Traditional Medicine: Don't Forget About Men

There has been a flood of recent articles, including those appearing in the Los Angeles Times, Chicago Tribune, and The New York Times, which have examined the affluent male baby boomer's quest for youthful aging, and the shift from mainstream medicine's disease-focused approach to treating the biological causes of age-related disease.

In their attempt to present a fair and balanced article, the journalists interviewed a few medical doctors, whom I believe hold to an irresponsible and uninformed medical approach. These doctors continue to ignore the emerging science behind age management's proactive approach to prevent and delay age-related disease, and disregard male menopause, known as andropause, entirely.

The current science clearly shows how declining hormones jeopardize a patient's health. As a doctor and a patient of age-management medicine, I know firsthand that if I hadn't started treating my andropause at age 64, I wouldn't be as healthy as I am today at 71, nor would I have the desire to work at maintaining my health as aggressively as I do. What's more, I strongly believe that these treatments should be made available to every man who wants to achieve healthy aging and lead an active, longer life.

The ravages of the aging process are well known to all physicians. Since 1990, there have been an enormous number of evidence-based, peer-reviewed scientific studies that clearly demonstrate the links between age-related degenerative diseases and declining hormone levels. And, there have been several studies revealing the many benefits of replacing these hormones as both men and women age.

Andropause has become a well recognized clinical disorder that many medical authorities believe necessitates treatment. There is a wealth of evidence underscoring the importance of maintaining adequate testosterone levels as men age in order to preserve bone mass, muscle mass, sexual function, stamina, exertional performance, cognitive skills, concentration, memory, coronary artery health, cardiac health, prostate health, insulin sensitivity, blood pressure, and mood. Healthy testosterone levels also play a crucial role in the prevention of visceral fat, the pivotal factor in causing metabolic syndrome associated with diabetes, cancer, and Alzheimer's disease.

The Facts

Here are just a few reasons why I believe in treating andropause, and why traditional medicine may have to change its naysaying ways:

• The Annewieke study showed a direct correlation between testosterone levels and lean mass in subjects over age 70, with an inverse correlation regarding body fat. (1)
• In two articles by Tenover, testosterone replacement was demonstrated to increase lean body mass (fat-free body tissue, comprising mostly muscle). (2,3)
• In the Kholsa study, subjects on testosterone replacement therapy showed an increase in bone mineral density (BMD) across all age groups, a reflection of bone strength - the more calcium, the better. (4) The Snyder study showed an average of 4.2% increase in BMD over a 36-month treatment period. (5)
• Numerous studies show improved sexual function and performance. (6,7, 8,9,10, 11,12)
• Marin, in two studies published in 1992, showed that normalizing testosterone levels can lead to weight loss, decrease belly fat, and improve waist-hip ratio. It also linked to a decrease risk of heart disease as testosterone was found to protect the body from insulin resistance, changes in cholesterol, and improve diastolic blood pressure. (13) Marin's second study concluded that testosterone replacement was associated with decreasing men's risk for diabetes. (14)
• Testosterone replacement therapy does not increase one's risk for prostate cancer and does not increase PSA or prostate size. Studies over the past ten years have demonstrated that low testosterone levels, rather than high, were a marker of prostate disease. (15,16,17,18,19)

Human Growth Hormone Therapy is not for Everyone

Another concern that these articles addressed is that human growth hormone (hGH) replacement therapy may put individuals at an increased risk for developing a malignancy. The literature, however, does not support this notion. (20,21,22,23,24) The Consensus Guideline for the Diagnosis and Treatment of Adults with Growth Hormone Deficiency II published in 2007 states, "There is no evidence that hGH replacement in adults increases the risk of new or recurring malignancies." (25)

In 2001, The Growth Hormone Research Society extensively reviewed the question of whether hGH therapy is associated with malignancy and concluded that hGH therapy is not associated with the promotion of pituitary tumor recurrence or the development of any other cancers. They stated that for patients receiving hGH therapy "no additional monitoring for other malignant tumors (such as tumors of the prostate, breast or colon) is currently suggested beyond the accepted standard of care for the patient's age and sex."

Human growth hormone therapy is only recommended for men who have clinically shown that they have a biological deficiency and are unable to correct this through diet, exercise, and optimizing their other hormones. This therapy is carefully monitored to assure healthy levels, and does not put individuals at an increased risk for cancer. What's more, when the FDA approved hGH therapy in deficient adults, the initial doses were five to ten times higher than current recommended doses.

It is true that high dose hGH will put people at risk for diabetes and joint pain and may even cause heart failure. The doses currently used do not increase risk for diabetes and do not cause joint pain or heart failure. In fact, patients on long-term hGH therapy are less likely to develop abdominal obesity, diabetes, hypertension, joint pain and declines in their cardiac performance.

Women are embracing hormone replacement therapy, and have been for decades. It's our turn to look and feel better, now, and for years to come.

REFERENCES

1. Annewieke, W. J Clin Endo Metab. 2000

2. Tenover, JS. J Clin Endo Metab. 1992

3. Tenover, JS. J Clin Endo Metab. 1997

4. Khosla, Sundeep. J Clin Endo Metab. 1998

5. Snyder. P. J Clin Endo Metab.. 1999

6. Kwan, M. J Clin Endo Metab. 1983

7. Skakkebaek, NE. Clin Endo (Oxf ). 1981

8. Hajjar, F. J Clin Endo Metab. 1997

9. O'Carroll, R. Br J Psychiatry. 1984

10. Morales, A. Eur Urol. 2005

11. Carani, C. Arch Sex Behav. 1990

12. Jain, J. J Urol. 1998

13. Marin, P. Eur J Med. 1992

14. Marin, P. Int J Obes Relat Metab Disord. 1992

15. Zhang, L. J Prostate. 2002

16. Massengill, JC. J Urol. 2003

17. Rhoden EL. J Urol. 2003

18. Hoffman, MA. J Urol. 2000

19. Gann, PH. J Nat Cancer. 1996

20. Gotherestrom, G. J Clin Endo Metab. 2007

21. Beauregard, C. J Clin Endo Metab. 2008

22. Savin, R. Hormone Research. 2000.

23. Besson, A. J Clin Endo Metab. 2003

24. Maison, P. J Clin Endo Metab. 2004

25.  The Consensus Guideline . . . GH Deficiency II. Euro J Endo. 2007