The effects of growth hormone (GH) treatment on protein metabolism were studied in adults with GH deficiency (GHD). A double-blind, placebo-controlled trial of recombinant human GH, 0.018 IU/kg/day for 1 month followed by 0.036 IU/kg/day for 1 month, was performed with isotopic whole-body protein turnover studies at 0 and 2 months. In all, 18 adults with GHD (9 men, 9 women; mean age, 46.6 years; range, 30-56 years) were studied. Whole-body isotopic leucine turnover using L-[1-13C]leucine was assessed by measuring leucine Ra (a measure of protein degradation), non-oxidative leucine Rd (a measure of protein synthesis) and leucine oxidation rate. Lean body mass and circulating insulin-like growth factor I were significantly (p < 0.02) increased at 2 months in the GH-treated group, but not in the placebo group. There was no change in leucine Ra in either the placebo or GH-treated groups at 2 months. Leucine oxidation decreased (p < 0.01) and non-oxidative leucine Rd increased (p < 0.02) in the GH-treated group at 2 months. There was no significant change in either leucine oxidation or non-oxidative leucine Rd in the placebo group at 2 months. These results indicate that the increase in lean body mass resulting from GH treatment in adults with GHD is due to an increase in protein synthesis.