recent NYTimes article on anti-aging therapy

[Michael Eisenstadt]

This article is SO informative and SO need-to-read that I copied
it into this email rather than just putting in a link to the Times.

One of our subscribers is/was undergoing this therapy. His comments 
on this will be appreciated.

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Chasing Youth, Many Gamble on Hormones
By GINA KOLATA

Dr. Ron Livesey was fat, tired and out of shape. At 49, he felt that his
best years were behind him.

So one day seven years ago, on his way to a medical meeting, he stopped
at a doctor's office in Palm Springs, Calif., for his first hormone
injections. 

Early the next morning, Dr. Livesey was at the meeting, sitting in a
darkened auditorium watching slides of technical data. To his surprise,
he found himself alert, taking everything in. He continued the hormone
treatments.

"People started commenting that I had so much more bounce and energy,"
he said. He lost 50 pounds — thanks, he said, to diet changes and
exercise made possible by the increased vigor.

So Dr. Livesey, then an internist in New Hampshire, decided to go into
business for himself. With a colleague, Dr. Joseph Raffaele, who went on
a similar regimen, he founded Anti-Aging Medicine Associates, a clinic
in Manhattan. They are part of a growing movement among doctors to offer
a hormone replacement therapy that claims to restore the bodies and
energy of youth. 

Until recently, most scientists considered anti-aging treatments to be
little more than snake oil, provided by hucksters. Now, few doubt that
growth hormone and testosterone can reshape aging bodies, potentially
making them more youthful.

But whether they counteract aging is unknown. And their long-term risks
are ill defined. So medical experts ask whether it is right to regard
aging as a disease, as fierce as a malignant cancer, to be fought with
any and all means, tested or not.

"How much are you willing to pay for a treatment that is not proven?"
asked Dr. Huber Warner, an associate director at the National Institute
on Aging. "How much risk are you willing to take?" 

But Dr. Ronald Klatz of Chicago, the founder and director of the
American Academy of Anti-Aging Medicine, says patients cannot wait for
long-term studies, which are not even in planning stages and would take
years or decades to complete. "We'd have to wait," he said, "until the
baby boomers are dead and in the ground and worms' meat."

Clearly, many are not waiting. The academy, which began with 12 doctors
in 1993, now has 8,000 physician members in the United States, Dr. Klatz
said.

The treatment is expensive: $1,000 a month for the panoply of drugs and
dietary supplements, including human growth hormone and testosterone for
men and women, estrogen and progesterone for women (the doctors say
their "bioidentical" hormones are safe), melatonin, DHEA, vitamins and
antioxidants.

The unlikely hero of today's anti-aging movement was Dr. Daniel Rudman,
an academic researcher at the Medical College of Wisconsin who asked if
he could reverse the effects of aging by giving growth hormone to
elderly men.

Aging people, he noted, lose muscle and put on fat, their skin thins and
their bones weaken. At the same time, growth hormone levels steadily
decline. He observed that the effects of aging also appeared in young
people who lacked growth hormone for medical reasons. 

So he gave growth hormone to 12 elderly men for six months, reporting
that they gained muscle and lost fat. Nine men who served as controls
had no such body changes. In his paper, published on July 5, 1990, in
The New England Journal of Medicine, Dr. Rudman concluded with this
sentence: "The effects of six months of growth hormone on lean body mass
and adipose-tissue mass were equivalent in magnitude to the changes
incurred during 10 to 20 years of aging."

Dr. Klatz, of the Academy of Anti-Aging Medicine, called the paper "a
thunderclap in the medical profession." 

"It was the first clinical paper in a mainstream U.S. medical journal to
show that there were available interventions that could have a dramatic
effect on the physiology of aging," he said. 

Human growth hormone has been approved by the Food and Drug
Administration for use by people with medical deficiencies, and once a
drug is on the market, doctors can legally prescribe it for any reason.



"I was thrilled by the concept," said Dr. Maxine Papadakis of the
University of California in San Francisco. But Dr. Papadakis said she
worried about the sweeping conclusion about reversing aging. It was a
small study, she said, and the men who took part knew who was taking
growth hormone and who was not.

Dr. Papadakis set out to test growth hormone in 52 healthy men from 70
to 85. She designed the study so that the men did not know if they were
taking the drug or a dummy medication.
 
Reporting in 1996, she found that growth hormone slightly increased
muscle mass and decreased body fat but, paradoxically, did not make the
men stronger. People had claimed it improved their mental clarity, but
she found no such effects; if anything, those taking growth hormone did
slightly worse on memory tests. They also suffered swollen legs and feet
and achy joints, making them so uncomfortable that a quarter taking
growth hormone had their doses reduced during the study.

Dr. Papadakis said her results were ignored by growth hormone
enthusiasts. "They can't let go of the hypothesis because they like it,"
she said.

Others, like Dr. Warner, worry about animal studies.

"I agree that mice and rats are not people, but mice that don't make
growth hormone live longer," Dr. Warner said. "Mice that overproduce
growth hormone live shorter lives. The same principle applies in fruit
flies and little worms called nematodes. It may be irrelevant, but it
makes us wonder."

The next major paper was published on Nov. 13 in The Journal of the
American Medical Association. In it, Dr. S. Mitchell Harman of the
Kronos Longevity Research Institute in Phoenix and Dr. Marc Blackman of
the National Center for Complementary and Alternative Medicine, part of
the National Institutes of Health, reported that older men and women
taking growth hormone lost fat and gained lean body mass without dieting
or exercising. They did not formally assess the subjects' appearance.
But Dr. Harman said, "you could see that some of these guys lost a
significant amount of pot belly."

On the other hand, many had the same side effects that afflicted Dr.
Papadakis's subjects. Although they went away when the subjects stopped
taking growth hormone, they gave the investigators pause.

The American Academy of Anti-Aging Medicine said in a statement that the
doses used in the study were far too high. Lower doses that reproduce
the hormone levels of youth are safe and effective, the group said.

But Dr. Papadakis said those were the levels her study reproduced.
"Maybe we don't know the right dose," she said. "But then how can you be
giving it to people? Get a grip."

Dr. Livesey and Dr. Raffaele, at the Anti-Aging Medicine clinic in
Manhattan, had expected most of their patients to be old people trying
to gain enough strength to rise from a chair unassisted, or middle-aged
people wanting to look young. Instead, they tend to be baby boomers, the
doctors said, who are searching for something that other doctors did not
provide.

"By the time they come here, they've already gone to places to look
better," Dr. Raffaele said. "They've had the Botox, the plastic surgery.
The reason they're here is they want to have a good quality of life."
Most keep their visits a secret, he said, adding: "They don't even want
to tell their close friends. It's kind of like plastic surgery."

They are like a 50-year-old woman living in New York who arrived at the
doctors' anti-aging clinic last February. "I was feeling desperate,"
said the woman, who did not want to give her name because she is keeping
the treatment secret from her friends.

She was depressed, gaining weight, feeling old and fatigued. But, she
said, when she began taking growth hormone, estrogen and progesterone,
she noticed an immediate change in her mood and energy. It gave her the
stamina and enthusiasm to start dieting and working out at a gym and she
dropped 10 pounds. She said her libido returned, her hair grew, and even
her bunions regressed so she could wear high heels again. 

Was it the drugs or the power of suggestion, the diet and exercise or
the growth hormone that made the difference? Will she develop a serious
disease as a result of taking the drugs or will she enter old age
healthy and vigorous, younger than her years?

It is impossible to know, researchers said, and that is why good studies
are needed.

"Our concern is that the evidence is mostly based on personal
testimonials rather than good data," Dr. Warner said. "It's not hard to
get people to believe something works, particularly if they are paying a
lot of money for it."

Dr. Alvin Matsumoto, a geriatrician at the Veterans Affairs Puget Sound
Health Care System, sounded a similar note of caution.

"For any particular patient, the trick is to determine who is the
practitioner who has your best interests at heart. It is hard to
distinguish that sometimes."