HGH: Performance enhancer or healer?

He was born Sharmon Shah and that is how he entered UCLA, where he went on to become two-time team MVP and rush for more than 3,000 yards. By the time he was drafted by the Miami Dolphins in 1996, he was Karim Abdul-Jabbar, a convert to Islam. Later, with his profile rising after leading the NFL in total touchdowns, he was sued by the basketball legend and fellow Bruin alumnus Kareem Abdul-Jabbar for the inconvenient similarity, and agreed to change his name again. His identity has evolved over time.

Kind of like his right knee.

When he was a boy, it was fine. But hip surgery at age 10 created a structural imbalance, and the pounding from football led to problems with the knee. At UCLA, he had knee surgery for the first time. With the Dolphins, he went under the knife again, with limited results. After five years in the NFL, all of the cartilage and half of the meniscus were missing, causing painful deformations in the joint. "It was pretty much bone on bone," he said.

That's when Abdul-Karim al-Jabbar, as the player ultimately became known, turned to human growth hormone. A Miami surgeon injected HGH directly into the compromised joint. Every other week for two months, al-Jabbar returned to the doctor's office, where more of the bio-synthetic fluid was pumped into the knee in an effort to re-grow the cartilage necessary for him to return to the field.

He says he had no ethical qualms with using the controversial substance.

"The bottom line is we get beat the hell up," said al-Jabbar, who shared his story with ESPN.com. "We need whatever's available to keep ourselves out there."

Growth hormone is regarded as a performance enhancer by the World Anti-Doping Agency, the NFL and other leagues, and thus a banned drug. It is usually discussed in tandem with anabolic steroids, for the drugs have been used together by elite athletes who seek a competitive edge. After steroids and HGH user Ben Johnson was stripped of his sprint gold medal at the '88 Olympics, the two substances were criminalized by federal lawmakers. In the public mind, GH and 'roids are the Beavis and Butt-Head of sports dope, as inseparable as they are subversive.

But many athletes such as al-Jabbar think of the drugs in distinct ways. One set (steroids) is known to build powerful muscle, while the other (growth hormone) is "more to recover from injury," he said. "I haven't heard of growth hormone giving you strength."

His impression has some support in the scientific community. Most of the research on HGH has been done on the elderly, not elite athletes, but studies have shown that while the drug might grow the size of a muscle, it is not associated with a spike in strength. In a 2004 review of the literature that was published in the American Journal of Sports Medicine and written as a guide for team doctors, the authors concluded that "there is no evidence that growth hormone supplementation will lead to an increase in performance."

Produced naturally by the anterior pituitary gland, at the base of the brain, growth hormone plays a major role in body growth by stimulating the liver and other tissues to produce insulin-like growth factor, or IGF-1. One of the chief actions of IGF-1 is that it stokes the creation of cartilage and bone, a benefit that has not gone unnoticed by athletes and orthopedists. Injected, synthetic HGH has the same effect.

"I've seen a whole spectrum from professional athletes in all sports, down to college and even high school players that have been on growth hormone," said Dr. Rick Delamarter, a Los Angeles spine surgeon and UCLA professor who has treated scores of big-name athletes. "I have seen the benefits of growth hormone post-operatively in recovering from surgery."

Delamarter said he does not prescribe growth hormone to his patients, as surgical rehabilitation is not one of three approved uses (short stature in children, AIDS wasting and adult Growth Hormone Deficiency) by the federal Department of Health and Human Services. Athletes get it through other means, often anti-aging doctors who focus on the third, controversial diagnosis as a rationale for prescribing the drug. But he does not discourage its use as he has not seen, in his anecdotal experience, a detrimental response to growth hormone. And recovery periods are sometimes cut in half.

"If the science proves that it's efficacious and safe in the post-operative recovery period," he said, "then I think it becomes a standard of care for sports medicine and surgeons."

Yet, Delamarter doesn't doubt that some athletes would abuse the drug in an attempt to gain a performance edge. If there's any crowd that subscribes to the notion that one shot is good so five must be great, it is elite athletes with million-dollar careers at stake.

The proven risks of those who do abuse it are considerable: diabetes, worsening of cardiovascular diseases, muscle and joint pain, hypertension, carpal tunnel syndrome, abnormal growth of organs and accelerated osteoarthritis. There is no evidence that growth hormone will cause cancer, though it could lead to the spread of a tumor, said Dr. Shlomo Melmed, a Los Angeles-based endocrinologist and expert on the topic.

None of the studies so far has shown that the benefits provided by growth hormone supplementation are long lived, he said. "My advice to any patient who wants to use it for sports injuries is, don't take it," Melmed said. "There is no proof it is going to help and, with unnecessary growth hormone, you can do yourself a lot of harm."

But that warning is a tough sell to athletes, even those who don't make a living from their sport.

Joe Root, 50, a pro-am motocross rider from the Los Angeles area, shattered his hip and broke his femur in a race six years ago. His orthopedic surgeon told him to expect 9-12 months of rehabilitation. He returned to racing in just eight weeks, using a regimen of growth hormone initiated and monitored separately by Mark Gordon, an area doctor and prominent member of the American Academy of Anti-Aging Medicine (A4M).

Root continues to use moderate doses of the drug, injecting himself in the stomach area once a day, six times a week. He contends the shots have given him the fitness level of an athlete half his age, allowing him to bounce back from tough spills. He is the Julio Franco of SoCal motocross, competitive well beyond the age of expected retirement.

"I haven't seen any negative effects -- other than sometimes it is hard for people to believe I'm doing this well," said Root, who wins many of the six races a day that he enters at weekend motos. "It freaks people out."

Al-Jabbar received growth hormone in a manner more specific to his injury, with injections directly into his knee joint. Dr. Allen R. Dunn, his Miami surgeon, scraped away the scar tissue in the running back's knee, then filled the joint with HGH. Now a personal trainer in Maryland, al-Jabbar regained some function in his crippled knee. Not enough to return to the NFL, as he had hoped, but enough to be able to jump and run like a recreational athlete.

Dunn said he has used the drug in this manner on more than 800 patients, including a handful of pro athletes, with a 70 percent success rate. He said state law in Florida allows him to get around federal restrictions and use growth hormone in his experimental procedure. He said he has seen no negative side effects when the drug is used in this manner, which he markets as an alternative to knee and hip replacement.

"I definitely think he's on to something," said al-Jabbar, who played five seasons with the Dolphins, Cleveland Browns and Indianapolis Colts. "It's obvious what growth hormone does. It's just a matter of time before that (procedure) is perfected."

That notion, of HGH as an agent of rehabilitation, ensures athletes will continue to seek it out for many years to come. It's mostly insider knowledge right now. But in the next decade or two, aging non-athlete baby boomers, who have a habit of re-writing the rules of society as they move through the life cycle, are expected to popularize use of the drug.

So, the question becomes: If the case for HGH as a recovery tool grows, is there some way for leagues to prevent abuse that could threaten both the athlete's health and the integrity of games? Just because studies have yet to prove a performance advantage does not rule out discovery of such an edge. Or that one doesn't already exist, informally. Indeed, the line between sports medicine and performance enhancement is already far muddier than we like to acknowledge. If a pitcher extends his career an extra five years via the use of growth hormone, but gains no extra zip on his fastball, does that constitute a performance advantage? Any more than Tommy John surgery that tightens up the band in his elbow?

And, is that even a scenario a profit-seeking team would object to?

The commissioners and players' unions have shown little enthusiasm in tackling the issue. The NFL recently promised to contribute $500,000 to the development of a urine-based test that would detect HGH abuse. Major League Baseball previously made a similar pledge. But experts say such a test, if even possible, would require far more funds than that to create. HGH is found in urine in extremely small quantities, less than 1 percent of that which appears in blood, according to WADA. The better bet is to piggyback on the $6 billion and 10 years of research that already have gone into developing a blood test, a preliminary version of which was used during the 2004 Olympics. No athletes in Athens were flagged, although the test's detection window was small and there were no out-of-competition checks beforehand. A more scalable, advanced screen is in the final stages of development.

The leagues have no interest in asking their athletes to bleed -- at least for a drug test. An NFL executive called the blood test "ineffective and unreliable," a contention disputed by Dr. Gary Wadler, a WADA consultant. Wadler said that what the NFL is "really saying is, in essence, you can use [HGH] with impunity."

Gordon, Root's doctor, offers a compromise: Let athletes use the drug when they need it, but with controls. He suggests the leagues take the IGF-1 levels of every rookie to establish a personal baseline, just as they do with cognitive tests that are used later to evaluate when players can return to play after a concussion. When a player suffers a serious injury, he would apply for a medical exemption that might permit the use of HGH for a limited time and under league supervision. Levels of IGF-1, which can be measured in urine or blood, would be checked during and after the rehabilitation period to ensure the drug is not being abused.

"Cheating is not condonable," said Gordon, who also treats several current and retired NFL players. "But a person who has a valid injury, and who is hormonally deficient, should be allowed through an exemption and appropriate monitoring to cycle onto the hormones until recuperation."

Al-Jabbar seconds that approach, with controls to avoid the reckless dispensing of drugs by doctors such as James Shortt, the physician at the center of the Carolina Panthers' scandal (see related story). "Maybe only an approved group of doctors can give it out," he said.

There are mechanisms in place for the use of banned drugs. WADA, which handles the drug program for Olympic athletes, and the NFL have granted medical exemptions to use testosterone that addresses illness-based deficiencies. There are no known instances of athletes gaining permission to use HGH. Of course, pragmatically, there's no need to ask for consent if there's no test to identify who is using -- or abusing -- the substance.

For now, growth hormone will have to settle for being the worst-kept secret in sports.

"I think anything that's helpful should be legal," al-Jabbar said. "Because when you're done, they fold you up and say goodbye."

Tom Farrey is a Senior Writer with ESPN the Magazine, and a contributor to ESPN.com and ESPN's Outside the Lines. He can be reached at tom.farrey@espn3.com.