Geriatricians constantly ponder whether supplementing hormones is a good idea. Various estrogens, progesterones, testosterones and human growth hormone are considered.
The Women’s Health Initiative (WHI), a decades long landmark study begun in 1991, gives us some information on the effects of postmenopausal female hormone replacement. The study was imperfect. Parts of it ended prematurely because of poor outcomes in some study arms. There remain many unanswered questions.
WHI did make it clear that progesterone therapy significantly increases breast cancer rates, heart attack rates and blood clot rates such as pulmonary emboli to the lungs that can be fatal. That arm of the study was stopped for obvious reasons.
Today almost all agree progesterone is to be avoided if possible. If given, for example, to help with sleep (often very effective) or reduce endometrial cancer risk in women taking estrogen (considered important by some), the risks must be carefully considered.
Estrogen by itself, especially in women who have had hysterectomies, looks much better. It does reduce bone loss and hip fractures and cuts colon cancer rates, disorders that should shorten lifespan and health span. That’s good.
Estrogen probably has no effect on breast cancer risk and may actually reduce that risk. However, it increases endometrial cancer rates slightly and perhaps blood clot rates.
WHI gave no definitive answer to questions about estrogen and longevity. The “estrogen only” arm of the WHI still goes on and may eventually answer these questions, but estrogen is promising.
Most of the data we have on estrogen’s benefits and risks were done in studies using conjugated equine estrogen (Premarin), a combination of estrogenic compounds, mostly estradiol and estrone. Some find its horse urine origin disturbing, but the product is actually quite good. Estrogen also comes in skin patches and gels which have some advantages and usually use just synthetic estradiol.
Testosterone has been tested in both men and women. Many older men are testosterone deficient and in them the hormone clearly improves quality of life. It improves energy, libido and erectile function. It makes drugs like Viagra work better. It builds bone and muscle mass, decreases body fat and corrects anemia. It may slow memory loss. However, it’s possible effects on the risk and growth of prostate cancer are of concern.
Testosterone pills should not be given to men. Given that way the drug goes through the liver and in the high doses men usually need can cause hepatitis. Topical products and shots every few weeks are the routes of choice, the shots being much cheaper.
Testosterone levels in women are always much lower than those of men, but testosterone supplements in women can have similar beneficial effects. Levels of testosterone in women also drop by about 50% between age 20 and 40. Post menopausal testosterone levels may go down further, or may instead go up a little. Supplements can help with libido, muscle loss and the age related frailty we see commonly in elderly women. It can be given orally (smaller doses) or topically on the skin.
Another hormone that gets a lot of press is Human Growth Hormone (HGH). The pituitary, a pea sized gland at the base of the brain makes HGH. It is very important in childhood where it drives growth, so healthy children have high levels. It falls off rapidly in adulthood and slowly drops further as we age.
HGH can be easily measured and there are some adults who are very deficient, usually because they have had a problem with or had surgery on their pituitary gland. They should get the drug, but most healthy seniors have normal adult levels.
As to whether HGH could help healthy seniors, the evidence is mixed. It can build muscle mass and reduce body fat some, but improved strength and longevity have not been shown. HGH can cause diabetes, carpel tunnel syndrome, spinal stenosis and other problems, so we tend to avoid it.
HGH must be given by injection, there is no pill form. There are pill “supplements” sold that claim to raise HGH levels, but there is no proof they do so. Don’t be fooled.
Whether or not seniors should take hormone supplements is complex. Blood levels of these hormones can and perhaps should be measured. A discussion of the use of estrogen, progesterone, testosterone and even HGH should then be done in depth with your physician. The choices are numerous and must be individualized taking into account the risks and benefits in your particular case.
Live long, be well.
Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance www.skyparkpfc.com. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital. Email questions and topic suggestions to [email protected]
or call 310-378-6208.
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