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The field of age management medicine is growing by leaps and bounds, fueled by millions of baby boomers now reaching their 50s and 60s. As a physician board-certified in both preventive and holistic medicine, I believe it is incumbent upon those of us in the anti-aging field to provide our patients with scientifically valid methods to maintain optimal health. One of those ways is through complete hormonal testing.
Almost all hormones, including estrogen, testosterone, progesterone and dehyroepiandrosterone (DHEA), decline as we age. With this decline come changes intimately associated with aging, including impotence, loss of libido, muscle degradation and memory loss. By starting hormone testing in patients in their 20s, age management physicians can head off these and other potential health problems later in life.
Here's an overview of tests I incorporate in my comprehensive age management practice.
Thyroid Panel
One blood test I order on almost all my new patients is a thyroid panel. The thyroid gland has such broad effects on all-around health that many physicians consider it the master gland. The thyroid exerts powerful effects on the human body through at least four hormones, two of which-thyroxine (T4) and triiodothyronine (T3)-are produced in the highest quantities.
The secretion of thyroid hormones is controlled via a feedback loop by the pituitary gland; if the pituitary detects low levels of thyroid hormones in the bloodstream, it secretes thyroid-stimulating hormone (TSH) to trigger the thyroid to release more of its own hormones.
Subclinical hypothyroidism affects 4 percent to 10 percent of the general population and 7 percent to 26 percent in the elderly.1 It's defined as elevated TSH levels but normal T4 and T3 levels. Even though subclinical hypothyroidism affects millions of people, a number of mainstream physicians believe treating subclinical hypothyroidism is a waste of time.
However, this flies in the face of solid evidence from myriad studies that conclusively show people with subclinical hypothyroidism suffer a variety of debilitating symptoms such as poor memory and fatigue,2 peripheral artery disease,3 hyperlipidemia and coronary artery disease(4) and musculoskeletal disorders(5). Fortunately, it's quite easy to use thyroid hormone supplements to raise hormonal levels back to normal.
DHEA
I also routinely test for DHEA. This hormone is secreted by the adrenal glands and then is converted in the body into DHEA sulfate (DHEA-S), the predominate form of DHEA. Production and secretion of DHEA declines 10 percent per decade once men and women reach their 30s. This decline is correlated with significant medical consequences, such as heart disease, cancer and osteoporosis.6 DHEA supplementation has shown to positively affect the following health conditions.
Mood and energy. A randomized, double blind, placebo-controlled trial of DHEA supplementation demonstrated improvements in mood and energy among participants. Researchers followed 17 women and 13 men ages 40 to 70 over a six-month period.7 For three months, participants took 50 mg/day of DHEA then three months of placebo at bedtime in random order.
Within two weeks of starting DHEA, the patients had attained DHEA blood levels of young adults. After three months on DHEA, 82 percent of the women reported an increased sense of well-being, which included improved quality of sleep, anxiety, energy and stress.
Libido. DHEA supplementation also can help women regain their sexual edge. A study published in the Journal of Sex and Marital Therapy, examined the effects of 50 mg/day of DHEA on 111 premenopausal women ages 35 to 55 years over a period of two to six months.8 This study showed women taking DHEA supplements reported significant improvements in sexual function in terms of desire, arousal, lubrication, satisfaction and orgasm.
Men's health. One of the most ambitious studies on the aging process and DHEA levels was begun in 1958 in Baltimore and continues today. The Baltimore Longitudinal Study of Aging (BLSA) has been carefully examining the aging process in more then 1,000 people from ages 20 to 90.
A study in the journal Science looked at the correlation of certain biomarkers, including DHEA-S and overall health.9 Researchers found men who had higher levels of DHEA-S lived healthier, longer lives then men with lower levels of DHEA-S. The authors concluded DHEA-S levels may be important in health maintenance and may serve as another potential longevity marker.
Testosterone
Testosterone therapy has a number of health benefits for men and women.
Women's health. Research demonstrates women who are post-menopausal or have had oophorectomies, judicious therapy with testosterone improves sexual drive, arousal and frequency of sexual fantasies.10
Besides helping women have an enjoyable sex life, testosterone may help women ward off heart disease and breast cancer. Testosterone deficiency is a key factor for heart disease in aging women or women who have had hysterectomies, research shows.11 Women who get a hysterectomy have three times the risk of cardiovascular disease compared to women who have not had this surgery.11 Testosterone therapy can lower these risks.
Testosterone therapy also may reduce the risk of breast cancer. A study in 2000 examined the effects of testosterone and tamoxifen, a widely-used chemotherapeutic agent for breast cancer, on breast cell stimulation.12 Researchers showed that while breast cells exposed to estrogen showed cancer-like rapid growth, those same cells, when also exposed to testosterone, showed significantly less growth.
Other researchers found that testosterone may protect against breast cancer, by analogy with P4 [progesterone] effects upon the uterus.13
Andropause. As in women, the rate of production of testosterone falls precipitously as men age. This decline in the level of testosterone is a hallmark biochemical signpost of a condition known as andropause.
Testosterone levels peak in a man at approximately age 30. By age 40, five percent of men are thought have low testosterone levels, and almost half of men in their 70s have low testosterone.14 This fall in testosterone levels may lower libido, sexual functioning, muscle mass and strength. Prostate size increases, leading to benign prostatic hypertrophy, along with fatigue and depression.
Yearly testosterone level checks are very important in monitoring a man for andropause. However, it's also important to make sure you're checking free testosterone levels-that is, testosterone that's not protein bound-to determine optimal levels.
I've had a number of middle-aged male patients who've come to see me with andropausal symptoms despite total testosterone levels within normal levels. Many were thus told by their doctors that their symptoms were all in their head. But these men had low free testosterone levels. If this is the case, supplemental testosterone can help give men back their vitality and zest for life when andropause hits.
Estrogen and Progesterone
Estrogen is actually three hormones: estradiol, estrone, and estriol. Produced in women's ovaries, body fat, and adrenal glands, estrogen promotes bone strength, protects heart and brain functioning, and maintains sex drive.
During perimenopause and menopause, decreasing estrogen levels can cause hot flashes, night sweats, mood swings, headaches and vaginal dryness. Low progesterone can cause irritability, headaches and anxiety. On the other hand, high estrogen levels are linked with breast cancer.
By balancing these two hormones and monitoring levels via annual testing, women can avoid many of the distressing symptoms and health problems associated with abnormal estrogen levels.
It's still erroneously thought that estrogen and progesterone play only a small role in the health of men. Fortunately, we now know otherwise. Estrogen, which is also produced by men in small amounts, is important for bone health in males. In fact, a study of 793 men reported on in the American Journal of Medicine showed men with lower estrogen levels had three times greater risk of hip fractures compared to men with higher estrogen levels.15
While having an adequate estrogen level may help protect men against fractures, having too much estrogen may predispose them to prostate cancer. A recent study concluded that estrogenic stimulation through estrogen receptor alpha in a milieu of decreasing androgens (testosterone) contributes significantly to benign prostate hyperplasia, prostate dysplasia and prostate cancer.16
Progesterone, like estrogen, is also needed in optimal amounts to maintain health in aging males. It's thought that in men progesterone inhibits the toxic effects of excess estrogen. Progesterone also may protect men from prostate cancer by its stimulation of genes that prevent the cellular overgrowth seen in both prostatic hypertrophy and cancer.17
However, elevated levels of progesterone in men can be problematic and have been linked to a number of problems including loss of libido and prostatitis.18
A Comprehensive Age-Management Program
The data correlating falling hormone levels and a rise in age-related disease underscores the importance of hormone testing in preventive and anti-aging medical check ups. All hormones are created in an intricate biochemical cascade where the optimal balance of these vital chemical messengers is crucial to maintaining health across the lifespan.
With timely and regular hormonal blood testing, physicians can keep abreast of patients' hormonal status, and if needed, recommend hormonal supplementation. (Click Page 2 for References.)
Edward R. Rosick, DO, MPH, DABHM is the Medical Director of the Family and Community Medicine Department at Michigan State University College of Osteopathic Medicine.
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