SUMMARYGrowth hormone deficiency in adult life is associated with a number of adverse biological changes which include osteopenia, reduced exercise capacity, altered body composition, deleterious alterations in the lipid profile and insulin status, and reduced quality of life. Most of these changes can be reversed by growth hormone replacement therapy, but in an era of health rationing, such therapy is unlikely to be offered to every growth hormone deficient adult. Therefore we have proposed a strategy aimed at delineating which adults with growth hormone deficiency might benefit most from growth hormone therapy.