Anti-Aging Medicine

[Ted_Shepherd]

I mentioned my interest in anti-aging medicine in another thread. Since one or two or more expressed interest in the subject, I started this thread where we can exchange views on the subject.

The basics of anti-aging medicine are the same as basic good health practices for people in general. These include diet, exercise, social connections, smoking and drinking and "recreational drug" habits, and regular medical check-ups. Beyond those considerations, there are medical treatments that are particularly useful or appropriate for people as they age. One of these is hormone replacement therapy. I've had happy experience with this. I'll devote the rest of this initial post to that subject from a male point of view. (I have less information about hormone supplementation for aging women.) Please chime in.

The normal range for testosterone in men according to one much-used blood test is 280 to 800 ng/ml (nanograms per milliliter). The units don't matter so much as that large range does. It seems that a typical doctor, if he is willing to test a man's testosterone level at all and finds a reading in that normal range, will consider that no supplementation is appropriate. A better informed or more kindly doctor might say "Your reading is in the normal range, but toward the low end. With supplementation, we can raise that reading significantly while staying in the normal range, and you will FEEL better." Generally, a man's testosterone level peaks in his twenties or thirties but by age forty, an annual decline of about 1% sets in. Those of you here who are in your forties or fifties are not too young to consider this therapy.

I found a urologist in Beverly Hills who prescribes testosterone supplementation for me. I have a lot of confidence in this doctor whose qualifications include having been Chief of Surgery at UCLA and Chief of Urology there too. (Truth in posting: I'm an alumnus of UCLA, BA and MS, and that might just slightly color my opinion. Go, Bruins!) The testosterone therapy is a cream that I rub into my shoulder or shoulders each morning. Early morning application is best because that matches the body's own daily cycle of testosterone production. I choose the shoulders because mine are naturally hairless. To get the hormone into the blood stream, the cream needs to go directly on bare skin, not saturate hair. (Research indicates that shaved skin is just as permeable to the hormone.) I chose the upper body since circulation is best there, although application to arms, legs, torso, or neck is also medically acceptable. Transdermal delivery of the hormone is about 10% efficient; the cream I have used is 10% testosterone although I moved up to 15% testosterone recently. My testosterone level was toward the bottom end of the normal range. It is now in the middle of that range. I'm willing for it to go higher. I combine this therapy with regular sweaty workouts with weights in my local Gold's Gym. It pleases me that even at my age I can still make progress there. In the last two years, I have added some muscle without gaining any body weight, so I have lost some fat too.

The commercially available hormone creams for transdermal delivery of testosterone are Testim and Androgel. A Business Week article from October 29, 2009, (available online) starts with this: "Testosterone Is Sure Looking Virile; despite legal setbacks and FDA delays, youth-crazed boomers are making it a billion-dollar industry." I don't consider myself youth-crazed and I'm not a boomer. The point was the billion dollar industry. I once asked a phamacist if he filled a lot of prescriptions for Testim and Androgel. His exact words were "Oh, my, yes!" Evidently my question was naive. Lots of men use testosterone supplementation therapy but it seems they don't talk about it much so I didn't know.

The medical profession has had a great concern that testosterone supplementation will accelerate the growth of prostatic cancer. Evidence for their concern is lacking as I can explain in some detail in another post. Anyway, the doctors want to monitor my PSA (prostatic specific antigen) level twice a year while I'm on the testosterone, rather than just once a year as is part of a standard annual physical. The normal range for PSA is 0 to 3.5 or 4.0, although a sudden jump within that range can be significant too. My PSA reading has been steady at about 0.9 from before starting the testosterone through two years of using it. I don't use Testim or Androgel but proprietary formulations from my doctors that are stronger.

Side effects from testosterone therapy may include mood disorders, scalp hair loss, excessive hair growth elsewhere, and acne. I have had no such problems, but then my dose is not large. I'm getting about 100mg a week, delivered through the skin into the blood stream. That's minimal. A safety precaution is not to have skin-to-skin contact with another person, particularly a child, for a couple of hours or so after using the cream.

[zinger1457]

Maybe I missed it in your post but what made you decide to take the hormone supplements, what specific problem(s) were you hoping to correct? Did it work? I know you said you have been able to add muscle while working out but I'm guessing there were other reasons that made you want to take them.

[GregLee]

Well, is there reason to think testosterone supplementation extends life, or is it just for virility and bulging muscles? I don't know anything about it. I'd be concerned, personally, with it exacerbating my BPH (benign prostate hyperplasia), enlarged prostate, which is already rather irritating to put up with. I understand that BPH is caused by testosterone. (My last PSA score was 4.01 -- on the high side.)

[donheff]

Quote:

Originally Posted by zinger1457 Maybe I missed it in your post but what made you decide to take the hormone supplements, what specific problem(s) were you hoping to correct? Did it work? I know you said you have been able to add muscle while working out but I'm guessing there were other reasons that made you want to take them.

That was my reaction. Hormone therapy sounds like it could be risky so the benefits should be significant. What are the problems you are trying to address?

[Alan]

Quote:

The medical profession has had a great concern that testosterone supplementation will accelerate the growth of prostatic cancer. Evidence for their concern is lacking as I can explain in some detail in another post. Anyway, the doctors want to monitor my PSA (prostatic specific antigen) level twice a year while I'm on the testosterone, rather than just once a year as is part of a standard annual physical. The normal range for PSA is 0 to 3.5 or 4.0, although a sudden jump within that range can be significant too. My PSA reading has been steady at about 0.9 from before starting the testosterone through two years of using it.

That fear would make it a big "no no" for me. I would need to have a real health concern to start HRT. As was asked earlier, is there a particular health problem you are addressing?

[Ted_Shepherd]

Quote:

Originally Posted by zinger1457 Maybe I missed it in your post but what made you decide to take the hormone supplements, what specific problem(s) were you hoping to correct? Did it work? I know you said you have been able to add muscle while working out but I'm guessing there were other reasons that made you want to take them.

My intent in starting the hormone therapy was to counteract the reduction in muscle mass that commonly accompanies aging. I have achieved that purpose and, to my surprise and pleasure, managed even to add some muscle mass. That helps me look, feel, and act younger, which has some benefits socially and psychologically. The major benefit of the therapy is in fact the improvement in mood or morale. Not that I was particularly gloomy before, but that life is sweeter with the restoration of hormone levels. That's my experience. YMMV

[Ted_Shepherd]

Quote:

Originally Posted by GregLee Well, is there reason to think testosterone supplementation extends life, or is it just for virility and bulging muscles? I don't know anything about it. I'd be concerned, personally, with it exacerbating my BPH (benign prostate hyperplasia), enlarged prostate, which is already rather irritating to put up with. I understand that BPH is caused by testosterone. (My last PSA score was 4.01 -- on the high side.)

I'm glad you asked. My purpose in writing here about testosterone supplementation was to answer a question from a poster here who asked about my non-financial experiences in retirement. It is not my purpose to recruit new users.

I have not seen evidence that testosterone supplementation extends life. However, Dr. Abraham Morgentaler of the Harvard Medical School has written: "There is evidence to suggest that a normal testosterone level may be beneficial for health and long life." Men have found that it improves the quality of life in various ways that differ in individual cases. My experience has been that the supplementation improved my morale and facilitated some muscle gains with fat loss. Regular, strenuous exercise was part of that, too, as was attention to my diet. Evidently the very large doses that come athletes use may have harmed their health ultimately and shortened their lives. My therapy, at about 100 mg/week, is not comparable to their usage which is much higher.

Is there evidence that hormone therapy exacerbates BPH? I have BPH as my doctor expected just from my age. It has not worsened with the therapy. Your PSA, as you say, is a bit high. Whether that rules out testosterone supplementation, I cannot say. As I wrote, my PSA level has not changed since I started taking the hormone.

[Ted_Shepherd]

Quote:

Originally Posted by Alan That fear would make it a big "no no" for me. I would need to have a real health concern to start HRT. As was asked earlier, is there a particular health problem you are addressing?

I support your caution with word and example. I do not smoke or drink or use recreational drugs or misuse prescription drugs. The particular health condition that testosterone supplementation addresses is andropause. That is a somewhat menopause-like condition related to the slow for steady reduction in the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men. It was not too hard for me to find qualified medical doctors who prescribe the supplementation for me while monitoring my PSA and BPH. (What is HRT?) In my judgement, and the opinion of my doctors and the man at Harvard Medical I keep quoting, the blanket fear of hormone therapy does not find justification in the facts, though of course, caution is in order.

The particular health problem I am addressing is the reduction in vitality, quality of life, and lean muscle mass that accompanies andropause. Anti-aging medical experts speak of "squaring the curve". By that, they mean that the quality of life need not decline gradually with aging, but can stay at a high level with suitable diet, exercise, and hormone therapy.

Ted

[GregLee]

Quote:

Originally Posted by Ted_Shepherd ... the quality of life need not decline gradually with aging, but can stay at a high level with suitable diet, exercise, and hormone therapy.

I'm all for that (though with reservations about hormone therapy). And like many, I imagine, as I pushed up past 65, I began taking diet and exercise much more seriously. I feel lots better since I did, too.

[Nords]

Dr. Rich, paging Dr. Rich...

[Alan]

Quote:

Originally Posted by Ted_Shepherd I support your caution with word and example. I do not smoke or drink or use recreational drugs or misuse prescription drugs. The particular health condition that testosterone supplementation addresses is andropause. That is a somewhat menopause-like condition related to the slow for steady reduction in the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men. It was not too hard for me to find qualified medical doctors who prescribe the supplementation for me while monitoring my PSA and BPH. (What is HRT?) In my judgement, and the opinion of my doctors and the man at Harvard Medical I keep quoting, the blanket fear of hormone therapy does not find justification in the facts, though of course, caution is in order. The particular health problem I am addressing is the reduction in vitality, quality of life, and lean muscle mass that accompanies andropause. Anti-aging medical experts speak of "squaring the curve". By that, they mean that the quality of life need not decline gradually with aging, but can stay at a high level with suitable diet, exercise, and hormone therapy. Ted

HRT is Hormone Replacement Therapy (usually when describing the treatment of post menopausal women) and over recent years there has been concern in the medical world about long term effects. I think the jury is still out.

You seem to live a pretty healthy lifestyle and be doing very well. Have you read the book Younger Next Year? A very good read indeed.

[TromboneAl]

1. This American Life had an interesting show on Testosterone:

Testosterone | This American Life

Act One. Life At Zero.

The interview with a man who lost his testosterone continues. He explains that life without testosterone is life without desire—desire for everything: food, conversation, even TV. And he says life without desire is unexpectedly pleasant. The man first wrote about his experiences, anonymously, in GQ Magazine. (8 minutes)


Act Two. Infinite Gent.

An interview with Griffin Hansbury, who started life as a woman, but began taking massive testosterone injections seven years ago, and now lives as a man. He explains how testosterone changed his views on nature vs. nurture for good. (17 minutes)

Act Three. Contest-osterone.


The men and women on staff at This American Life decide to get their testosterone levels tested, to see who has the most and least, and to see if personality traits actually do match up with hormone levels. It turns out to be an exercise that in retrospect, we might not recommend to other close-knit groups of friends or co-workers. (12 minutes)

You may be able to find a free download.

2. My friend on on testosterone suppression therapy because he has prostate cancer. After 6 months he hasn't noticed any side effects other than perhaps mild hot flashes.

[REWahoo]

Quote:

Originally Posted by TromboneAl 1You may be able to find a free download.

The "Play episode" button allows you to listen for free...

[toofrugalformycat]

Everyone is responsible for their own health decisions, and should do their own research.
I feel moved to post only because I lost two dear aunts to cancer, likely but not surely exacerbated by HRT (hormone replacement therapy), back when they treated menopause as a disease. I will not address any argument because I am not a doctor, although I do read medical literature. I am aware of genetic predisposition, yada yada, don't want to discuss, just want people to do their own research, and know the dangers of HRT before they decide to embark upon it.
I have recently lost another dear relative to prostate cancer. His treatment included suppression of testosterone once the cancer went malignant. He reported no ill effects from the loss of testosterone, but then he was always an easy going, pretty happy guy. However, he did suffer from bone breakage from osteoporosis, likely caused by the complete suppression of testosterone (no man would normally have so little). His oncologist did not even consider the danger of this! It was only after the first bone broke that another doctor got him started on treatment for that, but too late, too late.
So you pays your money and you takes your choice. And heaven help you if you can't do your own research.

[GregLee]

Quote:

Originally Posted by toofrugalformycat However, he did suffer from bone breakage from osteoporosis, ...

Just going off on a tangent, here, that is bad business, and doctors don't seem to be alert to the prospect of osteoporosis. My mother, a year before her death at age 89, started getting compression fractures of her spine -- very, very painful. But none of her doctors had ever said anything to her about taking countermeasures. Me, I'm taking calcium supplement, vitamin D3, getting some sun, and doing weight-bearing exercises.

[TromboneAl]

You guys know that you're going to get old and frail no matter what, right?

[GregLee]

Quote:

Originally Posted by TromboneAl You guys know that you're going to get old and frail no matter what, right?

Not right. "Squaring the curve" means the time of frailty is delayed until the time of death. There's nothing impossible about it in principle. In fact, if you allow for advancing the time of death to before the onset of frailty, it's even easy.

[Orchidflower]

Dr. Perricone has written books on anti-aging techniques. Have you skimmed any of his work yet? This subject is Perricone's main business I think.

[Tigger]

Low testosterone seems definitely bad. It can triple risk of depression, there could be links with metabolic syndrome and erectile dysfunction, type 2 diabetes and insulin resistance and cardiovascular disease. Low testosterone in aging men is also associated with a greater risk of death.

On the other most male animals tend to live longer when their testicles are removed, possibly because testosterone can interfere with the immune system, but I wonder (speculation) if it's not just because they engage less in risky behavior or stay away from females.

I remember from the debate on female hormone replacement that some are convinced that synthetic hormones are dangerous but bio-identical hormones are safe, but those claims are controversial.

Lifestyle measures that help your testosterone levels: exercise, adequate sleep and adequate vitamin D levels, and avoiding chronic stress and obesity. Those things probably aren't enough to maintain youthful testosterone levels, but there are enough other reasons to want them.

[Contrarian]

I thought for sure much would focus on anti-oxidants such as resveratrol. Much has been written long before resveratrol about aging on cellular level, with telomeres as reflective of the preset number of cell cycles left in cell line. Then much years later on how caloric restriction but well nutrient diet have extended life in experiments in such species as earthworms and others. Then more recent years identifying a gene which may be activated by caloric restriction, sirtuin, and its effect on chromosomal replication. Later how this gene may be activated as I understand it by antioxidents. (Those naturally in red wine insufficient unless drink enormous quantities). I was hoping others may have focused on this research. Much of it seems consistent over the years with areas I have read. Though I would not recommend what others do, I take an anti-oxidant resveratrol. Hope over long term no adverse effect, but for me feel prudent risk. I buy from reliable provider, for hear may vary upon purchase. Anyhow, thread caught my attention so lent my input.