April 10, 2007 -- Age is said to bring wisdom and experience. But it can also bring some less desirable side effects: decreased energy, weight gain, loss of libido and slower brain function.
In women it's known as the "change of life," or menopause, when a woman's hormone levels drop precipitously, altering her body chemistry in ways that leave lasting results. Now, some doctors say it's not just women who experience menopause.
That's right -- male menopause, also known as andropause.
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It's different, to be sure. While women's estrogen levels drop relatively abruptly -- about 5 to 8 percent over the course of a year or so -- men's loss of testosterone happens more gradually at about 1 to 3 percent every year, starting in the mid-30s.
Some doctors say it's a condition that can be treated. Leading the way is Cenegenics Medical Institute, a Las Vegas clinic founded by Dr. Alan Mintz, who said he's found a way to help his 12,000 patients slow down the natural aging process. Mintz's clinic treats both men and women, but the vast majority of its clients are male.
"People come to us because they're concerned about the following four or five things: energy, body composition, libido or sexual function, cognitive function, and in some form, a weakened immune system -- they're getting sick more often," Mintz said.
"They may not be ill in the disease-based sense that we talk about, they may not have something wrong with them, but they know they're not the person they were 10 years ago. They're sick and tired of being sick and tired, and not getting answers. So we look, in a very comprehensive way, at why they're not feeling the way they did when they were 30 or 35 or 40. And there are real answers to be found in science."
Slowing the Aging Process
That answer, he said, is the endocrine system: the complicated balance of hormones that changes as people age. The normal level of any given hormone exists on a sliding scale, and the doctors at Cenegenics say their intention is to evaluate their patients' current levels and then prescribe a regimen intended to boost those levels to the upper end of that normal range.
Patients travel to the clinic for an intensive daylong examination and personal history. Most leave with a prescription for one or more hormones, which they'll inject at home, along with recommendations on changes to their diets and lifestyles.
Mintz said most doctors have long ignored the importance of hormone levels to a patient's health.
"I try and look at the analogy of an orchestra playing Beethoven, 9th Symphony -- 100 instruments in the choir. You need to pay attention to all the instruments in the choir. And if we try to achieve this endocrine balance, and metabolic balance, we're healthier."
He was his own guinea pig for this controversial treatment. Mintz, once an overweight child, started running to lose weight and eventually become a marathoner.
But in his mid-30s he started noticing his body declining.
"I didn't like it, and the answers I was getting from my colleagues was, you're just getting old like the rest of us, Alan. Well, I didn't like that. I felt like I had more than half my life ahead of me, and I didn't want it to be this slide downhill."
A radiologist, he started reading about hormone therapy and put himself on a regimen.
Now, at age 69, he said, "Think of it, and I'm probably on it. I'm on vitamins, minerals and antioxidants. I'm on injectible testosterone once a week. I'm on thyroids. I am on DHEA, 100 milligrams. I am on growth hormones, one unit a day, six days a week."
Mintz said the result is a body that won't suffer the indignities of old age, and he's confident that it's safe.
"Sure there's controversy," he said. "Like everything else, it'll take 20, 30 years and then everybody will say 'Yeah, I told you so.' So are we the leaders on this? Yes. Are we out in front? Are we expecting controversy? That's OK, because controversy sparks dialogue. So we love the controversy. But I'll tell you, the literature's on our side."
But Dr. Marc Blackman, a leading endocrinologist at the National Institutes of Health, said that's just not so.
"Medical science, advanced as it is, doesn't yet know whether these treatments are effective, in meaningful ways, and even more importantly, doesn't know whether these powerful hormones are safe in the long term," Blackman said.
Blackman said that while hormone therapy for men holds promise, there hasn't been a single, large, scientifically rigorous study that would give doctors a solid basis for thoroughly examining the risks and benefits of the treatment.
"A little information can be dangerous," he said. "Many of these early studies are very nicely done, but they're small. And in the scheme of things, they're inconclusive."
Among the greatest concerns is the effect of testosterone on the prostate.
"As men age, their prostates naturally enlarge, most often in a benign way," said Blackman. "But of more concern is the issue of prostate cancer. And it has been hypothesized that testosterone administration may either increase the formation of new cancers, for which there is, at present, no good evidence. Or, it may stimulate the growth of a known or occult, that is unknown, cancer, for which there is some evidence."
In fact, Blackman said that concern about the risks of prostate cancer and heart disease in healthy men receiving testosterone therapy is what has delayed the execution of a major study.
In other words, the medical establishment is so wary of the possible consequences of hormone therapy in men that it's waiting for more evidence of its safety before subjecting men who would participate in a study to potential risks.
Blackman said this caution is in many ways the result of a major study on female hormone therapy that revealed that some of the risks of hormone therapy in menopausal women outweighed the benefits.
"Look at all the information that has been accumulated over the last 30 or 40 years related to estrogen and other female hormones as they relate to the natural menopause or change of life in women. The information has been here, there, and everywhere. And that's the natural evolution of knowledge. We're way back to 30 years ago, in the testosterone and aging and older men story. Which is why we really should proceed with caution."
Treatment, With Caution
Cenegenics patient John Leslie Wolfe, 58, said he's walking into the experience with his eyes wide open. He recently completed his primary evaluation at the clinic (price tag: $2,495) but hasn't yet started on any Cenegenics-prescribed hormones (which would cost another $5,000-$12,000 a year.)
Wolfe said he came to the clinic in search of better health, not the fountain of youth.
"I don't need to go backwards. But while I'm working, I have young children, I want to be as healthy as I can," he said. "I watched my parents go through decline in their later years, and their last few years were very poor quality of life. And I guess I want to be as healthy as I can until the day I drop. And then it'll be over."
That, said Mintz, is exactly the idea.
"I want my kids and grandchildren to have their place in the sun," said Mintz. "So I think it's sort of egomaniacal to think I ought to live longer than my intended life span. I just want that life span to be good. I'd rather die in my late 70s than have 10 bad years with Alzheimer's and not know who my children are. Hopefully I can make it to 90, 95 in great shape. That's my goal. That's what most of our patients want."
Blackman, himself 62 years old, said that desire is understandable.
"My generation of baby boomers has historically wanted to do everything its way, since we were adolescents. I also think it's universally true, that all of us wish, among other things, to age gracefully. And that's a good thing."
But, he said, the hormone therapy practiced at Cenegenics is not a magic bullet.
"It's of unproved effectiveness and unproved safety, and until we know more, I think it's not the right thing to do."
His prescription for healthy aging? It's less cutting edge and more common sense: everything in moderation.