The use of growth hormone (GH) replacement for GH-deficient adults is now in its 10th year of FDA-approved use in the United States; it has been used for a longer period of time in some European countries. Despite widespread experience, there is still lack of consensus regarding the best approach to GH initiation and titration in adults with growth hormone deficiency. Several factors must be considered prior to dose selection, including patient age, gender, symptoms, and the use and route of estrogen replacement therapy. We retrospectively examined GH dosing practices within our institution over a 5-year period to define GH dose requirements during the initial titration and maintenance phases, the frequency of dose adjustments, and the reasons behind the dose adjustments in young and older adults. Based on this review, we offer practical recommendations for endocrinologists in the management of adults with hypopituitarism and long-term GH treatment.