12 January, 2015

A new article reviews the effects of age-related hormone decline on the aging process and age-related diseases such as sarcopenia and falls, osteoporosis, cognitive decline, mood disorders, cardiovascular health and sexual activity [1]. Information on the efficiency and safety of hormone replacement protocols in aging patients is provided as well. Anti-aging therapies are a huge business world-wide, and this reflects a human desire to fight nature and prolong longevity. During the last 20 years, a multitude of anti-aging practices have appeared, aiming at retarding or even stopping and reversing the effects of aging on the human body. One of the cornerstones of anti-aging is hormone replacement. Women live one-third of their lives in a state of sex hormone deficiency, whereas men are also subject to age-related testosterone decline, but andropause remains frequently under-diagnosed and under-treated. Due to the decline of hormone production from the gonads in both sexes, the importance of dehydroepiandrosterone (DHEA) in steroid hormone production increases with age. However, DHEA levels also decrease with age. Also, the age-associated decrease in growth hormone may be so important that insulin growth factor-1 levels found in elderly individuals are sometimes as low as those encountered in adult patients with established deficiency. Skin aging, as well as decreases in lean body mass, bone mineral density, sexual desire and erectile function, intellectual activity and mood have all been related to this decrease of hormone production with age. Great disparities exist between recommendations from scientific societies and the actual use of hormone supplements in aging and elderly patients.

Comment

Before getting into the heart of the matter, one must define several key parameters. Brüssow gives the accepted definitions of health, aging and healthy aging [2]. Health, according to the 1948 WHO definition, is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Aging is a progressive decline in structure and function of the body, or regression of physiological function accompanied by advancement of age. The definition in the Nurses' Health Study for successful aging was as follows: being free from 11 major chronic diseases (such as cancer, cardiovascular, pulmonary, renal, Parkinson’s disease), no cognitive impairment, no physical disabilities, no mental health limitations [3]. The pivotal physiological change throughout the perimenopause is the decline in estrogen and progesterone production, whereas an abrupt, substantial decrease in all sex hormone levels follows castration. This creates a significant deficiency state to which the body must adapt. The associated metabolic alterations may therefore be regarded as induced by the menopause but, in fact, in most cases the effects of aging itself are the main underlying factors. Nevertheless, it has always been tempting to believe that treating menopausal women with estrogen replacement will change the hormonal milieu, correct the deprivation state and reverse not only the menopause-related but also the age-related physiological processes. This is very logical, but does this work in real life?

What is actually the meaning of anti-aging therapies? Are we treating a disease of aging or aging itself? Do we aim at becoming physiologically younger or just feeling younger? Could prevention of the chronic diseases of aging, or reducing the risk of such diseases be considered as an anti-aging intervention? I guess there is no straightforward answer, and certainly there is no consensus over these issues. Scientists would say that we have not reached a state of knowledge that could be implemented into arresting the aging process, but the most we can do is just to slow down certain domains of aging. How should we measure anti-aging effects? One way might involve a serial follow-up of telomere length, which negatively correlates with age [4]. Any intervention which slows the telomere shortening over time may be considered as an anti-aging approach. For example, better adherence to the Mediterranean diet among the Nurses' Health Study participants was associated with greater telomere length [5]. However, there is probably no correlation in regard to telomere length and menopauseper seor the use of hormone therapy [4]. Needless to say, many are doing business and making profit from the advertisement and practice of various anti-aging interventions. A web search for the term 'anti-aging' yields tons of citations which are impossible to track or summarize, though I liked one recent article that highlighted the principal problematic issues associated with the concept of anti-aging [6].

Do we have enough good-quality clinical data to support any alleged anti-aging properties of estrogen in menopausal women? Strangely enough, but perhaps not, a PubMed search for such clinical information yields only 49 hits, of which many are irrelevant to the current discussion. The most popular item among those publications relates to potential rejuvenation of the skin by estrogen. This actually means that the well-proven and important anti-fracture, anti-atherosclerosis and possibly neuroprotective properties of estrogen are covered by the medical community within the context of preventive medicine rather than within the framework of anti-aging. In conclusion, the disputed issue of anti-aging therapies cannot be resolved at this stage. Nevertheless, I thought it deserves aMenopause Livecommentary, being a real life issue that cannot and should not be ignored by menopause specialists because of its popularity and use among postmenopausal women.

Amos Pines

Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

References

1. Samaras N, Papadopoulou MA, Samaras D, Ongaro F. Off-label use of hormones as an antiaging strategy: a review. Clin Interv Aging 2014;9:1175-86
http://www.ncbi.nlm.nih.gov/pubmed/25092967
2. Brüssow H. What is health? Microb Biotechnol 2013;6:341-8
http://www.ncbi.nlm.nih.gov/pubmed/23647782
3. Sun Q, Townsend MK, Okereke OI, et al. Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study. BMJ 2009;339:b3796
http://www.ncbi.nlm.nih.gov/pubmed/19789407
4. Pines A. Telomere length and telomerase activity in the context of menopause. Climacteric 2013;16:629-31
http://www.ncbi.nlm.nih.gov/pubmed/23808382
5. Crous-Bou M, Fung TT, Prescott J, et al. Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study. BMJ 2014;349:g6674
http://www.ncbi.nlm.nih.gov/pubmed/25467028
6.https://www.fightaging.org/archives/2002/11/what-is-antiaging.php