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But federal law seems clear about testosterone and steroids. The Anabolic Steroids Control Act of 1990 classifies them as Schedule III drugs that are legal only if a patient has a diagnosed medical condition. Human growth hormone, meanwhile, is one of a handful of drugs the FDA has allowed for a small set of diseases mostly related to growth deficiencies. In all, fewer than 45,000 people nationwide have such conditions, according to a 2012 Associated Press investigation.
Florida has its own specific prohibitions on all three drugs. State Statute 458.331 outlaws "prescribing, ordering, dispensing, administering, supplying, selling, or giving growth hormones, testosterone or its analogs, human chorionic gonadotropin (HCG), or other hormones for the purpose of muscle building or to enhance athletic performance."
Yet unlike the offices of dentists, chiropractors, nutritionists, or even massage parlors, anti-aging clinics aren't required to register with a state medical board or to list a licensed medical director. That means anyone can open and own one, and if the owner — like Yusem or Bosch — isn't a doctor, he or she doesn't even have to list the physician who's providing controlled substances.
Most trace the beginning of the industry's growth to 1992, when the American Academy of Anti-Aging Medicine (A4M) was founded by Dr. Ronald Klatz, a Belize-educated osteopath who claims he coined the term "anti-aging," and Dr. Robert Goldman, a former anti-steroid advocate who became a vocal force for chemical enhancement.
According to his website, Goldman is a "black belt in karate, Chinese weapons expert and world champion athlete with over 20 world strength records." The site includes an animated GIF of him doing one-handed pushups. A4M stages annual conventions in Orlando and elsewhere that draw tens of thousands. Under their stewardship, clinics like Tony Bosch's Biogenesis have exploded. There are more than 26,000 worldwide, and the lobby's headquarters are located in a plush Boca Raton office.
The industry has found a legal gray area in which to thrive. Many anti-aging doctors simply check patients' testosterone or growth-hormone levels, pronounce them "deficient," and then prescribe the drugs as a remedy. They point out that HGH is approved for "Adult Hormone Growth Deficiency" and say that's what they're treating.
"Poor presentations of the science... [have] erroneously suggested that the replacement of HGH in aging adults is illegal, and has led to sensationalized headlines," A4M says in a statement. "Patients are not given HGH for a diagnosis or treatment of 'anti-aging' ... The A4M does not endorse or condone the use of any illicit substances for sports cheating. However, the A4M does support the continued availability of such substances to adult patients with objectively assessed hormone deficiencies."
But many mainstream doctors say lower hormone levels are just a natural part of aging and question the benefit of HGH and synthetic testosterone. A 2010 New England Journal of Medicine study estimates that only 2 percent of men aged 40 to 80 actually suffer from real hormone deficiencies.
Other studies have suggested HGH can increase cancer risk and cause other adverse health effects (a claim A4M disputes). "The marketing and sale of growth hormone for... anti-aging or age management is a pure scam," says Dr. Thomas Perls, an age researcher at Boston University. "The anti-aging industry markets and sells this drug because it has a great name and they can make huge profits with it [by] charging clients about $12,000 a year."
Indeed, the clinics aren't the only ones making beaucoup profit. Drug makers pulled in $1.4 billion selling HGH in 2011, according to the Associated Press. The top profiteer, AP found, was Roche subsidiary Genentech, which banked almost $400 million in HGH sales in the United States in 2011, a two-thirds increase from 2005; Pfizer and Eli Lilly sold $300 million and $220 million, and Pfizer's HGH medicine, Genotropin, actually outsold its famous antidepressant Zoloft.
In all, the industry's HGH sales were up 69 percent between 2005 and 2011, while the average drug saw only a 12 percent increase, the AP found. A separate study by research firm IMS Health determined that sales of hormone and androgen drugs nearly doubled between 2007 and 2011, from 2.9 million to 5.3 million, according to figures shared earlier this year with the New York Times.
South Florida clinics are packed into strip malls, tucked into tanning salons, and operating out of gyms. Side businesses have even popped up to connect unlicensed clinics looking for drugs with licensed physicians. Consider AA Life, a Northlake, Illinois-based company with a satellite office in Fort Lauderdale. The firm faxes ads to doctors' offices: "We are in need of a physician with a valid M.D. or D.O. license," they write. "Doctor can work at own location."
After receiving this note, Boca anti-steroid activist Dr. Woliner sent an email to AA Life asking for more details. A woman named Olga replied that AA Life would provide patients' bloodwork and exams plus a recommendation for how much testosterone and HGH was needed. All Woliner had to do was sign for the drugs. His compensation: "$100 for each prescription." If he got up to ten per week, he'd get $1,000 extra. "We have a database with the patients who need Hormone Replacement Therapy!" Olga wrote.
Critics like Woliner say such offers amount to "renting" doctor's licenses, an illegal but common practice in Florida. "That's aiding an unlicensed practice of medicine," he says. "But this is widespread. This happens with a lot of these cash clinics."