The neuroendocrine hormone ghrelin, a recently discovered acylated peptide with numerous activities in various organ systems, exerts most of its known effects on the body through a highly conserved G-protein-coupled receptor, the growth hormone secretagogue receptor (GHSR) type 1a. The GHSR's wide expression in different tissues reflects activity of its ligands in the hypothalamic-pituitary, cardiovascular, immune, gastrointestinal, and reproductive systems. Its extensive cellular distribution along with its important actions on the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis and other neuroendocrine and metabolic systems suggest a pivotal role in governing the mechanisms of aging. A more comprehensive characterization of the receptor, and a more thorough identification of its various agonists and antagonists, will undoubtedly introduce important clinical applications in age-related states like anorexia, cardiovascular pathology, cancer, impaired energy balance, and immune dysfunction. Although present knowledge points to a single functional receptor and a single endogenous ligand, recent investigations suggest the existence of additional GHSR subtypes, as well as other endogenous agonists. It has been more than a decade since the landmark cloning of this ubiquitous, highly conserved receptor, and the considerable extent of its effects on normal physiology and disease states have filled the literature with incredible insights on how organisms regulate various functions through subtle signaling processes. But science has barely scratched the surface, and we can be assured that the mysteries surrounding the precise nature of ghrelin and its receptor(s) are only beginning to unravel.