- Annie Internicola
Everyone has their "certain age." For Deborah George Gold, it was 46. "What I noticed is, I started losing my memory. I was beside myself, because I would be sitting at my computer looking at a spreadsheet, and I would have no idea what I was working on." Although she wasn't having the classic menopause symptoms such as hot flashes or trouble sleeping, Gold was visited by mood dips, faint libido, and low energy—perhaps the handmaidens of perimenopause, the hormonal wind-down period that precedes the finale of the menstrual cycle. "I ended up at my gynecologist's office, crying. I wasn't leaving there without something." The year was 2003, and the solution at the time—despite a massive $91 million Women's Health Initiative study in 2002 linking it to a greater risk of heart attacks, breast and endometrial cancer, blood clots, and stroke—was synthetic hormone therapy (HT). Her doctor prescribed Premarin. "It helped a little at the beginning," says Gold, "and then I felt like crap again." She started researching on her own and found a hopeful answer: bio-identical hormones, touted as a "natural" therapy because their chemical makeup, derived from plants, is considered identical to the hormones that the human body manufactures. "It took a little time to get the mix right," says Gold of the balancing act of estrogen, progesterone, and testosterone, which she rubs onto her skin in the form of a transdermal cream. She doesn't mind that, at 57, she still gets her period. "I've got my life back. I have energy, and I have my libido, which is great. I feel like a million bucks."
Wanted: A Fountain of Youth
Despite our best efforts, we're all aging. For some it's a peaceful process, and for others it's a life-changing affront—Mother Nature's ultimate insult. As the baby-boomer generation rounds the corner toward more golden years, many want a cure for aging and they want it now—preferably in the quick-fix form of a pill or potion—and the need has given rise to a burgeoning field of health care. Anti-aging medicine quietly crept onto the medical scene about 15 years ago, and lately it's making its way into more doctors' offices and take-home brochures. Practitioners offer a mixed bag of treatments ranging from preventive care against aging-related diseases, to supplements and nutraceuticals purported to ward off aging, to bio-identical hormone therapy (BHT) for both men and women, à la Gold's experience. Never mind the fact that anti-aging medicine is not recognized as a medical specialty by big-player organizations like the American Medical Association. The field finds a unifying body in the American Academy of Anti-Aging Medicine (A4M), which trains and accredits physicians to practice in the arena. Gaining popularity as a side-dish offering by integrative and functional medicine practitioners, endocrinologists, and a few OB-GYNs, anti-aging medicine is finding its niche, and its fans. It even has a celebrity spokesperson in the 1970s sitcom actress Suzanne Somers, newly incarnated as a "health expert" and looking eerily wrinklefree and dewy at 67. "Aging gracefully?" asks the back-cover copy on Somers's book Bombshell (Harmony, 2012). "How about not aging at all!"
Naturally—or unnaturally, as the case may be—the anti-aging movement has attracted its share of controversy. While the field's championing of preventive measures, like regular exercise and a healthy diet, is unassailable, its promotion of BHT, along with so-called youth-restoring nutraceuticals like adrenal extracts and red yeast rice, hasn't earned widespread acceptance by the larger medical establishment. Many doctors hesitate to jump on the anti-aging train because the field has precious little clinical data behind it. Bio-identical hormones are a case in point: Since they're formulated by small compounding pharmacies rather than by the large pharmaceutical corporations, Big Pharma has no reason to invest millions of dollars into their research and development. And since small compounding pharmacies don't (as of yet) fall under FDA jurisdiction, the BHT products they produce are of varying quality; some experts say women are risking their health by taking them.
"There's a cohort of people who suggest that bio-identicals are safer than the pharmaceutical-brand estrogen and progesterone, but there are very little data to support that," says Amy Novatt, MD, an OB-GYN with Mid-Hudson Medical Group in Rhinebeck and Kingston. "The idea that they are risk free, I don't agree with that. I think they have the same potential risks as synthetic hormones. Not because I know that for sure, but because I don't know—there aren't enough data yet." Novatt does prescribe the hormones, both synthetic and bio-identical, with a few caveats. "I think they're a wonderful option for women who are really struggling, and who might have tried other approaches without success. But they're not something that should be given across the board to all women. They're not the panacea for aging. They should be used with caution like any other medication."
The Hormone Doctor Will See You Now
Govind Gill, MD, an endocrinologist who practices anti-aging medicine in Poughkeepsie, and who prescribes bio-identical hormones to youth-seeking patients, thinks differently. "Gynecologists have a very myopic view of hormones. They think hormones are for the uterus, for reproduction, and that's it. I call it a utero-centric view. But we have estrogen receptors in the brain, the bones, the skin, the heart," says Gill. "The paradigm used to be that our hormones are coming down because we are aging. That paradigm is reversed now. We now believe we are aging because the hormones are coming down. If you believe this paradigm, then the obvious question is, by replacing the hormones can you prevent the aging or slow it down?" A lack of clinical data for BHT doesn't deter Gill. "You have to define what is evidence-based medicine. As far as the pharmaceutical industry is concerned, their definition of evidence is a $91 million randomized, placebo-controlled study. I'm a biochemist by training and by practice. To me, evidence is based on biochemical pathways. If I can understand by a biochemical pathway that this is working, I don't need a $91 million study."
Anti-aging medicine might be new in health care, but researchers have been looking into it since at least the 1970s. On a cellular level, what they've found is that aging happens with a decrease in the length of the telomeres—the compound structures at the end of a cell's DNA. During a cell's lifelong cycle of replicating and regenerating, it eventually starts to make errors; ultimately, the cell goes into senescence and breaks down. Hormones, among other things like anti-inflammatories and antioxidants, are one of several factors that some researchers believe can help prevent this cellular breakdown. So by restoring hormone levels back to the youthful state, can we bring back youth? "Well, not exactly," says Gill. "But we can sort of mimic the effects we had in the youthful years when the hormones were raging." Along with women, Gill treats men who are nostalgic for those hormone-raging days. "Men are as much interested as women in increasing their youthfulness, vitality, performance, and so forth. Men need testosterone and women need estrogen, though we each have the other's hormones and we need both." Like Viagra, bio-identical testosterone therapy can increase libido and virility, but it works differently than a pharmaceutical drug. Anti-aging doctors say that it's more of a natural fit, making use of the hormones' lock-and-key cellular mechanism.
"Natural" is, of course, relative here. "Anti-aging is interventional medicine, I wouldn't deny that," says Gill. "You are intervening in a natural process. If you want to leave it alone, please leave it alone. The patients who come to me, they don't want to leave it alone. They cannot accept that 'I'm 55 or 65 and I can't jog,' or do this or that. I'm here to help those people."
In Defense of the Wisdom Years
Susun Weed, herbalist and director of the Wise Woman Center in Saugerties, has been writing and speaking about aging—particularly women's aging—since before 1992, when she wrote New Menopausal Years: The Wise Woman Way (Ash Tree Publishing). Her teachings are all about staying fit, hale, and healthy at every stage of life, but she is not anti-aging. She's pro. "If you eat well and have vigorous exercise in your life, you will live longer, and if you live longer, you will get old," says Weed. "Getting old is the reward. I think what we need is different adjectives. Excitingly old. Deliciously old. Stunningly old. Sexily old." Naturalists like Weed don't agree that rubbing on a transdermal cream, taking a sublingual pill, or injecting a hormone are the right ways to intervene in the body's sunset years. For menopausal women, she offers a gardenful of herbal remedies—such as motherwort tincture, nettle and oat straw infusions, and vitex tincture—to counteract the hot flashes, brain fog, and other difficult symptoms. "I've been telling women for over 20 years that bio-identical hormones are even worse than synthetic hormones," says Weed. "These are experiments on women, and no one is tabulating the results."
Yet it's not about sitting back and doing nothing while you slowly grow decrepit. It's about being proactive. "I think it's wise for us to not want to be senile or debilitated," says Weed. "There are preventive things that we can all do to help us be vigorously healthy at any age. You can take steps—and when I say steps, I literally mean steps." Weed, who is nearing 70, loves her Fitbit—a pedometer that runs on Wii technology. Her goal is 6,000 steps a day. Weed is also an outspoken proponent of herbal infusions made with plants like nettle and red clover, lavish with vitamins and minerals; she claims that drinking a quart a day can not only prevent many age-related diseases but also even reverse longstanding conditions like diabetes and osteoporosis. Without any clinical data to support this, she points to an online community, the Wise Woman Forum, for anecdotal evidence. But perhaps her juiciest advice centers around sexual health: "Did you know that the clitoris is the only part of the human body that never ages? So if you're looking for anti-aging, it is literally at your fingertips, ladies." Weed prescribes seven orgasms a week for all women. "You do that, and your body will make all the hormones it needs. You are never too old for this therapy, and it's free!"
Meanwhile, the anti-agers hold fast to their bio-identicals. Gold, who has been doing BHT for the last seven years, is evangelical about its benefits: better memory, great energy, healthy skin and hair, a flat stomach—the list goes on. And Gill walks his talk: He says that he, too, takes the hormones he believes in and prescribes. But you don't have to balance your biochemistry, boil herbs, or buy a vibrator to agree with the preventive bottom line: To thrive through aging, we need to be more active, and more nourished.