f.a.q.'s > Other Information > What is the current study on Aging?

Age Management is a medical specialty that emphasizes preventive medicine first-focusing on the prevention of disease, slowing the aging process, and enhancing health. Hormone modulation is the second component of Anti-Aging medicine, and it is geared towards enhancing performance, as well as preventing disease. Prior to discussing the specifics of hGH and testosterone, it should be noted that lifestyle modification, sound nutritional practice, and careful monitoring are essential to achieve the maximum benefit from hormone modulation.

Testosterone levels decline gradually in men, starting from approximately age 30, and this decline continues throughout life. In women, levels decline precipitously at menopause, along with estrogens and progesterone. In both sexes, along with this decline in testosterone, comes a decrease in libido, lean body mass, strength, energy, mood, sexual performance and mental acuity.

Somatopause is the decline in growth hormone level that occurs gradually from young adulthood throughout life, and it occurs in both sexes at roughly the same rate. This decline in growth hormone leads to a decline in IGF-1, the hormone that is made in the liver in response to growth hormone. The decline in IGF-1 also parallels the decline of all the attributes mentioned above under testosterone. In addition, with lower IGF-1 levels we also see a decrease in skin thickness, bone density, aerobic capacity, and the healing rate of wounds. On the other hand, some things go up as growth hormone (and IGF-1) go down; these are: body fat, waistline, waist to hip ratio (an indicator for risk of heart attack), LDL cholesterol, average days of illness, and hospitalization rate.

Given the similarity of problems associated with the drop in both of these hormones, one might ask: is it the decrease in testosterone or growth hormone (IGF-1) that results in state of decline in body composition and functional capacity associated with aging? This is the question undertaken by the National Institute on Aging, under the guidance of Marc Blackman M.D. of Johns Hopkins University in 1994. They initiated a study of men and women, aged 61 to 84, who were in somatopause, as well as either andropause (for men) or menopause (for women). The objective was to determine whether the supplementation of growth hormone, estrogen plus progesterone, or testosterone, had any affect above placebo in the restoration of body composition and functional capacity in the aging population; and if so, which hormones were responsible for which benefits, and to what degree relative to one another.

This was a very ambitious study and a beautifully designed one. The study was double blind, which means neither the practitioner nor the patient knew whether they were receiving the real hormone or placebo. Enrollees in the study were randomly distributed to either the placebo or the hormone group. It was done in multiple different centers to minimize practitioner bias and it was, of course, placebo controlled. The men were divided into four groups to be administered the following:

1. Growth hormone plus placebo
2. Testosterone plus placebo
3. Growth hormone plus testosterone
4. Placebo plus placebo
Women were divided into four similar groups, the only difference being that estrogen plus progesterone was administered to women instead of testosterone.

The outcomes of the study (results) can be summarized as follows:

1. Total body weight did not change in any of the groups.

2. Lean body mass increased in both men and women who were on sex hormones alone (Testosterone in men, estrogen plus progesterone in women), or growth hormone alone, or both sex hormones and growth hormone. Lean body mass increased more in men on growth hormone plus testosterone, than on men who were on either of those hormones alone.

3. Strength was increased primarily by testosterone. Growth hormone had little or no effect on strength by itself, and estrogen plus progesterone had no effect on strength in women.

4. Aerobic capacity was primarily boosted by growth hormone. Testosterone improved aerobic capacity ever so slightly, but growth hormone improved it substantially. Interestingly, the combination of growth hormone and testosterone were again additive, meaning those on both hormones did better than those on either hormone alone.

5. Women on estrogen and progesterone did not reduce body fat. Men on testosterone reduced body fat by 3-5%. Men and Women on growth hormone reduced body fat by 14%. Once again, testosterone and growth hormone were additive. Men on both of these hormones decreased body fat by 17-18%.

6. LDL (bad cholesterol) was reduced in those on growth hormone. Total cholesterol also came down in the growth hormone groups, and the ratio of total cholesterol to HDL (coronary risk ratio) also declined, indicating less risk for heart attack.

7. No benefit of testosterone on cholesterol levels was mentioned on the report in this study. However, many other studies in the literature point to the fact that in men, testosterone lowers triglycerides and raises HDL cholesterol, both of which reduce risk for heart attack. In some studies on women, testosterone is shown to lower HDL (good cholesterol), indicating a potentially increased risk for heart attack. We approach this by monitoring the HDL carefully in women on testosterone. We have found that in some women the HDL goes down, and in others it does not. When it does go down we have several options:

a) We can reduce the testosterone dose or stop it all together;
b) We can use another agent to raise HDL cholesterol, such as Niacin (Vitamin B3);
c) Or we can use another agent for cholesterol control so that we bring the coronary risk ratio down where it should be.
The particular course we take varies with patient preference. The most important task is to continually monitor the testosterone and HDL level going forward so that we are able to learn how each individual's physiology is affected by the various interventions, arriving at the best possible benefit with the least possible risk.

8. Blood pressure did not change in any of the groups except one: those men on growth hormone and testosterone experienced a statistically significant decrease in diastolic blood pressure.

9. Side effects were non-existent in the testosterone group. The group of women on estrogen plus progesterone experienced some breast swelling and tenderness and rarely some irregular menstrual type bleeding. The patients on growth hormone did experience some fluid retention, although it was minor, and easily controlled by reducing the dose. The symptoms of fluid retention were water weight gain and mild joint discomfort (again, remedied by reducing the dosage).

Prostate health is a big concern for men, and often comes up when discussing risks of supplementing growth hormone and/or testosterone. In the NIA Study, both PSA (Prostate Specific Antigen) and international prostate symptom scores (IPSS) were followed. In men on testosterone alone, no change in either of these numbers occurred. In men on growth hormone plus testosterone, however, the PSA declined while there was no change in the IPSS. This was very reassuring to those of us practicing Anti-Aging medicine. Not only were there no prostate complications and no increase in prostate symptoms, but also the PSA actually dropped in men on growth hormone plus testosterone.

Our observations of men and women on testosterone, in general, show an increase in muscle mass, strength, libido, and energy levels, as well as mood elevation. We also often see improved sexual and cognitive performance. Cognitive performance is difficult to attribute to a particular hormone however, since we are also making lifestyle modifications and adding a variety of nutriceuticals, some of which are designed to enhance memory and cognitive function.

Our observation of men and women on growth hormone is that they sleep better and awaken refreshed. They have more energy and improved aerobic capacity. They are dropping body fat and increasing muscle mass and getting sick less often. Average bone density increases over the course of a year. Skin becomes thicker and smoother with fewer wrinkles. Spider veins also tend to decrease as a virtue of thickening of the skin. The cholesterol profile usually improves as LDL (bad) cholesterol generally goes down with the use of growth hormone. Finally, there is an enhanced feeling of well being, often described as mood elevation.

Testosterone is dosed in women using a vanishing cream that is applied every morning to the skin. Men may use the vanishing cream, but we prefer to use injectible testosterone. The patient takes an injection about once a week. We teach patients to do this right in the office, and very nearly 100% of patients are able to give themselves injections at home with very little discomfort. It becomes very routine. More importantly, the results of the injectible testosterone seem to be much better than any other method we've looked at, particularly in strength, energy, and libido. Our goal for laboratory measuring of our results is to see the testosterone level rise to the upper normal for men, and certainly not beyond that. This is another instance where monitoring the level is critical. We check the levels at least every three months.

Growth hormone is administered by subcutaneous injection, using a tiny 30-gauge needle that often is not even felt; there is now even a needle-less option. This is done six mornings a week. The dose of growth hormone is based on a patient's age, sex, weight, IGF-1 level, his or her response to therapy, and the affordability.

The cost of the growth hormone program can range from $300 - $500 per month. Monitoring of IGF-1 level, as with other indicators, is critical.

In closing, we must keep in mind that we are not treating hormone levels; we are treating patients. Hormones are merely an important tool in providing our patients with an enhanced quality of life and a longer potential life span.
 
Age Management Medicine and Anti-Aging Medicine are not interchangeable terms. There are substantive differences between the two that require clarification.
 
Age Management Medicine is defined as preventive medicine focused on regaining and maintaining optimal health and vigor. This medical specialty incorporates well-known and accepted markers of disease-risk into proactive patient management and uses hormone modulation for the endocrinologically normal by identifying hormone levels that yield superior health outcomes. For most hormones, this is simply the upper 33% of the normal range for a patients age. The exceptions are insulin and cortisol that should be modulated to the lower 33% of the normal range.
 
Age Management Medicine recognizes that successful therapies necessitate healthy lifestyle including optimal low glycemic index nutrition, appropriate nutrient supplementation, and the absolute need for physical exercise. Age Management Medicine focuses on the synergy of all of these elements in order to enhance vitality and extend our health span. While we may or may not be able to increase longevity, we are able to prevent premature disability and death and enhance quality of life.
 
Contrary to Age Management Medicine, the term Anti-Aging Medicine has gained a great amount of negative notoriety while making uncorroborated implications. The Anti-Aging industry continues to promote products that are useless and in some cases fraudulent in nature. Anti-Aging Medicine claims that aging is a disease. It is not a disease, but rather a process that we all experience.
 
The most important element necessary for the success of any medical therapy is the expertise and experience of the physicians in whom you place your trust for your health care. Our physicians are certified in Age Management Medicine and have a wealth of experience in hormone modulation therapies, nutritional strategies and exercise science.

Last updated on November 12, 2007 by Dr Wayne Johnson