Medication is self-injected 6 times a week at nighttime.  Medication is administered under the skin (subcutaneously) in the arm, thigh, buttock or abdomen using a very thin needle.  A detailed education will be given by a physician once you decide to start the treatment.  The duration of treatment depends on child’s age as well as the desired final height.  However, it is recommended to continue treatment for at least 6 months once treatment is initiated.

The growth hormone treatment is known to be quite safe.  It is very rare to have serious side effects in children with no underlying disease.  There could be pain and itching at the injection site temporarily.  Temporary flu-like symptoms, hypothyroidism, swelling, headache can occur during the initial stages of treatment.  Dosage of medication may be adjusted with close monitoring to counter these side effects.

Children can develop joint/muscle pain while they experience growth spurt during hormone treatment. If children already have scoliosis, the curvature of scoliosis can get worse during the treatment.  Therefore, close follow up with prescribing physician is recommended.  Human growth hormone treatment does not cause scoliosis in children.

Human growth hormone treatment is contraindicated in patients with active cancer, diabetes, thyroid disease and sleep apnea due to morbid obesity.

Yes.  It is required to follow up every month to check for any side effects from the medications, monitor growth rate and signs of puberty.  Spine and hip exams are performed periodically.  Blood test is necessary every 3 months for monitoring.  It is recommended to check bone age every 6 months through hand x-rays. Spine x-rays may be required in older children.

Human growth hormone is the only treatment that has been medically proven to be effective in treating short stature.  Below are two well-known studies that showed the effect of human growth hormone treatment.

1) Double blind, placebo-controlled study

This study had 71 children with short stature who were between the ages of 9 and 15 years.  The children were divided into 2 groups.  One group received human growth hormone and the other group received placebo.  It was a double-blind study which means neither the doctors nor the patients knew which group received the medication.

Result 1)

41% of patients in the human growth hormone group gained height to be above the 5th percentile of the general population for height as opposed to 0% of patients in the placebo group.

Result 2)

In terms of growth rate, 50% of patients in the human growth treatment group gained at least 1SD (standard deviation) in height across the duration of the study as opposed to 0% of patients in the placebo group.

“Gained 1 SD” means patients moved on Bell curve by 1 SD.  For example, a patient who was at -2SD in the general population of the same age/sex moved to be at -1SD after growth hormone treatment.  This means, patients on growth hormone treatment grew faster than the general population when controlled for age and sex.

2) Dose-response study

The dose-response study included 239 children between the ages of 5 and 15 years.  These children were randomly divided into 3 groups – A, B and C. Each group received different doses of human growth hormone for 2 years.  Group A had the highest dose, Group B had medium, and Group C had the lowest dose.

Result 1)

Group A grew 7.2cm taller than the baseline predicted height.  This means, if a child was expected to grow 8cm for 2 years, he/she ended up growing 8+7.2= 15.2cm during that time with growth hormone treatment.
Group B grew 6.7cm taller than the baseline predicted height.
Group C grew 5.4 cm taller than the baseline predicted height.

Result 2)

Prior to growth hormone treatment, nobody had height above the 5th percentile of general population in any group.  After treatment, 82% of patients in group A achieved final heights above the 5th percentile of the general population and 47% of patients in group C achieved above 5th percentile.

1) Sleep

Human growth hormone is secreted between the hours of 10pm to 2am and it is best to go to sleep before 10pm.  It is recommended to minimize the use of smart phone, computer or TV at nighttime for good quality sleep.  At least 9-10 hours of sleep is recommended for growing children.

2) Nutrients

Balanced diet with special emphasis on proteins (essential amino acids), good quality fats and micronutrients is recommended. Supplementation with vitamins, certain minerals and trace elements can be very beneficial.  Excessive sugar or fried foods should be avoided as these can increase insulin secretion and interfere with growth.

3) Exercise

45-60 minutes of exercise is recommended for adequate growth.  Running, basketball, volleyball and jump ropes are good exercises to stimulate growth plates.

The cost of treatment largely depends on dosage of medication which is determined by the child’s weight, age, gender and growth plate status.  Generally speaking, younger children weigh less which can significantly lower the cost of treatment while the effect is much better.        Dr. Choi is not in network with any commercial or public health insurances.  Please make an appointment for a consultation for further details.