We see many people in their 50s, 60s, 70s and 80s who attribute their symptoms to aging. This idea may come from their physicians, who, in glib response to their questions about the origin of symptoms, respond “What do you expect? You’re 70 years old.”
It is an error to attribute physical decline to aging alone. Because chronological age is not reversible, blaming a condition wholly on age is tantamount to saying nothing can be done about it. Despite their age, we have helped many patients improve by implementing life enhancement programs, no matter how old. There is an enormous variability of function in people of all ages, and many important influences on function are not fixed, but modifiable.
Aging effects are mimicked by:
- Hormone deficiency
- Overweight
- Unrelenting stress
- Poor diet
- Nutritional deficiencies
- Drug toxicity
- Undiagnosed medical conditions
- Lack of exercise
- Non-productivity
- Musculoskeletal problems
Each of these factors can be addressed and improved. We look at all of them, and offer ways of correcting deficiencies and imbalances. Most people of middle or older age are prescribed three, four or more medications, all of which generate side effects, and in combination further aggravate symptoms. Fatigue, forgetfulness, and lack of energy are common consequences of drug therapy. When drugs are reduced or eliminated these symptoms improve. Drugs can be discontinued when lifestyle factors requiring their use are corrected.
Hormone replacement is one way to avoid the need for certain drugs, such as bisphosphonates for osteoporosis, sedatives for anxiety, and antidepressants for depression. We evaluate levels of sex hormones, which decline in both men and women, and include estrogen, progesterone, and testosterone. Other hormones we assess are thyroid, adrenal, and growth hormone. Optimal therapy includes various combinations of hormones, depending on the patient’s response to initial measures.
Both men’s and women’s response to hormone replacement can be rapid and dramatic. Improvements in energy, libido and cognitive function can occur within days, leading the individual to wonder why she/he didn’t look into hormone therapy earlier.
Cardiovascular benefits of hormone replacement are documented. Estrogen maintains arterial elasticity, preventing arteries from becoming stiff. Stiffness is the first measurable defect in arterial function. It precedes the onset of vascular events- heart attacks and strokes- by several years. Further, a recent study reveals a lower rate of rupture of brain aneurysms, a major cause of brain hemorrhage and paralysis, in women taking estrogen replacement therapy. In men, higher levels of testosterone, estrogen, and growth hormone are all protective against cardiac disease.
The gains from hormone replacement are so marked, so effective in deterring and even reversing the process of aging, that it is inappropriate to manage any patient with age-related conditions without exploring the benefits, along with the risks, of hormone repletion.