Physician Directed Age Management and Hormone Replacement for Men

Hormone Replacement Therapy

Hormonal treatment for male andropause is focused on replacing your body’s own deficient hormones. The goal is to replace these natural hormones, in balance, to youthful levels. There are several important hormones you may receive at Premier Health Clinic’s Age Management Program. Our physician prescribes bio-identical hormones, natural hormones that are molecularly identical to the hormones in your body. Prior to any prescriptions for hormone medicines, we perform a comprehensive blood and/or urine analysis which identify deficiencies and give clinical information about general health. Once patients are using the hormones, we perform frequent laboratory testing to ensure the safety and efficacy of your treatment (Click here for an example of the first year’s visit schedule). All hormone prescriptions and individualized replacement plans are directed by our accredited physician. Patients are given nutritional and exercise guidance to maximize the effect of hormone replacement as these strategies work together to give our patients the best results and medical benefits.

Bioidentical hormones are produced by licensed compound pharmacies, which specialize in hormonal medicines. You can not purchase bioidentical hormones from a regular pharmacy and these treatments are not available at regular medical clinics. The goal of hormone replacement therapy is to return deficient hormone levels to a natural youthful state. The key is balancing these hormones in effective amounts for optimal benefit and safety.

Brief summary of Hormone Treatments:

Testosterone

– The primary male sex hormone, is found in men and women. A sharp decline in testosterone has disastrous consequences in males. Mainstream medicine now recognizes male “andropause”, or loss of testosterone that cause symptoms with age. Testosterone declines continuously around age 35 in most patients, with some variability. Free, or active, testosterone declines at the rate of nearly 2% per year after age 35 in the majority of men, but this rate is more rapid in some individuals. After age 50, the decline is significantly more rapid for nearly all males. More infoon testosterone... Low testosterone is associated with impotence in males and low libido in both sexes. Deficiency is directly related to loss of muscle, increase in abdominal fat, loss of strength and conditioning, loss of energy, drive and competitiveness, depression and mental slowing. Recent studies have discovered that males with the lowest testosterone have the greatest incidence of heart disease, diabetes and increased mortality rates compared to males with higher testosterone.

Andropause-Male Menapause Information

Anti-aging benefits from testosterone replacement typically include:

  • Increased libido and sexual function
  • Improved erections
  • Improved mood and feeling of well-being
  • Decreased fatigue
  • Increased healing
  • Greater cardiovascular endurance with more red blood cells carrying oxygen
  • Preserving mental function
  • Stronger bones & resistance to osteoporosis.

Testosterone replacement is also being used to improve insulin resistance and sugar in Type II diabetics. Clinical studies have determined testosterone is a very effective and safe treatment for depression in patients with testosterone deficiency.

Whereas, most endocrinologists or doctors not familiar with detailed hormone replacement will not replace testosterone unless your blood levels low enough to measure off the charts, we believe replacing hormones to the mid-high normal range for optimal function in our patients. Many studies have compared patients in the top 25% versus patients in the bottom 25% of the testosterone range in their conclusions of testosterone replacement benefits. We measure both total and free (active) testosterone. The balance of testosterone to estrogen is also extremely important. Your physician at Permier Age Management has the knowledge to use diet and prescription medicines (Arimidex) to control your estrogen levels to minimize side effects and maximize results.

Younger patients worried about partially depressing natural production may be prescribed HCG, as directed by the physician specialist or may take breaks with hormone use. In older patients with significantly deficient levels, this is not an issue.

Side effects: When hormone replacement is properly monitored, there are no common significant side effects to treatment. Your physician will review possible side effects at each visit. Patients with a history of breast and prostate cancer are not candidates for replacement in the program.

The goal of replacement is to return your testosterone to youthful levels to revitalize your health, activity, and function.

Estrogen

– Estrogen, the female sex hormone, is actually three hormones. In males, estrogen is primarily made from the conversion from testosterone via the aromatase enzyme. In females, estrogen is produced primarily in the ovaries until menopause. Low levels of estrogen have many symptoms in females, including: weakening of bones, arterial clogging, hot flashes, vaginal dryness, sleep disturbance, depression, poor energy and declining mental function, increase in Alzheimer’s risk and Colon cancer. A base level of estrogen is necessary for health in males but high levels have significant repercussions, including: abdominal fat deposition, water retention, breast tissue enlargement, increased cardiovascular disease, growth of the prostate gland, and possibly increased incidence of prostate cancer. Your physician can direct you in specific dietary measures and medication to decrease your estrogen levels if necessary.

DHEA

– Known as the father hormone, DHEA is the most abundant hormone in the human body and serves many roles. DHEA is a weak androgen produced by your adrenal glands. DHEA is one of the first hormones to decline with age and significantly contributes to the symptoms and decreased physical function with aging. By age 65, it is only a fraction of the level it was in your 20s. DHEA is a pre-cursor to other steroid hormones, it is converted by the body into other hormones such as testosterone and estrogen. DHEA itself can help improve body composition, has been studied to boost the immune system. Some studies show that DHEA may be beneficial in autoimmune disease and chronic illness. Several clinical trials have shown DHEA to have anti-cancer properties. In addition to these benefits, DHEA helps to counteract the destructive properties of excessive cortisol. As we age, our cortisol levels increase and our body’s slowly shift into a catabolic state, where tissues are damaged faster than they are repaired. There are many more suspected benefits from DHEA. While it can be purchased over the counter, these supplements are not regulated or inspected and can contain impurities, contaminants, and variable strength, not necessarily what is listed on the bottle. Prescription pharmaceutical grade compounds are superior. For patients that convert DHEA to estrogen, we may suggest a metabolite, 7-Keto DHEA.

Growth Hormone

– Human Growth Hormone (HGH) is responsible for the growth and repair of all tissues in the body, including: muscles, skin, bone, tendons, ligaments, and body organs. HGH levels rise sharply before age 20, peak, and then decline thereafter. Nearly all patients have declining levels after age 35. At age 70, HGH is a fraction of what it was at age 20. Growth hormone deficiency undeniably contributes to the visible and physiologic effects of aging. While HGH is under some media scrutiny from its inappropriate use by younger athletes, we uphold the American Academy of Anti-Aging’s (A4M) stance on Growth Hormone replacement as being significantly beneficial to aging patients who are deficient in this hormone with minimal risks when properly dosed and monitored. We follow the A4M guidelines for replacement in deficient adults only.

Clinical evidence is clear on the many benefits of replacing HGH. Potential side effects are easily managed with proper dosing and laboratory monitoring. Nearly all studies agree on the benefits, but some studies site side effects, such as: fluid retention, carpal tunnel symptoms, mild increase in blood sugar and joint aches. Most of these studies used inappropriate dosing and did not adjust medication amounts, other studies were not carried out long enough for the short term side effects to abate and ability to measure the full benefits. All of the potential side effects are reversible on withdrawal of the medicine. At Premier Age Management, we offer increasing HGH using Sermorelin, if HGH is cost prohibitive, and reserve HGH for individuals where sermorelin may not be as effective. Because of cost, this medicine will never be recommended by medical academies to all patients. This is a medicine that is used, in replacement in deficient patients, to increase the regeneration and rate of repair in most tissues and optimize feeling and function.

HGH’s benefits include:

  • Increased vitality and energy
  • Reduced abdominal fat, reduction of overall fat at 6 months averaging 18-20%
  • Average increase in lean muscle of 9-15%
  • Improved thickness and elasticity of aging skin
  • Accelerates healing of wounds and injuries
  • Improved sleep quality and depth
  • Improved immune function
  • Increased organ function and a trend towards normalizing organ size in elderly patients.
  • Improved mood and brain function (there are HGH receptors in the brain too)
  • Increase in bone mass at 6-12 months with prevention of osteoporosis
  • Overall increase in metabolism
  • Increase in heart function and output
  • Beneficial effect on cholesterol
  • Combats age and illness related muscle wasting
  • Supports healthy sexual function

For best results, HGH should be used for a minimum of 6 months. It took years for the deficiency of HGH to cause symptoms and it takes nearly 6 months before the full benefits are realized. HGH also works better in combination with other hormone replacement, combined with a healthy, moderately low carbohydrate diet. HGH is effective by prescription injection only, oral formulations advertised do not work. HGH is injected most or all days of the week into the skin with a tiny insulin needle. We will instruct our patients with proper protocol and can help provide sterile needles. At Premier Health Clinic, we only prescribe HGH and Sermorelin for adults with growth hormone deficiency who are 40 and older. HGH can be prescribed to younger adults who have a history of pituitary damage. Our doses are formulated to return your growth hormone to youthful levels, supraphysiologic dosages have not been well studied and are ill advised. There has not been a consensus reached on the effect of growth hormones in a patient with established cancer. Therefore, we do not replace HGH in patients with active cancer, proliferative retinopathy, or advanced diabetes.

Sermorelin

– Sermorelin is a biological analog of growth hormone releasing hormone (GHRH) that is produced in the brain to stimulate growth hormone release from the pituitary gland. Sermorelin stimulates production of the body’s own growth hormone. In youth, ample amounts of GHRH are produced so that the pituitary is able to produce sufficient growth hormone to sustain health and vitality. GHRH significantly declines with age causing reduced production and secretion of pituitary growth hormone and thereby increasing the sequelae of growth hormone deficiency.

Unlike growth hormone, Sermorelin affects a more primary and natural source of failure in the growth hormone axis, has even fewer potential side effects than growth hormone, and has positive affects on overall pituitary function. Sermorelin promotes the release of your body’s own growth hormone in the natural hormonal axis of the body.

Benefits of Sermorelin:

  • Increases the body’s natural production of Growth Hormone
  • Decreased Body fat, particularly around the abdomen
  • Increases lean muscle mass
  • Increased Bone mass
  • Improved Immune function
  • Improves Sleep quality
  • Accelerates recovery from exercise, injury and wounds
  • Overall increase in metabolism
  • Improves mental function
  • Elevates Mood and helps prevent Depression
  • Increased cardiac function
  • Supports healthy sexual function

While Sermorelin produces similar effects on body composition and all the other benefits of growth hormone, it has additional positives. The effects of Sermorelin are regulated at the pituitary gland through negative feedback by the release of somatostatin so that safety concerns associated with growth hormone overdose are minimized. Tissue exposure to growth hormone released by pituitary stimulation of Sermorelin mimics normal physiologic output. By stimulating the pituitary, Sermorelin preserves more of the growth hormone neuroendocrine axis, which is the first to fail with aging. At Premier Health Clinic, we only prescribe sermorelin to patients with growth hormone deficiency confirmed by symptoms and laboratory testing. Studies point to sermorelin being less effective in elderly patients with significantly depressed pituitaries and less effective in patients with critical growth hormone deficiencies. This medicine is more affordable than growth hormone.

Thyroid Hormones (T3 & T4)

– Healthy thyroid function is critical to the function of all other hormones in the body. Low or borderline low thyroid is extremely common and often missed. Borderline hypothyroidism is increasingly common with age. At Premier Age Management, we screen all our patients for thyroid disorders prior to the program and monitor thyroid function throughout the treatment. Active Thyroid hormones regulate energy levels, cardiovascular function, mental function and overall metabolism. These medicines are prescribed in our Age Management if there is a mild decline in laboratory thyroid function producing symptoms.

Deficient thyroid hormones can cause:

  • fatigue, mental sluggishness, depression, infertility, weight gain, dry skin, constipation, high cholesterol, poor cardiovascular function, hair loss, sexual dysfunction, joint aches, poor muscular function and other symptoms.

Severe deficiency or overproduction will require further work-up and treatment outside of the program.

Melatonin

- Melatonin is a natural hormone that plays a major role in setting the body’s internal clock and circadian rhythms. Melatonin’s anti-aging benefits include:

  • Improved sleep and ease of falling asleep
  • Greater proportion of deep and REM sleep (restorative sleep)
  • Treating jet lag or changes in sleeping patterns
  • Stronger immune system
  • More positive response to stress
  • Enhanced overall well being
  • Anti-oxidant properties

Melatonin and DHEA both decline rapidly in your late 30s and continue to plummet thereafter. Melatonin is also a potent anti-oxidant, which may slow free-radical induced cellular damage.

Pregnenolone

– Pregnenolone is known as the mother of all steroid hormones. Pregnenolone is used by your body to produce DHEA, Testosterone, Estrogen, and Progesterone. Optimal levels of Pregnenolone are important for mental health and ability. By age 70, this hormone typically declines as much as 60%. Pregnenolone may increase acetycholine in certain areas of the brain and regulates other neurochemicals (GABA) and processes in the brain. Clinical research has shown pregnenolone to be effective in increasing job performance and learning in a cross section of individuals of various ages. They found pregnenolone helped test groups learn and remember difficult tasks compared to control groups. In a study of airline pilots under stressful situations, 50-100mg of pregenolone daily improved task performance with no side effects. Nearly all studies confirm that pregnenolone is well tolerated, even at high doses, with very few side effects. A study done in patients with rheumatoid arthritis showed significant improvements in inflammatory symptoms in the majority of patients studied.

Age management benefits typically include:

  • Increased ability of the brain and nervous system to deal with stress
  • Improved memory and learning, particularly in stressful situations
  • Reduction of inflammation
  • Maintenance of memory, improved mood
  • Enhanced well being and acts as a mild anti-depressant
  • Improved sleep patterns