“ Life flows on within you and without you”
– George Harrison, Sgt. Pepper’s Lonely Hearts Club Band
Anti-aging is defined as “used to prevent or lessen the effects of aging”. The American Academy of Anti-Aging Medicine was founded in 1992 to advance therapies for “prevention, treatment and reversal of age related dysfunction”. Over the last two decades there has been a proliferation of approaches for use of anti-aging therapies to reduce frailty and dependency in advancing age. Data is present and slowly developing. Many services are available and marketed directly to the public. Cosmetic services may be the most advanced and are commonly utilized at patient choice. Hormonal remedies are directed at both women and men and the data available is slowly developing in the medical literature. Supplements and multivitamins are well established and there are differing opinions in the literature as to the substance, amount and use of the myriad of products available directly to the consumer. Stem cell therapy is a controversial but promising area of research somewhat limited by public controversy.
A dilemma can arise in the way in which these therapies are presented to the lay public. Terms are used to advertise the therapy in question that are colorful but may be misleading. At times it could be the difference between pushing the envelope of truth versus the reality of the desired outcome. This at times creates a situation of twisting the actuality of the claim and what the consumer may expect from the use of any of the services. An illustration of this is:
When it is said “become young again” or “turn back time”, what can be claimed is, it can improve your sense of wellbeing, temporarily. What probably shouldn’t be claimed is that, it can change the underlying attributes which lead to the changes, be they genetic, environmental or behavioral.
When it is said “anti-aging”, what can be claimed is that, it can attempt to regenerate damaged tissues. What probably shouldn’t be claimed is that it is capable of “actively resisting or refusing to comply” with the natural process of aging, as Webster’s defines “anti”.
When a process can “retard, stop or reverse aging”, what may be more appropriate is that it may assist in improving your general health if a definitive diagnosis is first made by a physician. What probably cannot be claimed is that it can “reverse, stop or retard” normal…natural…aging.
When we are told it can “extend your lifespan”, we must define lifespan as it is, the biological life existence of a species, which is about 120 years for humans and about 10-15 years for dogs. If the diagnosis matches the therapy it may help a patient to attain and exceed their life expectancy, ie the average number of years a person is expected to live.
As of 2015, life expectancy in the United States is 82 years of age for the ladies and 77 years of age for the gentlemen, with the average age being 78. The United States ranks 43rd out of 224 nations listed. The top three are Monaco, Japan, and Singapore with average life expectancies of 90 and 85 years, respectively. Israel and Italy come in at 11 and 14 with an average age of 82 years, with France, Canada and the United Kingdom at 81 years of age. African nations round off the bottom 10 nations in life expectancies of 50 years of age.
Hormonal therapy has been used extensively for years. Testosterone was isolated and synthesized in 1935 and was used widely until the mid-1950s. Estrogen replacement therapy came into wide use in the 1960s and was cautioned in the 1990s when the Woman’s Health Initiative Study noted a greater risk of breast cancer, stroke and cardiovascular disease in users, despite its’ benefits against osteoporosis and its’ ability to lower colorectal cancer risk.
Replacement of hormones requires a deficiency in the hormone. The control of the hormone secretion begins in the emotional center of the brain, the hypothalamus. From there the message proceeds to the pituitary gland where chemicals are released that can stimulate each one of the glands (ex. thyroid and adrenals) and the gonads (ovaries and testicles).
There are two causes of the change in function of that natural flow
Primary causes are usually congenital and appear in children. Secondary causes are more related to external influences such as, Female Athlete Triad, a syndrome found in physically active women who exercise a great deal. It includes the triad of poor nutrition, premature loss of menstrual cycle and a reduction in bone density. Chronic illnesses like hypertension, obesity, excessive use of tobacco and/or alcohol, sleep apnea, work related stress and opioid induced androgen deficiency (first noted in the 1970s). From a clinical standpoint…work related stress/general stress can lead to excessive tobacco/alcohol use that can lead to obesity that can lead to hypertension and sleep apnea. That chain of events is very common in society.
Prescription of hormonal therapy is best served following a comprehensive history and physical exam with a physician. Baseline lab tests should be performed. In the case of testosterone replacement there are risks in the therapy. The main one is on the prostate and the PSA should be checked and followed periodically depending on the basic health of the individual. Cardiovascular risks are known when testosterone is used in body building. In deficient states it appears to be safe however at least one recent large study showed a higher risk of cardiac events with the findings being noted in men with prior risk factors for heart disease to begin with. The most common side effect is an increase in production of red blood cells which can cause clogging of the blood vessels.
There is always a balance between risk and benefit in virtually everything we do. In medicine we call that the risk to benefit ratio and the use of any intervention is guided by the first ancient law of the Art & Practice of Medicine – Primum Non Nocerum, First Do No Harm.
So it seems that the hope is to not battle nature but to work within it, learn from it and attempt to age in a healthy, successful and gradual fashion:
Try to remember what comedian Lewis Black says, “We’re all just little snowflakes”.
Enjoy the rest of the year and the holidays.
Dr. Rick Levine