Growth Hormone Replacement in Veterans With GWI and AGHD (GWIT)

Inclusion Criteria:

1. veteran of the Gulf War conflict with a history of deployment to Operation DesertStorm or Desert Shield between 1990-91

2. age less than or equal to 64 years old

3. have a diagnosis of Gulf War Illness assessed by study investigators

4. have adult growth hormone deficiency diagnosed by glucagon stimulation test (cutpoint 3.0 mcg/L if BMI is less than or equal to 25 or 1.0 mcg/L if BMI is greaterthan 25)

5. 4-week stability on any psychotropic medications

6. 3-month stability on all hormone treatments

7. able and willing to provide informed consent to participant in the study andcomplete study protocol

Exclusion Criteria:

1. history of a psychiatric disorder with substantial impact on functional status orquality of life (e.g., schizophrenia, schizoaffective disorder, bipolar, or otherpsychotic disorder)

2. history of neurologic disorder other than traumatic brain injury with substantialimpact on the quality of life

3. other known cause for growth hormone deficiency (GHD) including history of childhoodonset GHD, hypothalamic/pituitary disease, history of brain radiation, or geneticmutations known to lead to GHD

4. active suicidal ideation as determined by a score of 2 points or higher on theColumbia Suicide Severity Rating Scale

5. suicidal behavior in the past 6 months

6. contraindication to recombinant human growth hormone (rhGH) such as hypersensitivityto rhGH or any of the components of the supplied product

7. acute medical illness, active infection, cancer, or decompensated chronic medicalillness (e.g., decompensated diabetes mellitus, congestive heart failure, chronicobstructive pulmonary disease)

8. evidence of substance use disorder in the past 6 months other than mild alcohol orcannabis use disorder diagnosed by clinician at time of screening.

9. urine toxicology evidence of illicit drug use (excluding cannabis) within the past 90 days prior to screening

10. BMI > 35 or body weight > 350 lbs

11. abnormal pituitary anatomy documented by an MRI using a Sella protocol

12. women who are pregnant or of child-bearing potential who are unable/unwilling to useone of the following barrier contraceptives: condoms, diaphragm, cervical cap, orintrauterine device

13. current use of the following: growth hormone, estrogen or estrogen-like dietarysupplements, hormonal contraceptives, progestin, insulin growth factor 1 (IGF-1), orchronic glucocorticoid use in supraphysiologic doses

15. currently enrolled in any other interventional drug trials unless prior approval isprovided by the study chairs and the study sponsor