Growth Hormone Replacement Therapy in Veterans With Mild Traumatic Brain Injury (mTBI) and Adult Growth Hormone Deficiency (AGHD)

Inclusion Criteria:

1. OEF/OIF/OND Veteran

2. Score of 18 or more on Combat Experiences sub-scale of Deployment Risk andResilience Inventory-2 (DRRI-2)

3. Age 21 - 55 years old

4. One or more mTBI sustained during military service at least 12 months prior to thescreening date, as noted via the CRAFT survey.

5. GH deficiency diagnosed by: macimorelin stimulation test (cut point 5.1 mcg/L), orglucagon stimulation test (cut point: 3 mcg/L for BMI up to 25; cut point 1 mcg/Lfor BMI 25 and above) and IGF-I lab values have to be less than or equal to +1 SDSat baseline

6. Score of 11 or more on QoL-AGHDA

7. 4-week stability on any psychotropic medications

8. 3-month stability on all other hormone treatments

9. Able and willing to provide informed consent to participate in this study, andcomplete study protocol.

Exclusion Criteria:

1. History of moderate or severe TBI

2. History of neurologic disorder other than TBI with substantial impact on quality oflife

3. History of bipolar disorder, schizophrenia, or other concurrent psychotic disorder

4. Active suicidal ideation (no plan required) as determined by a score of 2 points ormore on the Columbia Suicide Severity Rating Scale (C-SSRS) suicidal ideationrating, or overt suicidal behavior in the past 6 months.

5. Contraindication to rhGH therapy

6. Acute medical illness, active infection, cancer or decompensated chronic medicalillness

7. Evidence of substance use disorder, -other than mild alcohol or cannabis usedisorder-, or urine toxicology evidence of the use of an illicit drug (excludingcannabis), in the past 6 months. Nicotine use is allowed.

8. Score less than or equal to 41 on Trial 2 or Retention Trial of the Test of Memoryand Malingering (TOMM).

9. BMI > 40 or body weight > 350 lbs

10. Pituitary anatomy documented by an MRI using a sella protocol within the last 2years indicating abnormalities consistent with an etiology other than mild-TBI (i.e.; pituitary mass)

11. Women who are pregnant or of child-bearing potential not on contraception

12. Current use of the following: growth hormone, estrogen or estrogen-like dietarysupplements, progestin, IGF-I, or chronic glucocorticoid use in supraphysiologicdoses

13. Currently enrolled in any other interventional study unless prior approval isprovided by the study chairs and the study sponsor (Cooperative Studies Program)