ARE ANTI-AGING HORMONES SAFE???

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Want to trade in your body for a younger model? Hormone supplements hold promise, but carry risks. Top experts debate what you should do.

IF YOU WANT TO STAY YOUNG, anti-aging hormone supplements sound great: They're touted to firm up flabby muscles, reduce your wrinkles, and ignite your sex drive. As you enter middle age, your own supply of hormones dwindles. So, anti-aging doctors reason, taking doses of hormones could turn back the clock. If you visit an anti-aging doctor, your treatment may include a cocktail of prescription-only hormones including human growth hormone (HGH), a substance you inject daily, and estrogen and testosterone, often prescribed as gels. You can also treat yourself with over-the-counter hormones like DHEA and pregnenolone. Physicians who prescribe these hormones say their patients love the results and look and feel years younger than they really are.

But some experts say these hormones pose serious risks. Because of a lack of long-term studies, no one knows what happens when you use them for years. One study suggests that HGH could increase your risk of cancer, and another shows that HGH triggers diabetes and joint pain (although hormone proponents dispute these findings). DHEA and pregnenolone may cause heart rhythm irregularities and irreversible hair loss. On top of that, these treatments can cost up to $1,000 a month.

Still, some say the benefits are worth the costs. Should you try these hormones? We asked five experts — representing a range of opinions — to debate the issues. Here's what they said.

IS THIS THE SECRET OF ETERNAL YOUTH? Natural Health: Are anti-aging hormones a fountain of youth, a health risk, or something in between?
Ron Rothenberg: Fountain of youth sounds too glib. But these hormones can help people improve their quality of life. Although there's not the perfect amount of data on these hormones, there's enough data to show that low levels [in people] are associated with health problems, and that more youthful levels are associated with better health.

Ray Sahelian: I believe these hormones have a good potential of risk. Over the last four decades doctors have been prescribing estrogen and progesterone. Data had come out for years that these hormones improved heart health and osteoporosis. And then we recently found out after four decades or so of using these hormones that they increase the risk of heart disease and cancers.

DHEA and pregnenolone … can cause side effects that I have noticed in my practice. People have gone to the emergency room with [irregular heart rhythms]. They can also cause acne, irritability, anxiousness, and hair loss in both men and women that's sometimes irreversible. … It boils down to this: They may be perfect for the short-term, but we know nothing of the long-term side effects.

Thomas Perls: They're a health risk. Or another answer would be, we just don't know. It would be very helpful to have large, randomized, placebo-controlled trials for these medications, but such trials are incredibly expensive and the research community may want to put its money into more disease-specific therapies, … treatments for heart disease, stroke, and cancer.

There's significant evidence that human growth hormone could actually shorten a life span, as well as increase the risk of cancer. So I would never go for prescribing human growth hormone in the long run. With regard to the over-the-counter therapies, DHEA and pregnenolone, that industry is so poorly regulated, and there is no way for people to report side effects. I think it is tremendously prone to abuse and hucksterism.

ARE HORMONES RIGHT FOR YOU?
Describe the person who you believe benefits most from anti-aging hormones.

Perls: There are some potential benefits in using human growth hormone in very frail individuals for a short period of time, but beyond that, I see no use for it, except in kids who are growth-hormone deficient.

Ronald Klatz: The person who benefits most is deficient in these various hormones. No one in the American Academy of Anti-Aging Medicine is recommending that these things should be taken blindly or willy-nilly without physician supervision and laboratory monitoring. When these hormones are taken under a physician's guidance and at pharmacologie replacement dosages [a dose that is naturally present in a healthy person], not super-physiologic doses [a dose that far exceeds the amount in a healthy person] … they are incredibly safe.

Sahelian: As far as DHEA is concerned, those who are middle-aged and older and who have very low DHEA levels could benefit, and they could well get an enhanced sense of well-being, feel more alert, and have increased stamina and libido. This is for both men and women. But we don't know the long-term dosage requirements or what the ideal form is.

Who should definitely not take anti-aging hormones?
Sahelian: That's hard to say, but certainly people who have cancer or severe heart disease.

Rothenberg: The cancer situation is very controversial. … The package insert on human growth hormone says “should not be used in active malignancy.” But there's really no data to support that statement, so [some growth hormone experts] think it should be removed. … Every hormone is different; we can't talk about them all in one sentence. In general, I'd be very cautious. I'd educate the patient about the benefits and risks and have the patient make an informed decision.

Klatz: I have a real hard time with these bogeymen that are brought up about side effects and cancer, because we just don't see that. There are now over 11,500 members of the American Academy of Anti-Aging Medicine. Many thousands of our members are prescribing hormone replacement therapy for their patients. Hundreds of thousands of patients and our doctors get together frequently throughout the year, and if there was a horrendous side-effect profile, it certainly would make itself known.

Rothenberg: We're not just talking about human growth hormone. In anti-aging medicine, we're looking at the whole patient and [changing her lifestyle first]: nutrition, exercise, and stress reduction. Then we're carefully measuring and monitoring hormones and replacing them as needed with bioidentical hormones — the same molecules that exist in humans — to achieve youthful levels.

Klatz: When you apply these therapies properly, it's common to have people [appear to be younger on] an objective, quantifiable basis. You can measure [parameters like their blood pressure and cholesterol], their strength, their energy levels, their memory. You can measure these biomarkers of aging and see a regression of two years, five years, 10 years, and in some remarkable individuals, a regression of 20 years. Rothenberg: What amazes me so much — and I have a very sophisticated group of patients — is that they say, “My life is much better than before I started [anti-aging] therapy.”

Sahelian: Just because we're noticing improvements in the short-term does not mean a person will live longer than they were going to live. I think the gentlemen are being overly optimistic and not cautious enough, which could be potentially harmful for a lot of patients.

Klatz: Even if our patients don't live a day longer, if their quality of life improves significantly, that's enough for me as a physician. But it's virtually impossible to find any study where you improve the quality of life without increasing quantity of life.

DOES SCIENCE BACK THIS UP?
Few anti-aging hormones have been thoroughly studied, but we do have new research about HGH: A recent study published in the Journal of the American Medical Association gave elderly people HGH for six months. Dr. Harman, as a co-author of this study, could you tell us what it reveals about HGH?

S. Mitchell Harman: I think it tells us two things. One is that in relatively high doses and given with testosterone, HGH can improve muscle strength and cardiac endurance. I think it's a very hopeful finding. … The downside was that we saw a lot of adverse effects [including diabetes and joint pain]. As has been pointed out by Dr. Klatz and others, we gave higher doses than are used in most anti-aging clinics, and we gave doses three times a week instead of every day, mainly for the convenience of our subjects. It is certainly possible that giving lower doses more frequently would reduce the adverse effects. … But as we reduce the doses, I think we're less likely to see the beneficial effects. So I think what our study says is: We need to do more studies, and better studies, and longer-term studies, and look at more dose regimens to find out what really works.

Rothenberg: I just wanted to comment on the dosage regimens Dr. Harman was talking about. The difference is that in a day-to-day clinical setting [we can adjust doses to] settle on a dose where the patient is completely comfortable with no side effects.

DO OTHER ANTI-AGING PRODUCTS WORK? HGH injections are so expensive that readers may want to try cheaper options, including amino acids like arginine, that are said to stimulate your body's HGH production. Do they work?
Harman: There are some compounds out there that we do know can increase human growth hormone. Most of them have to be injected. … There is nothing available over-the-counter that I know of that you can reliably count on to raise human growth hormone.

Klatz: I agree that… taking amino acids in small amounts is really not going to give you a beneficial effect with regard to human growth hormone. It's difficult to raise growth hormone levels, short of injection, unless you're taking very large amounts of amino acids.

What about homeopathic HGH?
Klatz: [Companies that make] homeopathic HGH [have] yet to show any independent science to support their claims. … I believe many of the homeopathic products, especially the spray products, are completely without science … and are just playing on the concerns of the public. Most physicians in anti-aging medicine do not endorse these products or use them in their clinical practice.

Sahelian: Homeopathic growth hormone, in a nutshell, is a huge scam. And those who sell it or promote it make the natural health industry look unreliable.

COULD YOU LIVE TO BE 120? Dr. Klatz, you've said that aging as we know it can be avoided. Are you saying we could all live to be 120?
Klatz: No, I'm not saying that at all. What I'm saying is that aging as we know it is really a constellation of degenerative processes that lead to chronic disease and finally to death…. You can… prevent and treat the conditions of aging, such as osteoporosis, Alzheimer's disease, macular degeneration, and cognitive decline [using diagnostic techniques, drugs, and other therapies]. And by treating them, you change what you can expect to look like at age 50 … or 90. By improving the quality of life and avoiding things that are going to kill you, such as heart disease and cancer, you live longer.

Perls: I actually also agree that we should do everything we can to allow people to maximize their time of good health. And whatever therapies can do that should be applauded. But they need to be proven and safe. We already have ways to maximize health that are not potentially dangerous: strength training, not smoking, and [following a sensible] diet. To me, those are the way to go. They require a lot of work. But if we can show that a healthy old age is worth fighting for, I'm hoping that people will do the work.

I think it's important to not lead people down a path of [believing that you can] get injected with this stuff and get to very old age in good health, because then people ignore some of these other things that they really should be doing…. I think that media campaigns, including the kind of books that Dr. Klatz puts out, deliver only one part of that message, and that is to take HGH. People don't hear about these other things. … I also think that the anti-aging industry uses marketing tools to try and equate its credibility with those of us in academia, whether it be calling things the American Academy of This, or the National Academy of That.

Klatz: I find it reprehensible that Dr. Peris and his ilk in the gerontological establishment try to diminish the message of anti-aging medicine by their false attacks upon our credibility and our credentials, which are excellent. We have a society of 11,500 physicians and scientists, many of whom are members of universities, who hold academic positions, including myself, who are well published, who have all the credentials and accolades that Dr. Perls and his ilk have. However, our members have a different position, that aging is a treatable condition, which is in conflict with the gerontological establishment that says, “Just grow old and die.”

Perls: Dr. Klatz has misrepresented the gerontological community. We are advocates of older people. We strive to improve their quality of life and minimize the diseases associated with aging. My problem is that the anti-aging community often takes inaccurate views of aging, thus biasing society against older people.

WHAT'S THE BEST WAY TO STAY YOUNG? What is your best advice for helping readers live long lives?
Klatz: You really should become educated…. The best way to get educated is to read. There are hundreds of excellent books about the prevention of disease states. … In every one of my books — none of which Dr. Peris has bothered to read — you will see a comprehensive approach to health care. There is no one magic bullet. No two people are identical. … And because of that, it is important that people seek a customized, optimized health care regimen that will … allow them to live their maximum possible life span…. So education is rule number one.

Sahelian: [Dr. Peris] already mentioned exercise and a good diet. There's also having a positive attitude… [and] getting deep sleep at night. If we do this, we're way ahead of a typical patient I saw two weeks ago, who had read a book on human growth hormone and came in and wanted to have these injections. And he had done hardly any of the things I just talked about. And I emphasized to him that first these things need to be done, and they're probably a lot more effective than getting hormone injections.

“There's evidence that human growth hormone could shorten a life span,” says Thomas Perls, M.D., M.P.H.

Our Panelists and Their Take on Anti-Aging Hormones
S. Mitchell Harman M.D., Ph.D.
Director and president of Kronos Longevity Research Institute in Phoenix. Co-author of a 2002 study that administered human growth hormone (HGH) to older adults and found both positive and negative effects.

His View:
Says doctors shouldn't prescribe HGH to healthy adults until conclusive evidence shows it's safe and effective.

Ronald Klatz D.O.
Founder and president of the American Academy of Anti-Aging Medicine in Chicago, which trains physicians in anti-aging medicine. Author of Grow Young with HGH (Harper Perennial, 1998).

His View:
Supports the “judicious” use of anti-aging hormones if they're administered by qualified physicians.

Thomas Perls M.O., M.P.H.
Associate professor of medicine at Boston University Medical School in Boston and director of the New England Centenarian Study.

His View:
Says proponents of anti-aging hormones wrongly treat normal aging like a disease; believes we can't trust anti-aging doctors to accurately report the side effects of hormones “because this is their bread and butter.”

Ron Rothenberg M.D.
Clinical professor of medicine at the University of California at San Diego. Founder of California HealthSpan Institute in Encinitas, Calif., where he treats several hundred patients with hormones.

His View:
Supports hormone use by qualified physicians. “We could wait around for the ultimate double-blind study, but we've got to take our best shot now to help our patients enjoy the life they have.”

Ray Sahelian M.D.
Family practice physician in Marina Del Ray, Calif., and author of Mind Boosters (St. Martin's Press, 2000) and other books on supplements.

His View:
Recommends the hormones DHEA and pregnenolone for some patients but in much lower doses than he once did, due to risks; says over-the-counter hormones should be used only under a doctor's supervision.

You Can Live Longer
Our panelists have fundamentally different opinions about the safety of anti-aging hormones like HGH and DHEA, but they agree that certain habits are essential to keeping you youthful.

SHAKE A LEG.
Exercise gets a wholehearted thumbs-up from our panelists, who praise the anti-aging virtues of strength training in particular. Work out with weights at least three times a week, and perform vigorous cardiovascular exercise like brisk walking at least three times a week.

WORK TO STAY SLIM.
Choose a diet that helps you maintain a healthy weight, our panelists say. Being overweight increases your risk of many diseases of aging, including heart disease, diabetes, and arthritis.

LOAD UP ON FRUITS AND VEGETABLES.
Our panelists recommend eating at least five servings a day. Produce supplies fiber and antioxidants that prevent disease.

CAN UNHEALTHY CARBOHYDRATES.
These experts advise you to limit your consumption of refined grains like white rice, white bread, and white pasta, which are devoid of disease-fighting nutrients and encourage weight gain. Some panelists say brown rice and whole-wheat bread and pasta are suitable alternatives, but others prefer that you rely more on fruits and vegetables and less on grain products for your carbs.

GO FOR GOOD FATS.
Minimize your intake of saturated fats and eliminate partially hydrogenated oils from your diet. In their place, our panelists recommend heart-healthy monounsaturated fats (found in olive oil) and omega-3 fats (from fish oil).

TAKE E EVERY DAY
Our panelists have different opinions about vitamin and mineral supplements, but most agree that vitamin E is a smart bet to ward off disease. Three panelists recommend that you choose a supplement that contains natural mixed tocopherols.

TOAST TO YOUR HEALTH.
Some panelists say that having one alcoholic drink daily (like a 4-ounce glass of wine or a 2-ounce glass of spirits) may extend your life by protecting your heart.

ACCENTUATE THE POSITIVE.
Our panelists stressed the importance of maintaining meaningful relationships with family and friends, keeping a positive attitude, and adopting habits that help you cope with stress, like deep breathing, yoga, and exercise.

PHOTO (COLOR): CAUTION Proponents claim these hormones could shave up to 20 years off your age. But critics counter they may shave years off your life.
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MODERATED BY Erin O'Donnell

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