While growth hormone (GH) replacement therapy has proven useful for children and adults with scientifically confirmed growth hormone deficiency, approximately 30% of human growth hormone (HGH) prescriptions in the United States are utilized for adult replacement in the anti-aging clinical setting.  In November 2009, the American Association of Clinical Endocrinologists (AACE) released new medical guidelines for the accurate diagnosis and effective ethical treatment of growth hormone deficiency.  These new guidelines dramatically update the AACE position held since 2004, and now not only acknowledge that low GH increases the risk cardiovascular events, but also recognize the impact of Traumatic Brain Injury (TBI) as a contributor to growth hormone insufficiency -- two key principles advanced by the American Academy of Anti-Aging Medicine (A4M; www.worldhealth.net) and its 24,000 member physicians and scientists.  Indeed, the A4M has held its position as to the safety and efficacy of adult GH replacement therapy since convening its first conference presentations on the subject in 1993 that document an extensive history of adult GH replacement therapy spanning 20+ years of rigorous scientific trials and practical clinical application. After ten years of controversy and stifling debate curtailing the uses of GH in the anti-aging clinical setting, the 2009 guidelines update by AACE offers a significant validation of the safety and efficacy of adult GH replacement therapy.