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Is Hormonal Treatment Good or Bad?

Taking hormones as we grow older has become a trend.  Fueled originally by experiences of people such as Suzanne Sommers, the idea that we can grow young again continues to engage our cultural imagination.  Do they work?  Are they helpful?  Are there any risks?

Only in the last decade have we begun to study these questions in depth.  There are a few things we’ve learned, but a lot more left to discern.

For instance, let’s look at several studies in past 2-3 years on testosterone.

What Do We Know?

What we know is mostly obvious and has been confirmed on repetitive studies.  We’ve always known that testosterone builds muscle, increases libido and generally promotes virility and vitality in our younger years.  We know that it will restore some sense of energy, muscle mass and higher functioning in older males when there is documented deficiency.  

Most recently, articles in the Mayo Clinic Proceedings journal looked at benefits to older males with congestive heart failure and low testosterone, and it was shown that exercise training combined with testosterone therapy was superior to either alone.  Increased nerve action for exercise, decreased muscle wasting and increased functional capacity in these men was seen with both exercise and testosterone.  Another study showed decreased re-hospitalization rates in older men with testosterone deficiency if they were given testosterone in the month following the hospitalization (for a wide range of conditions).

What do these studies mean? 

Well, it’s hard to say beyond what we know already about testosterone’s basic functions.  Impact on muscular strength and function is a central effect of testosterone.  It makes sense that heart muscle function (although it is smooth muscle instead of skeletal) might improve when testosterone is put into the mix.  Likewise, as the authors of the article on hospitalization point out, muscle wasting and the effects of that (decreased exercise capacity, increased falls, etc) are well-known effects of hospitalization.  These problems are accelerated, especially in the elderly, when we are immobile and confined as occurs in a hospital stay.  So, it makes sense that repair of that damage over the next month with testosterone would show reductions in the side effects caused by being in the hospital in the first place.

What do we not know? 

Well, we still don’t know a lot.  Mainly, what is the long-term effect?  How low a level of hormone warrants replacement?  To what level is it safe to raise the testosterone level?

Multiple studies, in prestigious journal JAMA and the New England Journal of Medicine, have shown worsened cardiovascular events with testosterone use in older-aged men.  There are multiple studies showing no adverse effects apparent with short-term use.  However, it takes time to build plaque in arteries.  Alternatively, it may be that testosterone helps by decreasing fat mass, improving insulin sensitivity and improving cholesterol profiles.  These remain to be documented.

Also, there’s a world of difference between studying effects of testosterone in the setting of documented deficiency and active illnesses (CHF and hospital-induced sarcopenia in the above studies) and giving hormones to otherwise healthy adults just because they can give us energy and more muscle.  Steroid hormones have been abused in the athletic population for decades.  We outlaw them because of the unnatural advantages they convey.  It’s also given us a lot of information through the years on what long-term abuse can do.   Just because we can make something grow doesn’t mean it’s necessarily a good idea.  Damage seen in body-builders who use steroids include shut-down of natural hormone production centers and kidney problems.  So, the idea that everyone past menopause and andropause should start pounding their bodies with hormones should not be just assumed to be a good thing.

Concerns:

A strong concern voiced by some, one I share, is the potential effect on cancer growth of hormonal usage of many types.  A large meta-analysis study supports this concern.  It showed increased risk of ovarian cancer with post-menopausal hormone use.  There are two key concepts to this.  First of all, one of the primary foundational effects of steroid based hormones (both male and female) is as a growth factor.  Hormones make tissue grow.  It’s one of the reasons why we have higher levels of them when we’re young.  The second critical fact is that we all make cancer cells all the time.  Cancer is just regular body cells growing out of control.  It’s not a foreign invasion.  It’s our own cells simply not knowing when it’s time to die.  Our immune system is responsible for weeding them out of the population and removing them.  The problem is that as we age our cells become more fragile, cancer cells more common, and we accumulate more cellular damage.  It’s basically why cancer is so much more prevalent in the old than the young.  So, what happens when we start pouring growth factors on top of an ever-increasing population of fragile and pre-cancerous cells?  More cancer is a distinct possibility.  It’s like kerosene on smoldering embers. Consider that a primary element of anti-cancer treatments in the incredibly common cancers of breast and prostate is blockade of hormone. Estrogen blockade and testosterone blockade are used in large number of cases because they slow the tumor growth.  Do we have to wait for a tumor to appear to assume the obvious?  The take-home message is that hormones stimulate tissue growth, so be careful where you use it.  In research studies, it will take time to thoroughly document this effect, so the current short-term hormone usage studies are of no value in answering this question.

I believe deeply, as a holistic physician, in the wisdom of the body.  That includes the wisdom to shut hormone production down to lower levels as we age.  We need to be cautious as we intentionally breach that principle that our bodies have demonstrated.  At the very least, I think that bringing documented low levels back into a low- to mid-range of normal is the most we should be doing.  Hormone clinics now abound that are injecting hormones willy-nilly with little regard for levels, side effects and potential damage, usually all in the name of “it’s all natural”.  Well, no, it’s clearly not.  What’s natural is the body’s reduction of these levels.  It is a completely allopathic intervention and in no way natural to be making a 65 year old’s hormone levels that of a 25 year old.  I also repeatedly see levels being pushed far beyond what a person has ever naturally had in his or her body.  It doesn’t mean that there might not be potentially beneficial and safe usages, but it isn’t natural.

There are also a plethora of other avenues available to target energy and hormonal drops.  Lifestyle factors hugely impact post-menopausal and andropausal symptoms, more than people realize.  Dietary control and exercise can bring hot flashes down by an enormous amount.  Herbals and supplements can often be of benefit.   A recent meta-analysis in JAMA confirms the usefulness of herbals in helping hot flashes.  Given that numerous studies have shown stress, obesity and lack of sleep can decrease testosterone, working on these lifestyle factors can increase not only your health overall but hormone levels as well.  We often blame hormonal issues for the way we feel, when it’s just as much the other way around.  When we work on stress reduction, centering practices such as meditation or yoga, finding meaning and connection in our lives, eating better and exercising, we increase our hormones.  Augmentation should one of the last choices, not the first.

 

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