Sermorelin isn’t new, but it has recently gained a new popularity in the Hormone Replacement Therapy (HRT) space as an anti-aging medication. This is because ultimate purpose of HRT is to help the patient live a high quality, long life. HRT providers have long recognized that Human Growth Hormone (HGH) decreases as the patient ages. This decrease in HGH can lead to an increase in fat mass, a decrease in muscle mass, and poor sleep quality. The benefits of replacing HGH may reverse some of the decline that comes with aging, however, HGH can be cost prohibitive and can have a list of its own side effects. The high safety profile and affordability of Sermorelin can make it a great medication to increase HGH, while side-stepping the drawbacks of exogenous HGH therapy. Today I want to dive into the efficacy, benefits, and drawbacks of Sermorelin so you can make the most informed decision when choosing your specific path of HRT.
I want to start off this blog just like every blog. I’m not a doctor. I have a math background, and I’ve been involved in the fitness space for 10 years. In addition, I’m the owner of Steel Health and Hormones Centre. We’re a medical weight loss and HRT clinic located east of Pittsburgh, Pennsylvania. Over the course of growing my practice I’ve attended seminars, read books, conversed with practitioners, and interviewed other HRT clinic directors. Although I believe I have accurate information with everything I’m about to share, I want to reiterate that I’m not a medical professional and this is not medical advice. Now onto the subject at hand…
Sermorelin is a peptide analogue of growth hormone releasing hormone. In layman’s terms that means Sermorelin is a medication that closely mimics a naturally occurring hormone and causes the release of growth hormone. To fully appreciate how Sermorelin can be used as part of a comprehensive HRT program, it’s important to understand its history. This medication was originally developed under the brand name Geref and it was used as a diagnostic tool for growth hormone deficiency (GHD) in children. The medication would be administered into the child, and if there was a subsequent rise in Human Growth Hormone (HGH), then the medical provider could conclude that the anterior pituitary gland can produce HGH. If there was a consequent rise in HGH after administration of Geref, the patient can continue with Sermorelin as treatment for GHD1. The doses used for treatment of GHD is .5 or 1mg of Sermorelin administered subcutaneously.2 Geref received FDA approval in 1997 and was used until 2008 where manufacturing difficulties caused the producer (EMD Serono) to discontinue the medication.3
This story tells us a few things. First, it is an FDA approved medication that was not recalled for reasons of safety or efficacy. Additionally, if the patient has a functioning pituitary, it will increase HGH in people suffering from GHD.
Now I want to make the case that Sermorelin is also efficacious in increasing HGH in individuals not suffering from clinical GHD, but are symptomatic in a way that indicates suboptimal HGH levels.
For me to make this case it’s important for the reader to understand IGF-1. IGF-1 stand for Insulin-Like Growth Factor -1 which has a similar chemical composition to insulin. It’s responsible for growth in children and has anabolic effects in adults. HGH is upstream of IGF-1. This means that in healthy adults, if we stimulate an increase in HGH, we should see an increase in IGF-1. Many clinics will test IGF-1 as a proxy for HGH since it’s much more stable in the bloodstream than HGH.
This is exactly what I see in patient’s bloodwork. With administration of low-dose Sermorelin we see a predictable increase in IGF-1 to the high-normal range.
Now we have strong evidence that Sermorelin can increase HGH and IGF-1 levels in adults not suffering from clinical GHD, but rather, growth hormone insufficiency, what does this mean for HRT?
Conversing with patients, providers, and scouring the forums, here are some of the benefits reported with Sermorelin use;
- Deeper, more restful sleep
- Increased muscle mass
- Decreased fat mass
- More energy
- Reduction of fine lines and wrinkles
- Improved hair quality
What about the drawbacks?
There are drawbacks to having HGH levels that are too high. These include;
- Carpal tunnel syndrome
- Insulin resistance
- Edema
- Joint and muscle pain
- Gynecomastia
- Increased risk of certain cancers4
However, remember that Sermorelin is not HGH; it’s simply causing your body to produce more of its own HGH. As a result, when the pituitary increases HGH, it is modulated via negative feedback by a neurohormone called somatostatin. This means that if HGH gets too high, somatostatin will bring it back down to safe ranges. This negative feedback relationship is preserved while using Sermorelin, making overdose extremely unlikely. Additionally, the release of HGH caused by Sermorelin is episodic instead of continuous, therefore the levels of HGH are only increased transiently which is more in line with the natural release of GH. Exogenous HGH therapy is not episodic, and the long term rise of growth hormone cannot be blunted my somatostatin which may contribute to the above side effects. We also have to look at the dose. This is where Geref and compounded Sermorelin differ most substantially. Sermorelin used for HRT in aging adults is a fraction of the dose used for children suffering from GHD. Lastly, stimulating the pituitary may result in improving other hormonal parameters, preserving youthful anatomy and physiology.5
In the trenches, the only drawback we see in bloodwork in some patients is a slight increase in fasted blood glucose. This is not nothing and should be constantly monitored. If we see fasted blood glucose continue to rise we reduce the dose or halt administration. This is why it’s so important to work with a clinic like Steel Health and Hormones Centre, where we constantly monitor you and make sure you’re getting maximum benefit with minimum harm.
What are the takeaways? In my opinion, I believe Sermorelin is a fantastic medication to help with body composition, sleep quality, skin quality, hair quality and libido. I believe there is a potential drawback of increasing fasted blood glucose which should be monitored and the dose should be adjusted accordingly. HRT should always be about improving health span and lifespan and I believe with proper monitoring, like we do at Steel Health and Hormones Centre, both can be achieved.
https://link.springer.com/article/10.2165/00063030-199912020-00007
https://www.aafp.org/pubs/afp/issues/1998/1015/p1484.html
https://www.goodrx.com/geref/what-is
https://my.clevelandclinic.org/health/articles/23309-human-growth-hormone-hgh https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699646/
