Can Doctors Really Turn Back Time?

SPECIAL TO THE TIMES

Never mind growing old with dignity. You can do better, say doctors who now treat aging as a disease. You can grow old with daring, with drive, with a good forehand and a lush libido. Enter a marathon instead of a nursing home. Be good in bed rather than confined to one. At the very least, say these doctors, give yourself the chance to travel, learn, truly "live," well into your 70s, your 80s, even beyond.

"Aging is a terminal disease, and there's no cure for it," says Ronald Klatz, an osteopath who founded the Chicago-based American Academy of Anti-Aging Medicine. "But we are showing that it is a treatable disease. You don't have to be crippled and decrepit after age 65. You can be as strong and mentally alert as someone 20 years younger. That's a very positive and optimistic view of aging."

Since its founding in 1993, the A4M, as it is known, has grown from 12 members to more than 8,500 in 55 countries, including cardiologists, anesthesiologists, osteopaths, plastic surgeons, family doctors, chiropractors, even a clairvoyant. What are their secrets for reversing age?

They are almost too many to name. Vitamins, enzymes, B-12 shots, omega-3 oils, herbs, nutraceuticals, bioflavonoids: whole shelves of supplements. Then there are special diets and exercise programs, stress-reduction techniques, and simply listening to patients.

But the meat in any anti-aging sandwich is a controversial treatment called hormone replacement therapy, or HRT. Its logic is easy to understand.

After age 25 or so, our glands secrete less and less of several valuable hormones. These include human growth hormone, or HGH, which helps cells grow, divide and repair themselves; melatonin, which synchronizes sleep and waking cycles; testosterone, which helps keep bones and muscles strong; and DHEA, whose levels soar when the body is most healthy.

The levels of these hormones don't crash, as estrogen levels do during menopause, signaling the end of a woman's reproductive life. Rather, they decline gradually, shadowing the physical decline of age closely enough to prompt some doctors to propose that, in effect, hormone loss is aging. Young people whose bodies make lower-than-normal amounts of HGH, for example, look as weak and listless as elderly people; the same goes for young men who aren't producing normal levels of testosterone. From here it is a very short step to replacement therapy. With the development of mass-produced versions of these body chemicals, anti-aging practitioners have made them available to consumers--HGH (injections), testosterone (injections, patches and, soon, a gel), melatonin and DHEA (tablets).

The Siren Song of Renewed Youth

"If you're going to do it [hormone replacement]," says Fouad Ghaly, an anesthesiologist who has an anti-aging practice in Torrance, "you really should take all the hormones together. The hormone replacement is most effective when you replace everything. It should be a symphony."

And clients are waltzing to the music, from senior citizens down to the tail end of the baby boom.

"This is the fountain of youth, I'm telling you," says Michael Watson, 66, who's been taking dozens of supplements, along with the hormone DHEA. "I started on this about five years ago, and I feel great. I play racquetball three times a week, and since I've been on this anti-aging program I've been able to play very well, very aggressively, even beat guys 10 or 20 years younger."

Jane Schnall, a 55-year-old Rancho Santa Fe woman who has struggled with osteoporosis, now takes 85 pills a day, plus a shot of HGH.

"I feel stronger, my workouts are much better, my osteoporosis gone, people say I look better, and I think my doctor is a genius," she says.

And no wonder. The effects of testosterone (in men) and of HGH (in men and women) are, by most accounts, immediately noticeable: weight loss, increased muscle mass, stronger bones, and an almost immediate bounce in mood.

Yet the testimonials and optimism mask several hard realities. First, HRT is very expensive. The initial checkup and hormone blood tests cost anywhere from $1,000 to $5,000, depending on the doctor and the number of tests performed. Regular injections of HGH run from $300 to $1,000 a month, based on the dosage. Throw in an additional $100 or $200 a month for other supplements, and you're up to $12,000 to $15,000 for the year--and counting. To realize and sustain the benefits of HRT, you have to keep anteing up.

"Once you're committed, you're committed, and it is costly," says Alan Brauer, who runs a thriving practice in Palo Alto. Brauer says most of his patients are white-collar professionals from the Silicon Valley with high disposable incomes. "One of the new groups I'm seeing in here are males in their mid-30s who've sold their successful dot-com ventures, who have plenty of time and money, and no family, no kids. They're looking around for another project to devote themselves to, and what better project than themselves?"

Going Mano a Mano With Father Time

The second drawback is biology itself. No hormone can turn back time. Despite some of the marketing claims--"scientists have proven that 10 to 20 years of aging can be reversed in less than a year," reads one doctor's Internet site--there's no evidence that HRT has extended anyone's life by a single day. Injections of growth hormone often make people look and feel fitter, for instance, but they don't seem to be any stronger. Only weight training can do that, and there's no evidence that taking HGH even enhances muscles' response to pumping iron.

The reputation of DHEA as an anti-aging elixir rests largely on a study released by UC San Diego researchers six years ago, in which investigators trumpeted large boosts in feelings of well-being for healthy older men and women taking DHEA pills. Many endocrinologists were skeptical at the time, and indeed a longer-term 1999 trial found no such lifts in mood from DHEA.

As for melatonin, its mildly sedating effects are barely distinguishable from those of a sugar pill, endocrinologists say.

The most promising of these hormones may be testosterone. Older men taking it quickly recover sexual potency, a leaner body, and, with exercise, become stronger than they may have without the hormone. But investigators still don't know enough to say whether these benefits translate into a longer life or even a significantly healthier one.

Finally, HRT's long-term risks are a wild card. This may not bother an 80-year-old who's trying to buy a few more good years. But it's very relevant to a healthy 50-year-old who might have 20, 30 even 40 years left.

"I'm not worried about DHEA and melatonin--they're pretty innocuous," says Lawrence Frohman, a hormone researcher at the University of Illinois, Chicago. "But growth hormone and testosterone are potent hormones, and the potential for long-term problems is very real." The big knock against testosterone is its link to prostate cancer: The hormone could accelerate the growth of prostate tumors.

"Certainly there's the possibility that testosterone could make a slow-growing cancer more aggressive," says Ronald Swerdloff, chief of the division of endocrinology at the Harbor-UCLA Medical School.

Side effects of HGH treatment include carpal tunnel syndrome, diabetes, and pooling of fluids in the skin that, over time, may lead to high blood pressure and heart failure.

"Some of these effects are reversible if you bring down the dosage," says Paul Fitzgerald, a clinical endocrinologist at UC San Francisco, "but there's a group of people out there who will go to any lengths to look younger, take any risk, and who will escalate to very high doses."

A Troubling Dearth of Treatment Standards

The unknowns might be less worrisome if anti-aging doctors were predominantly endocrinologists with proven clinical records. They aren't. The A4M does conduct a certification exam, requiring at least five years' experience treating patients and 200 hours of study, with a strong emphasis on the endocrine system. Though not recognized as a specialty by the American Board of Medical Specialties, anti-aging certification at least establishes standards for treatment and dosage. Yet most A4M members are not board certified.

"We have some very good people," says Klatz, A4M's president. "But like any profession, there are people with checkered pasts."

This is one reason why mainstream academic researchers, along with scientists at the National Institute on Aging, have been skeptical of anti-aging practitioners; such a lucrative opportunity, they suspect, very likely has attracted doctors who are prescribing hormones carelessly.

"Allow me to put it this way," says Thomas Perls, director of the New England Centenarian Study and chief of gerontology at Beth Israel and Deaconess Medical Center in Boston. "I think these anti-aging guys are hucksters and snake oil salesmen. They paint a very grim picture of old age that just does not match the reality. . . . The retirement years can be a most wonderful time of life, if you take care of yourself, exercise and watch your diet. I wonder how much these anti-aging doctors really understand about aging."

Many anti-aging doctors, for example, determine a client's HGH level by taking a single blood sample and sending it to a lab to be tested for something called IGF-I. Growth hormone naturally stimulates production of IGF-I, and low levels of one usually reflect low levels of the other. Usually--but not always.

"The IGF-I test is not a reliable test for growth hormone," Fitzgerald says. "A person's blood may show very low levels of IGF-I, yet they are still able to produce significant amounts of HGH. We see it all the time."

For this reason, Fitzgerald says, anyone using IGF-I tests to determine supplemental doses of growth hormone must monitor patients closely for possible side effects, such as signs of prostate growth. Many careful anti-aging doctors do just that. But some have prescribed hormones to people who visit from out of state, then left it to the patient to arrange checkups back home.

The result, Fitzgerald contends, "is that we now have hundreds of men and women who are participating in a large, uncontrolled study of the long-term effects of hormone therapy."

And as uncontrolled as it is, this is one experiment whose results will affect us all. As anti-aging doctors might tell their patients, few Americans want to go gently into that good night. We may or may not age with dignity, but we won't go without a fight, and the practice of anti-aging medicine is likely to grow along with its swelling demographic base. Taking hormones may be more expensive and risky than exercising and eating right; but it's a whole lot easier, and there's no shortage of people willing to give it a try.

Indeed, A4M's Klatz suggests that the public may be ahead of the traditional medical establishment in its acceptance of the notion of aging as a "treatable disease."

"People don't want to be weak and sick when they're older, and that's why they come to us," he says. "I don't think we've educated all our medical colleagues. . . . It's going to take some time and more experience."

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Living Longer

Life expectancy for U.S. men and women based on birth year.

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Source: National Center for Health Statistics

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