Thrive: Another shot at youth Patients swear by hormone-replacement therapies, but some doctors prescribe caution
By Ken Alltucker | The Republic azcentral.com
Every two months, Cari Yates goes to her north Phoenix doctor to get two pellets implanted in her hip. The pellets contain versions of estrogen and testosterone, and she says these every-other-month hormone treatments make her feel like a young, vibrant woman.
“It’s almost like turning back the clock,” said Yates, 48, of Buckeye. “I’m going from my 40s back to feeling like I’m in my 20s.”
Yates is such a believer in hormone-replacement therapy that she prodded her 53-year-old husband, a firefighter at Luke Air Force Base, to visit her doctor, Eric Honing. He’s now on a testosterone regimen that helped him recapture his youthful vigor, she said.
Such hormone treatments for men and women are increasingly popular among the Baby Boomers and others seeking the fountain of youth in a pill, pellet, patch or gel. These treatments are touted by anti-aging centers and some doctors as a way to battle the bulge and loss of muscle, strength, sex drive and stamina that may come with aging.
Doctors who specialize in these treatments say clients range from people seeking ways to boost sagging energy levels and libido to professionals striving for an edge with sharper focus. Although elite athletes such as Lance Armstrong have used testosterone to gain an edge over competitors, some doctors say that supervised use of hormone treatments can help in everyday life.
“You’ve got Baby Boomers who have always been driven and used to a way of life,” said Honing, whose clinic specializes in hormone therapy, fitness and sports medicine. “They want to make sure they are very proactive and take care of their health. This is what patients demand.”
Although hormone treatments such as testosterone, human growth hormone and estrogen for years have been the province of anti-aging clinics and the fringes of medicine, there are signs that more mainstream pharmaceutical companies are increasingly cashing in on the trend.
Drug companies have pitched ads directly to consumers about “low T” and encouraged them to ask their doctors about testosterone therapies. It must be working. Sales of testosterone gels and other hormones reached $1.7billion in 2011, a 24percent surge from the year before, according to IMS Health, a health-care technology and information company.
Possible health risks
Still, many medical experts and researchers doubt the benefits of these costly hormone treatments. They say there is little evidence that such therapies provide benefits for normal adults, and worse, may expose people to long-term health risks.
For every patient who receives testosterone or other hormone for a legitimate medical need, many others are getting treatments for questionable or lifestyle reasons that provide little medical benefit, they say.
“It is very difficult to differentiate real symptoms from some of the stuff that comes along with normal aging,” said Mitchell Harman, an endocrinologist and former president of the Phoenix-based Kronos Longevity Research Institute. “There is a downside to anything you give someone. Even a hormone like testosterone may cause problems.”
Harman ticked off the potential health risks associated with testosterone therapy. Sleep apnea can worsen, red-blood-cell counts may surge and risk of stroke may increase. AndroGel, the top-selling testosterone prescription cream for men, warns of side effects such as enlarged prostate, increased risk of prostate cancer and lower sperm count.
But doctors who offer testosterone, estrogen and other treatments say they carefully monitor patients’ blood counts to ensure proper health.
Honing, a former college-sports medical trainer who is board certified in family medicine and sports medicine, said he operated a conventional family practice years ago. He tired of shuffling through patients and writing prescriptions for common chronic diseases without making a meaningful difference.
When he began administering hormone treatments and counseling patients on proper nutrition and exercise, he said his patients began to feel much better. So he converted his practice to concentrate on hormone and anti-aging treatments.
He charges patients $395 for an initial 60-minute consultation that discusses the patient’s goals and potential treatments. He also orders blood tests to check hormone levels. Honing said a patient can expect to pay as much as $3,000 to $4,000 each year for comprehensive treatment, which includes office visits, lab tests, drugs and vitamins.
Although he does not accept insurance, he instructs patients on how to seek reimbursement from insurers.
Honing said most insurance plans reimburse for blood tests ordered at laboratories. He orders a lot of blood tests to keep close tabs on the patient’s hormone levels and blood counts.
Catering to menYates began exploring ways to feel better after she had a hysterectomy at 42. The mother of three lacked energy and gained about 20 pounds. Her doctor recommended she get an estrogen patch to counteract the symptoms she was experiencing after the hysterectomy, but she did not want to do that.
She visited Honing, who told Yates that her thyroid levels were imbalanced. He started her on the “bio-identical hormone” treatment that included estrogen and testosterone pellets from a compounding pharmacy. She said she also takes progesterone pills and vitamins.
She said the treatments helped recapture her energy. She revamped her diet to include fruits, vegetables and protein drinks. She exercises at a gym and has lost about 20 pounds.
Yates said she has been taking the synthetic hormones for about four years, and she has no immediate plans to stop the treatment. After starting testosterone, her husband has shed 30 pounds and now works out at the gym five days a week.
“I feel amazing,” Yates said. “It was a chain reaction. Once you get (hormone levels) balanced, the rest of your life falls into place.”
Although hormone replacement has been a popular treatment for post-menopausal women, some doctors say it’s gaining popularity among middle-age men who see testosterone levels dip during andropause, male menopause.
Mark Engelman, a Phoenix doctor who specializes in anti-aging medicine, said more doctors and drug companies are catering to men seeking hormone treatment. But he said there is disagreement in the medical community about what “normal” testosterone levels should be. Some anti-aging doctors may be more aggressive in prescribing testosterone for a patient whose levels may be considered normal by an endocrinologist, a doctor who specializes in hormones.
Engelman said doctors should evaluate a patient’s overall health, prostate-specific antigen levels (PSA) or family history of prostate cancer before starting testosterone. “What is normal and what is not? The scale is huge,” he said.
Harman, however, believes doctors who dabble in hormone replacement can be too aggressive in prescribing hormones that may carry dangerous side effects. “The medical field has gotten so difficult with insurance companies and so on,” Harman said. “This is just a way of bringing in some extra money.”
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