How do I install the Ata Gh Titration skill?

Run npx skillmds@latest add dromlakhani/ata-gh-titration in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Ata Gh Titration safe to use?

SkillMD's automated safety review verdict for this skill is PASS. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: docs only. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Ata Gh Titration?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ata Gh Titration free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Ata Gh Titration?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Gh Titration by dromlakhani — Agent Skill

Name: Ata Gh Titration
Rating: 4.5 (4 reviews)
Author: dromlakhani

Ata Gh Titration

Titrates GH replacement dose to keep IGF-1 below the upper limit of normal and reduces dose when side effects appear. Use when monitoring GH replacement therapy; triggers include patient on GH replacement needing dose adjustment.

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Titrate GH replacement dose based on IGF-1 and side effects

STEP 1 — Gather Information

Collect current GH dose (mg/d), age-adjusted IGF-1 level and its upper limit of normal (ULN), and assess for GH-related side effects (fluid retention, arthralgia, myalgia, paresthesia, carpal tunnel syndrome, sleep apnea, etc.). Record IGF-1 as % above/below ULN and side-effect presence/severity.

STEP 2 — Rule In / Rule Out

Is the IGF-1 level above the age-adjusted ULN? If yes, proceed to dose-reduction evaluation; if no, assess for side effects to determine if dose reduction is warranted.

STEP 3 — Classify or Stratify

Classify IGF-1 elevation: mild (1–25% above ULN), moderate (26–50% above), severe (>50% above). If IGF-1 ≤ ULN, classify side-effect severity: none, mild, moderate/severe.

STEP 4 — Decide

If IGF-1 > ULN, reduce GH dose by 0.1–0.2 mg/d for mild, 0.2–0.3 mg/d for moderate, ≥0.3 mg/d for severe; if side effects present, reduce dose by 0.1–0.2 mg/d for mild, 0.2–0.4 mg/d for moderate/severe; recheck IGF-1 and side effects in 6 weeks. If IGF-1 ≤ ULN and no side effects, consider maintaining dose or increasing by 0.1 mg/d if clinically indicated and IGF-1 remains below ULN.

Clinical Guardrails / Mimics / Pitfalls

Do not titrate GH dose based solely on IGF-1 without assessing side effects; avoid exceeding dose that causes adverse effects such as significant fluid retention or hyperglycemia; do not use GH in patients with active malignancy or uncontrolled diabetes; do not ignore age-adjusted IGF-1 reference ranges; do not increase dose when IGF-1 is already at or above ULN; do not forget to assess for pituitary tumor recurrence in long-term therapy.

Concrete Clinical Example

A 45-year-old woman on GH replacement 0.3 mg/d has IGF-1 at 130% of age-adjusted ULN and mild ankle swelling. Dose reduced by 0.2 mg/d to 0.1 mg/d; after 6 weeks IGF-1 falls to 110% ULN and swelling resolves; dose held.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118

TODO: consider adding scripts/calc.py for the ata-gh-titration calculator

---name: ata-gh-titrationdescription: Titrates GH replacement dose to keep IGF-1 below the upper limit of normal and reduces dose when side effects appear. Use when monitoring GH replacement therapy; triggers include patient on GH replacement needing dose adjustment.---# Titrate GH replacement dose based on IGF-1 and side effects## STEP 1 — Gather InformationCollect current GH dose (mg/d), age-adjusted IGF-1 level and its upper limit of normal (ULN), and assess for GH-related side effects (fluid retention, arthralgia, myalgia, paresthesia, carpal tunnel syndrome, sleep apnea, etc.). Record IGF-1 as % above/below ULN and side-effect presence/severity.## STEP 2 — Rule In / Rule OutIs the IGF-1 level above the age-adjusted ULN? If yes, proceed to dose-reduction evaluation; if no, assess for side effects to determine if dose reduction is warranted.## STEP 3 — Classify or StratifyClassify IGF-1 elevation: mild (1–25% above ULN), moderate (26–50% above), severe (>50% above). If IGF-1 ≤ ULN, classify side-effect severity: none, mild, moderate/severe.## STEP 4 — DecideIf IGF-1 > ULN, reduce GH dose by 0.1–0.2 mg/d for mild, 0.2–0.3 mg/d for moderate, ≥0.3 mg/d for severe; if side effects present, reduce dose by 0.1–0.2 mg/d for mild, 0.2–0.4 mg/d for moderate/severe; recheck IGF-1 and side effects in 6 weeks. If IGF-1 ≤ ULN and no side effects, consider maintaining dose or increasing by 0.1 mg/d if clinically indicated and IGF-1 remains below ULN.## Clinical Guardrails / Mimics / PitfallsDo not titrate GH dose based solely on IGF-1 without assessing side effects; avoid exceeding dose that causes adverse effects such as significant fluid retention or hyperglycemia; do not use GH in patients with active malignancy or uncontrolled diabetes; do not ignore age-adjusted IGF-1 reference ranges; do not increase dose when IGF-1 is already at or above ULN; do not forget to assess for pituitary tumor recurrence in long-term therapy.## Concrete Clinical ExampleA 45-year-old woman on GH replacement 0.3 mg/d has IGF-1 at 130% of age-adjusted ULN and mild ankle swelling. Dose reduced by 0.2 mg/d to 0.1 mg/d; after 6 weeks IGF-1 falls to 110% ULN and swelling resolves; dose held.**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118> **TODO:** consider adding scripts/calc.py for the ata-gh-titration calculator

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