediate improvements in muscle tone and strength if there is less fat accumulation on top of the muscle. Hair, skin, and nail growth should feel more full and healthier. In months 2 and 3, some men report better digestion and better vision.

Entering month 3 should give the brain some clarity and improve mental health directly improving productivity and motivation. Some may see wound healing speed up and experience faster muscle recovery from soreness.

4-6 Month:

Entering the 4^th month of treatment may lead to healthier joints leading to improvements in flexibility. Noticeable reduction of skin wrinkles and cellulite have been reported. From month 6 and beyond men should be feeling confident and healthy as the IGF-1 and growth hormone levels have been fully restored and dialed into normal allowing the body’s engine to run smoothly again. Reference, Reference

Does sermorelin therapy last forever?

If IGF-1 levels are chronically low, then therapy will need to be used to restore the levels to a normal range. Some men come off therapy periodically and return to feel the results again. Our providers will advise the best protocol and length of treatment during your monthly follow-ups done via video visits on our telehealth platform.

Once optimal IGF-1 levels are achieved, our providers may switch to a less frequent maintenance protocol. Men should not expect to see immediate results of GHRH therapy. It can take 6 weeks to 2 months for the body to fully respond to therapy and the most impactful results begin to show after 6-8 months. Reference

Diabetes IGF-1, and Sermorelin

Low and high IGF-1 levels are both associated with insulin resistance. Growth hormone (GH) and IGF-1 have an antagonistic effect on insulin and lipid (fat storage) metabolism. When IGF-1 and the metabolism is operating normally, insulin burns to stoke energy while GH produces to regrow tissue.

Studies have shown that GHRH (releasing hormone, sermorelin) analogs to increase and preserve insulin secretion by beta-cells in isolated pancreatic islets, which could be useful for diabetic treatment. Reported blood sugar issues with “growth hormone” are typically caused by non-doctor prescribed high dosages of synthetic HGH which sends levels into the unsafe high bell curve in IGF-1. Reference, Reference

Creatine, IGF-1, and Sermorelin

There are hundreds of studies confirming that creatine “indirectly” works with testosterone grow muscles where creatine activates IGF-1 inside muscles to promote growth (via GH) and fire off (energy release).

When creatine is supplemented during or after resistance training IGF-1 concentration in muscles increases. Some studies saw a 20%+ volume elevation in how the body uses creatine and IGF-1 more efficiently during exercise. Researchers believe that the rise in muscle IGF-1 and creatine interaction is due to the higher metabolic churn and burn of muscles during an intense workout session.

As we talk about in testosterone and creatine, increasing cell hydration by allowing more water to enter muscle cells, which helps play a role in muscle growth and healing during intensive physical activity. Reference

BCAA, IGF-1, and Sermorelin

The branched-chain links of leucine, isoleucine, and valine work together creating essential proteins the body uses to function working side-by-side with growth hormone to build muscle. It’s important to keep optimal essential amino acids to help IGF-1 and growth hormone synthesis protein during and after exercise.

Of the three amino acids, leucine [ loo-seen] is the most trigger that initiates muscle protein synthesis and metabolic functions like regulating insulin spikes.

Leucine aids in the growth and repair of muscle and bone tissue by stimulating growth hormone (GH) in the muscle tissue. While leucine is found in many foods and deficiency is rare, BCAAs are a good alternative to sports drinks like Gatorade or Powerade.

Blood Pressure IGF-1, and Sermorelin

Healthy amounts of IGF-1 has a positive influence on blood pressure. In a review of 20 studies spanning 704 people, IGF-1 actually showed an antihypertensive behavior meaning IGF-1 helped keep blood pressure from getting too high. The reviewer found that Low IGF-1 when filtered by older age and weak vascular function showed protective function in the blood vessels. They concluded that GHRH treatments like sermorelin therapy to reach optimal levels is an effective cardiovascular medicine to improve vascular function. Reference

Medically peer reviewed by Jessica Zimmer, PA-C. Written by Our Editorial Team.

Give us a call at 817-900-0304 or sign-up through our online intake process if you would like to get started with treatment!

If you do have low testosterone it can be easily treated and monitored via telehealth with the same level of care as you would receive in our traditional clinic setting in Roanoke, Texas. Give us a call if you have any questions!