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The American Medical Association reported in June that "anti-aging hormones" are not safe and effective for treating hormone deficiencies.1 To support this position, the AMA passed a policy stating proponents of hormone therapy must inform physicians and the public of current evidence that proves anti-aging hormones are scientifically valid.
The AMA council reviewed clinical trials on hormone therapy, human growth hormone (HGH), testosterone, estrogens with or without progestins, and dehydroepiandrosterone (DHEA). It determined most studies did not support the safety and efficacy of these hormones as anti-aging treatments. The council concluded these therapies should not be recommended for age management.2
However, an in-depth review of AMA's report demonstrates several inconsistencies that do not fully support their claims.
Human growth hormone. The reviewers stated "there is no justifiable reason to use human growth hormone for anti-aging".1 This statement, however, fails to mention HGH has proven benefits for individuals with HGH deficiency, which often occurs as we age.
In fact, research referenced in the AMA review demonstrated that HGH improves cardiovascular health, body composition, skeletal integrity, exercise capacity and well-being among individuals with HGH deficiencies.3,4
DHEA. The reviewers concluded that "based on the available scientific evidence, the use of DHEA demonstrates neither meaningful
benefit nor adverse events, and its use as an anti-aging supplement should be discouraged".1
Yet, studies they selected found DHEA increases bone mineral density and improves body composition by decreasing abdominal body fat. Excess abdominal fat has been associated with heart disease, hypertension, insulin resistance and metabolic syndrome.
The report neglected to mention a selected study that found DHEA improves skin thickness and hydration, testosterone and estradiol levels, libido, and selectively increased bone density in women.5
Testosterone therapy. An immense amount of testosterone research was cited in the report. The reviewers noted it can improve libido, lean body mass, and decrease fat mass. Still, they concluded "testosterone therapy should be offered on an individualized basis to older men with consistently low testosterone levels".1
This seems clearly acceptable, as testosterone therapy is not meant for individuals with optimal or high testosterone levels.
Estrogen. The AMA council's review of estrogen with or without progestins largely referred to the Women's Health Initiative, which found negative health outcomes associated with the use of synthetic hormone replacement therapy.
Several studies have pervaded the medical community. These studies point to the association of synthetic, chemically-altered hormones with an increased risk in breast cancer, heart disease, and stroke in postmenopausal women.6,7,8
The AMA states that "no credible scientific evidence exists on the value of so-called 'bioidentical hormones,' and there are concerns about their purity, potency and quality because they are not approved by the FDA."1
However, there is growing popularity in the use of bioidentical hormone therapy (BHRT) as a safe and effective alternative to synthetic counterparts. Bioidentical hormones are molecularly similar to hormones naturally produced in the body and obtained through compounding pharmacies. AMA claims there is no evidence to support the use of BHRT.
Earlier this year, however, Postgraduate Medical published a meta-analysis comparing the efficacy of bioidentical hormone studies to synthetic hormone studies. Researchers found that bioidentical hormones have distinctly, different physiological effects, compared to their synthetic counterparts.
Additionally, BHRT was associated with a decreased risk of breast cancer and cardiovascular disease, whereas synthetic hormones increase these health risks. Researchers concluded bioidentical hormones are superior in providing greater benefits to health and well-being.9
Restoring Hormone Levels
Hormone depletion leads to a rapid decline in health and well-being. To avoid related health risks, hormone levels need to be restored to their appropriate levels. A review of the literature demonstrates that anti-aging hormones are safe and effective:
· Estrogen (estriol, estradiol) supports mood, protects bones, and cardiovascular health.10,11,12,13,14 Additionally, estriol lessens breast cancer risks, which increase in postmenopausal women not using hormone replacement.15
· Natural progesterone balances cholesterol and improves estrogen's efficacy.16 Furthermore, it reduces the proliferation of breast cancer cells.17
· Testosterone improves well-being and sexual function, increases lean body mass and bone density, and decreases body fat in men.17,18 Furthermore, it eliminates hot flashes, fatigue, depression, and migraine headaches, while improving bone density, well-being, cardiovascular and sexual health in women.19,20
· DHEA improves mood, fatigue, immune function, and cognition.21,22,23
· Human Growth Hormone improves muscle mass, cholesterol levels, insulin sensitivity, and cardiovascular health.24,26,26
The AMA's weak research review only leads to greater confusion in the medical community. With the persistent fight against hormone therapies, it is imperative to base hormone administration on proven medical research, and refuse to rely on medical organizations that create weighted reports based on their own personal biases.
The AMA may claim anti-aging hormones lack scientific evidence, but studies continue to support the efficacy of BHRT. The proof is in the scientific literature.
Neal Rouzier, MD, is the director of the Preventive Medicine Clinics of the Desert, specializing in medical age management and preventive care. As a renowned expert in the field of bioidentical hormone replacement therapy, Dr. Rouzier has over 15 years experience as an educator and practicing physician in the field of age-management. He is the author of How to Achieve Healthy Aging (Wordlink Medical Publishing, 2007), which examines the need for natural hormone replacement based upon the medical research.
References
1. Dudowicz L. AMA adopts new policies at annual meeting. American Medical Association. 2009 June 16. Retrieved on June 17, 2009 from http://ama-assn.org/ama/pub/news/news/new-public-health-policies.shtml
2. Robinowitz CB. The use of hormones for "antiaging": A review of efficacy and safety. Report of the council on science and public health. 2009;CSAPH Report 5-A-09.
3. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML;
Endocrine Society's Clinical Guidelines Subcommittee of the Clinical Affairs Committee. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91(5):1621-1634.
4. American Association of Clinical Endocrinologists Growth Hormone Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children-2003 update. Endocr Pract. 2003;9(1):64-76.
5. Baulieu E, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEage study to a sociomedical issue. PNAS. 2000;97:4279-4284.
6. Gambrell RD. The Women's Health Initiative reports: Critical review of the findings. The Female Patient. 2004;29:25-41.
7. Rossouw E. Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial, JAMA. 2002;288:321-333.
8. Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study, Lancet. 2003;362:419-427.
9. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009 Jan;121(1):73-85.
10. Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women. Arch Gen Psychiatry. 2001;58:529-534.
11. Stanosz S, Zochowska E, Safranow K, Sieja K, Stanosz M. Influence of modified transdermal hormone replacement therapy on the concentrations of hormones, growth factors, and bone mineral density in women with osteopenia. Metabolism. 2009 Jan;58(1):1-7.
12. Teede HJ. Sex hormones and the cardiovascular system: effects on arterial function in women. Clin Exp Pharmacol Physiol. 2007 Jul;34(7):672-676.
13. Ho JY, Chen MJ, Sheu WH, Yi YC, et al. Differential effects of oral conjugated equine estrogen and transdermal estrogen on atherosclerotic vascular disease risk markers and endothelial function in healthy postmenopausal women. Hum Reprod. 2006 Oct;21(1):2715-2720.
14. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Research and Treatment. 2008;107(1):103-111.
15. Hargrove JT, Maxson WS, Wentz AC, Burnett LS. Menopausal hormone replacement therapy with continuous daily oral micronized estradiol and progesterone. Obstet Gynecol. 1989 Apr;73(4):606-612.
16. Pasqualini JR. Differential effects of progestins on breast tissue enzymes. Maturitas. 2003;46(1):45-54.
17. Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 2004 May;89(5):2085-2098.
18. Darby E, Anawalt BD. Male hypogonadism : an update on diagnosis and treatment. Treat Endocrinol. 2005;4(5):293-309.
19. Braunstein GD, Cameron DR. Postmenopausal androgen therapy in women. The Female Patient. 2004 Nov;29:40-45.
20. Golden SH, Maguire A, Ding J, Crouse JR, et al. Endogenous postmenopausal hormones and carotid arteriosclerosis: a case-control study of arteriosclerosis risk in communities cohort. Am J Epidemiol. 2002;155(5):437-445.
21. Wolkowitz OM, Reus VI, Keebler A, Nelson N, et al. Double-blind treatment of major depression with dehydroepiandrosterone. Am J Psychiatry. 1999;156(4):646-649.
22. Oberbeck R, Dahlweid M, Koch R, van Griensven M, et al. Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Critical Care Medicine. 2001;29(2):380-384.
23. Hunt PJ, Gurnell EM, Huppert FA, Richards C, Prevost AT, et al. Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double blind trial. J Clin Endocrinol Metab. 2000 Dec;85(12):4650-4656.
24. Blevins LS. Beneficial effect of growth hormone replacement in growth hormone-deficient adults. Endocrinologist. 2002;12(5):405-411.
25. Gotherstrom G, Elbornsson M, Stibrant-Sunnerhagen K, et al. Ten years of growth hormone (GH) replacement normalizes muscle strength in GH-deficient adults. J Clin Endocrinol Metab. 2009;94(3):809-816.
26. Boschetti M, Goglia U, Teti C, Esposito D, et al. Replacement therapy and cardiovascular diseases. Endocrinol Invest. 2008;31(9):85-90.
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