Anti-aging hormone therapies allow patients to reclaim hope of counteracting age-related hormonal changes. With nearly 48% of menopausal American women taking hormone therapies, this industry is already a multi-billion-dollar business expected to reach around $53 billion by 2030. Francisco Llano, MD, a specialist in nutrition and anti-aging in Mexico City, Mexico, compares the endocrine system to an orchestra. “One out-of-tune hormone can result in significant changes to some of the body’s standard processes,” he said. In addition to skin aging, waning hormone levels manifest as weight gain, energy loss, decreased sex drive, sleepless nights, memory loss, mood swings, hot flashes, decreased muscle mass and more.
As the sex hormones estrogen (estradiol), progesterone, and testosterone lessen, shifts in bone health, protein synthesis, and muscle mass transpire in both sexes.
“There is this idea that only sex hormones age, but all hormones age,” Dr. Llano reported. Take, for example, declining cortisol, which hampers the body’s ability to react to stressors. Or changes to DHEA (considered an anti-aging hormone) levels. The adrenal gland shrivels, making low levels of DHEA, which compromises hormone function and can trigger dementia, osteoporosis, and cardiovascular disease.
Changes in sleep affect hormones as well. When melatonin is not secreted correctly, tiredness, increased weight and lack of energy result. Production of human growth hormone (HGH), which is critical for tissue and muscle growth, metabolism, cell division, strength, protein synthesis, and standard body structure, peaks during sleep. Growth hormone is paramount because of its involvement in the secretion of all other hormones, and a lack of it affects the body’s ability to carry out essential functions.
Other hormones, like cortisol, insulin, thyroid, follicle-stimulating, luteinizing, and parathyroid hormones, are equally susceptible to changes. However, not all hormones age proportionally or identically. For example, leptin (responsible for decreasing appetite and controlling weight) and the hunger hormone ghrelin do not decrease much. On the contrary, insulin – the only hormone that increases with age – causes insulin sensitivities, including glucose intolerance and diabetes.
Midlife Hormone Shifts
Menopause occurs in female patients around midlife and marks the end of the menstrual cycles. During this time estrogen dips suddenly, resulting in moodiness, hot flashes, sleeplessness, vaginal dryness and atrophy, as well as painful intercourse. Bone and skin health change as well.
According to Felice Gersh, MD (Irvine, Calif.), who is board certified in the practice of obstetrics and gynecology, as well as integrative medicine and an expert in menopause and hormones, “Estrogen-supported components of skin like fat, elastin and collagen levels change.” This can cause skin thinning, as well as an increase in wrinkles and dry skin. Chronic inflammation during menopause can also be attributed to low estrogen because estrogen regulates the immune system. “High levels of inflammation up-regulates 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT), increasing hair growth on the face and hair loss on the head,” added Dr. Gersh.
Men also experience hormone changes as they age, called late-onset hypogonadism. Unlike menopause, this shift results in a gradual decrease in testosterone. In addition to declining testosterone, male patients may also experience changes to androgen levels and the secretion of DHEA and DHEA-S. Symptoms from these changes can include muscle tone and mass changes, low libido and erectile dysfunction, low energy levels, depression, skin health decline and musculoskeletal deficiencies.
Is Hormone Replacement Therapy the Fountain of Youth?
Hormone replacement therapy (HRT) places power back in the hands of physicians and patients, and acts as a valuable tool to counteract the effects of aging.
Bioidentical hormone replacement therapy (BHRT) uses hormones that are most similar to those produced by the body to slow the negative effects of aging. However, BHRT is not a one-size-fits-all solution.
Jennifer Pearlman, MD, a medical doctor focusing on women’s health and wellness in Toronto, Canada, stressed the importance of customization so that each patient receives hormones to improve their specific symptoms. “Mammograms and vaginal ultrasounds, which provide accurate biomarkers of estrogen status, are necessary to determine any underlying malignancies in the breasts or uterine lining since both are hormone receptor-positive,” she explained. “Other hidden dangers and diseases, like hypothyroidism, may also be present and should be identified.”
Many doctors have hormones they prefer to administer to relieve a patient’s symptoms. “I give precedence to DHEA, growth hormone and testosterone for male patients, and estrogen for female patients,” said Jose Vazquez Tanus, MD, a board-certified integrative physician specializing in anti-aging and regenerative medicine in Ponce, Puerto Rico.
“In male patients, growth hormone must measure the insulin micro factor of insulin-like growth factor-1 (IGF1) and insulin-like growth factor binding protein-3 (IGFBP3); however, replacing growth hormone is controversial,” Dr. Tanus explained. “Integrating lifestyle changes can also help patients delay the decline of growth hormone and IGF1 secretion.
“ Female patients notice increased libido, plus other benefits when starting testosterone and estrogen,” Dr. Tanus continued. “Most patients see a difference in the body and brain. It helps those with dementia since testosterone improves focus, sharpness, brain health and memory.” BHRT can be administered via pellets, injections, topical creams, patches, vaginal suppositories and oral capsules. Dr. Tanus is a proponent of pellets, but not all physicians agree with this approach.
“In human physiology we never have a bolster of hormones that last a month,” Dr. Pearlman asserted. “Hormones work the opposite way; they have a rhythm and release profile,” she continued. So, her approach is to administer hormones via creams and patches instead of loading them up.
Dr. Gersh also favors transdermal methods like patches, gels and creams to deliver a steady dose of estrogen, progestin and testosterone for female patients, and testosterone for male patients. She uses other methods for non-sex hormones. “I usually prescribe a pill or another oral solution for thyroid hormone replacement. The goal is to create an environment akin to a patient at their healthiest via human identical hormones,” she noted.
BHRT injections are another modality. These weekly injections are a quick and cost-effective way to reestablish hormone levels but often result in dips by the end of the week
Some physicians, like Dr. Llano, use more natural approaches like supplements, diet and exercise to balance hormones. For example, clinical-grade supplements of melatonin and DHEA can protect against dementia, obesity, lipid metabolism, diabetes, atherosclerosis, and osteoporosis, and can elevate testosterone production in older male patients. “DHEA is one of the most important hormones to integrate into a treatment plan,” Dr. Tanus indicated. “I prefer supplements that increase the DNA chain’s length by reducing the loss of telomeres.”
Something that Dr. Pearlman often introduces is DHT supplements to treat low androgen and testosterone levels in female patients, as it helps to reverse the effects of hormone-related hair loss and thinning.
A well-devised nutrition plan can also help counteract age-related hormonal changes. Anti-inflammatory diets that incorporate antioxidant-rich fruits and vegetables may help improve metabolic function and insulin secretion. High-calorie restrictive diets may reduce obesity and improve longevity.
“Exercise is also critical,” Dr. Llano stated. “Patients who do not workout lose the ability to maintain hormone health. Routine exercise is essential for maintaining bone and brain health, and resistance exercise stimulates muscle protein synthesis. ”Newer technologies like PRP injections can also help declining hormone levels, according to Dr. Tanus. Extracting platelets from a patient’s blood allows the growth factors in the platelets to stimulate healing. “Platelets are regulated by estrogen, which accelerates vascular system healing. That is why older skin does not heal as well as younger skin,” Dr. Gersh commented.
Incorporating Hormone Therapies in Your Practice
Patients and consumers continue to invest in therapies that will improve their health span, making anti-aging treatments and therapies here to stay. While HRT can be a valuable addition to any practice, experience is paramount. “Patients should only receive bioidentical hormones from doctors well versed in the therapy,” stressed Dr. Pearlman. “When hormones are out of balance or taken in the wrong form, they can contribute to serious problems like estrogen-dependent breast cancer in female patients. Even though hormone replacement can be part of a successful anti-aging plan, there is liability associated with this type of therapy and it requires a skillful, experienced physician.” Dr. Llano suggests incorporating basic hormone practices with plant-based options for physicians interested in integrating hormone therapy into their practice. “Some schools teach how herbal supplements work and how to dose and administer them,” he shared. He also recommends physicians explore additional courses to learn about normal and optimal hormone levels.
Some doctors also partner with hormone experts and endocrinologists to offer services within their practice so that therapies can be provided under the watchful eye of an expert.