I’ve been meaning to book a consult one of these days, but my problems tend to let up for a bit and then I think I can figure things out on my own, before they kind of come back. I tend to struggle with tendinopathy symptoms and progressively overloading without flaring that up. Right now it’s mainly a load management thing I think, and perhaps stress/underrecovery too. But I do wonder if some element of this is from having a very small frame?
I grew up with anorexia from age 9-20, and I noticed my wrists/ankles are well under the 1st percentile for men according to Pubmed studies and that U.S. army anthropological measurement study from 2012. One of my parents has around 50th percentile for their gender, the other around 25th percentile but as you can see I should fall somewhere around there, not well-under 1st percentile in size. I believe this was from the anorexia.
Questions:
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Could HGH treatment allow me to get thicker bones still? I’m 22 years old. I also assume my skeletal maturation is slightly delayed. My growth plate scars are still visible in the proximal femur as far as I can tell, there’s still some distinction of where the growth plate was but it’s not really “open” anymore to my layperson eyes. My proximal humerus plate was actually somewhat open last I had an x-ray of it (I get regular scoliosis x-rays so that’s how I know but haven’t had one in a year). My elbow growth plates are definitely fully closed. My shoulder width has increased and appears to still be slowly increasing since I started eating well and stopped being underweight, some of it is just muscle and fat but it looking at pictures it seems like some structural growth happened too. My height or wrist thickness hasn’t changed as far as I can tell though. I say all this more as an indicator that my skeleton is still in a young-ish stage where perhaps significant appositional bone growth is still possible?
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How small do one’s bones have to be before the size becomes pathological for things like tendon health (I’m thinking reduced cross-sectional area?), strength potential, etc.? Or does small bone size/diameter ever become pathological?
Most advice online tells one not to worry about such things, but most people asking the questions (according to the measurements they list) fall under the 10th-20th percentiles, not <1st percentile. I do have some more pressing reasons to be inquisitive about this as well:
My bones read as osteoporotic on DXA scans, with T-scores -3.6 at the worst, but there are hints that my true bone density might be fine. My bone quality reads as completely normal from the TBS score add-on to my DXA scan. From my research, which could be wrong, the areal bone density measured by DXA severely underestimates the density of very small bones due to quirks of 3d >>> 2d projection and is cautioned against use in young children because it gives a misleading result of low bone density.
Nonetheless, DXA-measured bone density is apparently what best predicts fracture risk in the long-term, so it doesn’t really matter if one’s bones are extremely small but metabolically healthy like mine seem to be, vs. normal size and metabolically unhealthy. It seems that however you got to a low DXA BMD T-score, it’s a bad thing.
I know my wrists/ankles are about 1-2 inches less in circumference than my father’s, who is the smaller-framed of my parents relative to their gender, and I believe that would be my genetic potential. If HGH could get me 1-2 inches thicker wrist circumference, it would likely be thickening my vertebrae and femur by 15-25% too, and could boost my DXA BMD a lot without even changing my actual bone density at all.
I’m being monitored by an endo but wanted to find out if HGH could benefit my overall lifting experience, as my endo wouldn’t know whether <1st percentile wrist/ankle size is a hindrance for weightlifting performance or tendon health, but you would. I like getting stronger and if taking HGH now could both improve my DXA scan results AND give me a higher strength potential over the rest of my lifetime, AND decrease fracture risk when I get older and lose bone quality, AND maybe a larger tendon cross-sectional area for less tendency to tendinopathy, I’d be all the more for it. But maybe I’m being too optimistic about HGH, I don’t know?
I know they say anorexic recovery in late adolescence usually doesn’t height restore, but that’s not what I’m after, and that’s something highly dependent on the right growth plates still being open. Appositional growth I have no idea on which is why I’m seeking your medical expertise. It’s not studied but is it theoretically plausible that I could stand to get significant appositional growth from HGH given my history of anorexia/stunted growth relative to my genetics?
Thanks so much.