Frequently Asked Questions

Q: What is Age Management Medicine?
A: Age Management Medicine is the medical specialty that focuses on prevention and treatment of age related physical, mental and emotional changes, which may start after age 30. Age Management is a focus of study, rather than a new field of medicine, as information is drawn from all areas of science and medicine. Common age related changes include: increasing abdominal fat, loss of muscle mass, slower recovery from exercise & injury, declining sexual function, bone thinning, poorer skin quality, loss of strength and cardiovascular conditioning, slower brain function, decreasing energy and drive, declining memory, depressed immunity, increased susceptibility to infections, cancer, heart disease, stroke and diabetes, sleep disturbance and mild depression. Age Management encompasses education and medical interventions related to balancing & optimizing hormone levels, healthy nutrition, supplementation, vitamins & herbals treatments, exercise programs, anti-oxidant and other cellular protective medicines and general preventative medicine. We are also studying gene and cellular manipulation for future treatments.

Q: What does "bio-identical hormones" mean?
A: Most hormones used to prevent or treat deficiencies can be classified as "synthetic" when their chemical structure resembles, but is not the same as, the human hormone. They are "bio-identical" when they match the exact chemical structure of their human hormone. Bio-identical hormones are typically safer and better tolerated than the synthetic derivatives. The goal is to use the same hormones as your body uses at levels it remembers in youth.

Q. How are the hormones replaced?
A. Testosterone can be replaced using a topical gel with individualized dosing, determined by your physician. The gel is applied around the neck and collarbone area once or twice per day. The other option is weekly injections in the clinic (or at home after we instruct you with proper technique). Growth hormone is taken by daily injection in the skin, it’s a tiny needle. Thyroid and melatonin are taken by pill orally. DHEA and Pregnenolone are available by prescription gel or oral forms.

Q. What results can I expect from this program?
A. In general you can expect:
Week 1-4:
Increase in mental sharpness, general feeling of well being, more energy and drive - which carries over into personal and professional activities. Improved confidence and competitiveness. Increased sex drive, spontaneous morning erections and improvement in mild depression that many men experience with hormone decline.
Weeks 6-12:
Increased strength and stamina. Improvement in workouts, cardiovascular conditioning and physical activity. Continued mood & energy improvements, libido/sexual performance and well being.
Weeks 12 & beyond
Measurable body composition changes. Decreased abdominal fat, increased lean muscle mass, slow increase or stabilization of bone mass. Slight organ re-growth and improved function in the elderly (our organs shrink as we age). Decreased risks of diabetes and heart disease, Alzheimers and possible improvement in blood pressure and cholesterol.

Q. Will hormone therapy help sexual performance, erectile function or sex drive?
A.Yes. Hormone therapy, particularly testosterone, has a definite effect on sex drive and improves erections in most men. Growth Hormone also has been shown in some studies to improve sexual function. Imbalances of hormones (Too much estrogen and/or progesterone, or thyroid abnormalities) can also contribute to sexual dysfunction. You may also talk to our physician about Viagra or Cialis, which improve blood flow to the genitals and improve erections. We consider improving sexual function as part of our Age Management program. It is important to rule out other causes of sexual dysfunction first.

Q. Are hormone replacement therapies safe?
A. Yes. Studies have been published with increasing scrutiny over the last 10 years, which have attested to the safety of natural hormone replacement for men. We use bio-identical hormones in our therapy, hormones that are the same as the body naturally produces. These tend to be safer and more predictable than synthetic hormone derivatives. Hormone therapies may have significant side effects if not properly dosed and monitored. Patients need to seek an expert in hormone replacement, general doctors do not receive in depth training in this area.

Q. What about prostate Cancer?
A great body of research has demonstrated testosterone and HGH replacement do not cause prostate cancer. Prostate cancer is most likely related to genetics, lifestyle, chemical/environmental exposure and possibly estrogen. Poor prostate health is more closely related to changes in estrogen. Men with prostate enlargement should inform their physician before treatment as this could worsen, particularly with an elevation of estrogen (and possibly DHT).

Q. Are there side effects to hormone treatments?
A. If hormones are properly medically monitored with frequent visits and laboratory testing, the treatments are safe and effective. Most side effects occur from improper dosing and management. In the case of HGH, most reported side effects are related to water and salt retention. There is a mild decrease in insulin sensitivity in some individuals that is avoided by proper nutrition and monitoring. Because we don’t have enough studies on HGH use in patients with cancer, Premier Age Management clinic does not give HGH to patients who have a history of cancer, even if they are deficient. HGH is also not used in patients with severe diabetes or proliferative retinopathy. Thyroid hormones are delicate and require frequently monitoring. This is why it’s essential to partner with a competent and certified Age Management physician. Patient safety is our primary concern.

Q. When should I consider hormone replacement or at least being tested?
A. In the average male, hormones decline at variable rates after age 30. By age 35 declines could be sufficient that symptoms are evident in some individuals, but this not the rule. The best time to be tested for hormone deficiency is around age 40. However, the older, and more deficient the individual, the more benefit they will see with treatment. There is no age limit to the benefits of treatment though we suggest starting as early as possible before the deficiencies have effected the patient for years.

Q. What are the benefits of replacing more than just testosterone?
A. The optimal hormonal treatment is to return the body’s hormones to more youthful levels and in balance. Testosterone is only one of several hormones that decline in with age. The benefits are greater when all modifiable hormones are balanced. Patient safety is always the primary concern, above all else, do no harm. By denying the benefits of hormone replacement to deficient patients, harm is already being done.

Q How long is the program?
A. The Age Management program is 1 year but we encourage our patients to continue because the benefits continue for life if you continue the treatments. Once the medicines are stopped, hormone levels will return to deficient levels and symptoms are likely to return. These treatments typically take 6 months for their full physical, mental and emotional effects.

Q: Is Hormone Replacement Therapy with HGH (Human Growth Hormone), testosterone or other hormones expensive?
A: Testosterone therapy is inexpensive. The cost depends on the dose and the pharmacy used. Generic testosterone can cost $20/month. Pregnenolone, DHEA and melatonin are also inexpensive, approximately $20 per month combined. If HGH is recommended, the cost is now $300-$350 per month. There is a cost/benefit determination that must be considered by the patient. Cost is one of the major reasons this treatment is not universally recommended. In time, we may see the price decrease. If sermorelin (growth hormone releasing hormone) is used in place of HGH, the cost is around $150/ month. A Physician- supervised program guarantees appropriate medication dosage, quality and potency. Do not consider any medicine that is not from an accredited pharmacy.

Q: Do Health Insurance Plans cover Age Management programs?
A: At Premier Age Management Clinic, your screening visits will be submitted to insurance. You are only responsible for your co-pay. If you become an Age Management member, you may submit the annual program fee and medicines to a flexible medical spending plan. Most insurance will not cover the medicines or visits if the focus is Age Management and Healthy Aging. The focus on traditional medicine and insurance companies are treating existing disease.

Q. Do non-prescription GH or testosterone supplements advertised actually work?
A. There are some products than may increase testosterone slightly but nothing remotely close to the prescription medicine. Be ware of testosterone boosters that do nothing for your actual testosterone, your often wasting your money. There may be stimulants or other ingredients at work. Product advertisements that state they can increase growth hormone levels are inaccurate. This is also a waste of money. HGH cannot be absorbed through the membranes of the mouth, skin or digestive system.

Q: Are these treatments the same as steroids abused by some athletes?
A: No. Testosterone is an FDA-approved medication used only for documented testosterone deficiency. The testosterone used at Premier Age Management is bio-identical, the same as your body produces. Although testosterone’s base molecular structure is a steroid, its indications are not the same as the illegal steroid drugs which are often derivatives of testosterone. Growth Hormone is not a steroid. Growth Hormone is used only in patients who are deficient by laboratory analysis with appropriate symptoms. We do not prescribe hormones to bodybuilders or anyone looking for isolated improvements in sports performance.

Q: Why choose Premier Age Management Clinic?
We are focused on your health, your safety and your results. This practice is focused on medicine, not business. Dr. Kocka has a personal passion for age management and optimal health. Being a former national bodybuilding champion and competitive mixed martial artist (About Dr. Kocka), he has both the practical and medical knowledge that most physicians can’t provide their patients. As you will see, we also go the extra mile with individualized treatments, more frequent visits and lab tests, email updates on new treatments and research, and a friendly professional atmosphere where the focus is on you.

Q: How can I start or make an appointment?
A: Please call our office at (216) 520-1220. We will answer all your questions and schedule your consultation.