There has been a lot of talk recently about anti-aging. We must first see what exactly aging is and how we can control it. I guess as a molecular biologist and physician I have to say that aging is really an accumulation of damage to molecules, cells, tissues, and eventually organs. The maximum known lifespan for humans is 122 years, while the maximum lifespan for a mouse is about 3 years. There are many reasons why this happens, genetic differences between humans and mice, fertility rate, DNA repair efficiency, and the old “buzzword” different rates of free radical production, etc. Antioxidants, including vitamins A, B-6, B-12, C, and E, are believed to counteract free radicals and go some way to preventing chronic diseases like heart disease and diabetes. There are many studies pointing to the benefits of beta-carotene, folic acid, and selenium. These antioxidants are found in a variety of fruits and vegetables. I guess as a scientist, I’m cynical about the advantage of these supplements in pill form.
Regarding the use of hormones, I am going to stand out and look at the evidence that supports their use. When people talk about hormones, they usually mean taking DHEA, testosterone, estrogen, and probably human growth hormone. Hormones are chemicals needed to help your vital organs work properly, which naturally decline as we age. It’s easy to see why people would believe restoring their level to go back to previous levels. Unfortunately, life is never that simple. We all know that HRT can restore skin, vaginal secretions, energy, etc. of a woman. but it also has its risks in older age groups. Look at the precursor hormone DHEA, which is converted in the body into estrogen and testosterone. DHEA has long been promoted as an anti-aging therapy, used to prevent chronic disease and maintain energy and vigor. Proponents say it also slows aging, increases muscle and bone strength, burns fat, improves cognition, and boosts immunity. However, an October 2006 study published in the New England Journal of Medicine by Sreekumaran Nair, MD, an endocrinologist at Mayo Clinic, Rochester, found no evidence that taking DHEA reverses the effects of aging.
DHEA is the most abundant natural hormone circulating in the human body. It is secreted by the adrenal glands and peaks in the early twenties and then declines with age. The decline in DHEA levels with age correlates with many age-related changes, including peak gaming, muscle mass, bone density, physical endurance, and ability to fight disease. The study has significant beneficial effects on any of those factors in men and women in their 60s and 70s. I don’t mind excelling at some subjects, but not this one, since I really don’t know. I hope not since its use is regulated by the FDA in the United States. This hormone is widely promoted and used as an anti-aging nutritional supplement by people hoping to restore the pleasure of youth or increase longevity. I guess the science doesn’t support its use, although I’m sure there are plenty of people who would disagree with me on this one. The increasing use of testosterone is also something to consider. Male menopause, does it really exist? We have known for many years that decreased testosterone levels have been linked to decreased energy and sex drive, decreased muscle mass, decreased mental ability, and even osteoporosis. We also know that more and more men are taking testosterone, but not enough is known about the long-term effects of testosterone therapy for this purpose.
In essence, doctors are uncomfortable prescribing this hormone due to a lack of scientific evidence to balance whether declining levels are unhealthy, especially since there are suspicions of possible risks, including prostate problems. We know that about 20% of men age 60 and older have testosterone levels below the normal range (testosterone deficiency). The question is, shouldn’t these men be treated? In one sentence I would agree. If a patient feels decreased energy, reduced strength or cognitive ability, less sexual interest or potency, I would definitely check their testosterone levels, as well as thyroid levels, mood, and medication. If his testosterone turned out to be low, he would treat him. In men with low testosterone, testosterone therapy can restore sexual function and protect against heart disease (atherosclerosis). Additionally, some men who take testosterone therapy report an increase in energy, sex drive, and well-being. Indeed, it would not deprive the patient of testosterone if he were aware of the possible benefits and risks of the medication. Although potentially beneficial, high doses of testosterone can cause sleep apnea, infertility, and can also raise issues with prostate and breast cancer in men. Patients with a family history of prostate or breast cancer should probably be warned. It can be taken in tablet form, but many doctors say that testosterone taken by this method can cause an unfavorable cholesterol profile, increasing the risk of blood clots and heart and liver problems. There are several other types of testosterone therapy. Intramuscular injections of testosterone (Delatestryl, Depo-Testosterone) are safe and effective. The injections are given approximately every two weeks. Each night a patch containing testosterone (Androderm) is applied to the back, abdomen, upper arm, or thigh. The application site is rotated to maintain seven-day intervals between applications to the same site to decrease skin reactions. In Ireland, your GP may prescribe a testosterone gel (TestoGel) to put on the skin of your lower abdomen, upper arm or shoulder. I think it also comes in the form of gum.
I am asked by many patients about my attitudes towards the increasing use of growth hormone, I guess my early mild memories are prejudiced due to my time working as a young doctor at Our Lady’s Children’s Hospital in Dublin in late the 1980s when news broke that the cadaveric growth hormone they had been using was implicated in multiple cases of Creutzfeldt-Jakob disease (CJD). This precluded an interest in limb lengthening procedures in our Orthopedic Department. The drug has also been used for children with kidney disease, Turner syndrome, Prader-Willi syndrome, and muscle atrophy associated with AIDS and HIV. We knew that growth hormone caused growth in childhood and helped maintain tissue throughout our lives. We also know that the level of growth hormone in our body begins to decline during middle age. in our 40s. Studies of adults with growth hormone deficiencies show that growth hormone injections can: increase bone density, increase muscle mass, decrease body fat, improve mood and motivation, and increase exercise capacity. It’s not hard to see why people believe synthetic growth hormone could help healthy older adults who have naturally low levels of growth hormone regain some of their youth and vitality. We don’t have a lot of clinical data, but most studies show that growth hormone injections can increase muscle mass and reduce the amount of body fat in healthy older adults. It wasn’t exactly clear if they got stronger or improved their mood. Studies have pointed to a number of side effects, including: swelling in the arms and legs, arthritis-like symptoms, carpal tunnel symptoms, headaches, muscle pain, and worse unfortunately, diabetes, hardening of the arteries and high blood pressure.
Many patients also ask me if hormones will restore the vibrancy of youth. I really hate sounding like a killer, especially since I am continually asked to speak at anti-aging conferences and I realize that this part of medicine is in its infancy. I am also aware that the new science of nutrigenomics will become more important. In essence, I would love to see a hormonal response to stop the aging process, but none of these supplements have enough medical evidence to support the claims made by anti-aging enthusiasts in light of the risks involved. We all know that postmenopausal hormone replacement therapy also carries significant risks, including breast cancer and an increased risk of blood clots that lead to heart disease and heart attacks. However, unlike the other hormones, it has been extensively researched and prescribed for years and I value its benefit in treating mental alertness, hot flashes, vaginal dryness, and damaged skin. The real fifty dollar question is whether the calorie restriction theory really applies to humans. I think the theory is based on animal studies, including rats, mice, fish, flies, and worms. These studies found that the lifespan of each species could be extended by reducing the number of calories consumed. Human clinical trials tend to show that underweight people are more susceptible to disease and death. We would need to ensure that calorie-restricted diets remain rich in fruits and vegetables so that dieters still get the nutrients they need.
In closing, I truly believe that aging is a more complex process than is currently perceived. It involves many aspects of tissue function, most notably genetic makeup, and it is still unlikely that a pharmaceutical can cure many of the ills that aging can bring. That doesn’t mean we shouldn’t keep chasing the elixir of youth. I suspect that things like intense exercise over the years can increase rust free radicals and shorten life. Any A&E officer will tell you about the number of myocardial infarctions caused by badminton games, tennis games, or even golf courses. Others say that’s what people do when they retire. That’s not to say that controlled exercise is, of course, beneficial for heart disease. Your best bet for a long and healthy life is to have the right parents, eat plenty of fruits and vegetables, maintain a healthy weight, get some exercise every day, don’t smoke, wear sunscreen, and laugh a lot… I guess. all the things i don’t do!