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Typically, a 35-50 year old man will come to me and tell me that he can't understand why he is still so thin and "underdeveloped". He'll tell me he is exercising at the gym, he is eating well, he sleeps well and doesn't smoke. He might even have a personal trainer who is routinely measuring his body fat %. Still, he says he is not getting the sort of fitness and shape that he sees others get at the gym. He is healthy by any common measure, but he is not what he wants to be.
Another patient might come in and tell me that he has been fit all his life, but that he can't maintain the fitness he had in youth. This chap is typically a bit older chronologically, but he is vibrant of mind and attitude. His body, though, is letting him down.
Upon assessment and blood testing of these patients we commonly find there is a relative lack of certain hormones such as testosterone, DHEAS and/or growth hormone. The patients may be in every respect in the top statistical quartile or decile for age, but the hormone levels might be in the bottom quartile for age or even lower relative to youthful levels.
In such an instance, the judicious prescription of physiological replacement levels of these hormones can have a very significant effect. Muscle growth improves, strength improves, stamina improves, attitude improves. Thinking clears, fat is lost, bones get stronger, skin improves, even hair is reported to improve.
Predictably, not everyone gets all these effects. There are many medical reasons why someone might lose muscle mass; including some major illnesses. Genetic processes acting outside of hormonal mechanisms cannot be corrected.
Still, when the symptoms and signs fit with a relative lack of a particular hormone, and there is blood test evidence of a lack of the same hormone, it seems worthwhile to try replacing the hormone for a few months to see if an improvement results.
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Hormone replacement in men is a contentious issue. It is NOT recommended by the majority of doctors, as the broader professional feels that the benefits of such treatment have not been adequately proven. The hormonal decline that men experience, and the consequences of such decline, are seen as "normal" parts of ageing and do not fit broadly held concepts of what constitutes a disease, and therefore, so the argument goes, there is nothing to treat.
On the other hand, women experience a precipitous drop in oestrogen and progesterone levels at the time of the menopause. It is the suddenness of this change, and the obvious correlation with cessation of menses, that has allowed us all to identify "menopause" as a medical condition (its normality notwithstanding) and consider it worthwhile to treat. By contrast, hormonal decline in men and non-gonadal hormone decline in women proceed much more gradually, and without a herald event such as menstrual cessation, and so have not been identified as medical conditions and have not been considered for treatment by the broader medical community despite the ultimate effects of such hormonal declines being comparable in degree to the effects of menopause.
Furthermore, the use of hormonal treatment for lifestyle purposes is not something with which our society is entirely unfamiliar, because this is exactly how the oral contraceptive pill works: by taking an excess of the hormones oestrogen and progesterone we produce a curtailment of the ovarian stimulation necessary to produce ovulation. So the question arises: if it is OK to prescribe hormones to young women to prevent pregnancy, can we dismiss, out of hand, the prescription of low doses of hormones to older people when such treatment can bring a wide range of benefits?
Of course, any treatment carries risks and hormonal treatment is no exception. Young women taking the oral contraceptive pill increase their risks of a wide range of medical problems, such as high blood pressure, stroke, blood clotting, migraine, gall bladder disease, breast disease.
Even Panadol is very dangerous in overdosage. So all treatments carry risks
The risks of treatment need to be discussed in consultation, but the primary concerns regarding testosterone treatment in men are to do with testosterone’s effect on the prostate gland and on scalp hair. In women, testosterone treatment, if undertaken, must be with a very small dose so as to avoid inducing hirsutism and acne. DHEA is converted in the body to testosterone (unless the 7-keto form is prescribed) and so carries similar (albeit lower) risks to testosterone. Growth hormone carries little risk in physiological doses but in larger doses may cause fluid retention, raised blood sugar and joint aches in the short term, and if overdosing is high and prolonged then all the symptoms of acromegaly could arise.
These are only examples of risks and the list is not at all complete. The point is that the risks of treatment are discussed in consultation as part of assessing whether overall benefit might be had with hormonal treatment in a given patient. Once hormonal treatment is commenced, ongoing monitoring is important in order to watch for the development of any possible side effects.
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