Americans are experimenting on themselves: to delay aging, approximately one in fifteen US residents regularly takes bioidentical hormones.
Synthetic hormones, which brought a genuine revolution to anti-aging medicine in the early 1990s, are now being replaced by bioidentical hormones. Scientists assure us that these substances fit the human body perfectly, like a key in a lock, causing minimal side effects. It seems that a sharp turn has appeared on the endless road to eternal youth. What wonders and dangers lie around the bend?
According to neuroendocrinologists, a kind of biochemical reactor operates inside the human body, producing hormones and hormone-like substances that, in turn, control virtually all vital processes. While we are young and full of energy, hormones are produced in sufficient quantities to keep the body in good shape. With age, however, hormone production decreases. By the age of 45, men generally approach andropause, meaning that secretion of testosterone, a hormone essential to their bodies, declines significantly. At approximately the same age, women approach menopause, a sharp fall in estrogen levels. This is when the problems of aging come down on us with their full weight: persistent fatigue, insomnia, difficulty concentrating, irritability, weight gain, loss of muscle mass, wrinkles, rising blood pressure and elevated cholesterol.
And this is far from a complete list of the symptoms indicating that a hormonal imbalance has emerged in the body. How can balance be restored? Having learned to synthesize some of the hormones essential to the human body, biochemists proclaimed a revolution in anti-aging medicine back in the early 1990s. Many celebrated: at last, pills against old age had been created! But it was not so simple. Endocrinologists worked out regimens and dosages of synthetic hormones by trial and error, virtually feeling their way in the dark. While the first ten years of hormone therapy were enthusiastically welcomed by millions of aging men and women in the United States and Western Europe, optimism declined noticeably with the start of this century. More and more studies began to appear showing that hormone therapy did more harm than good. Scientists demonstrate a direct link between taking hormones and the risk of developing, for example, uterine or breast cancer. Their explanation is that synthetic hormone molecules do not match those of our own hormones. Prolonged and often uncontrolled use of these “synthetics” causes side effects, including cancer, because foreign hormones remain in the body longer and act aggressively on receptors and tissues.
And so, just when the very idea of hormone therapy seemed to have been discredited, scientists decided to seek hormone substitutes in nature rather than in chemical laboratories. These are bioidentical hormones, which molecularly match the hormones produced by our adrenal cortex or sex glands and therefore fit easily into metabolism. Plants are the principal source of bioidentical hormones: soybeans, wild Mexican yam and nettle root, for example. Scientists say that bioidentical hormones fit our receptors like a key in a lock. Whereas synthetic hormones were introduced into the body through injections or pills, bioidentical equivalents are usually applied as a cream to the upper arm or thigh, or as a special patch attached to the body. Doctors maintain that these hormones have a low concentration, are nontoxic and do not burden liver metabolism. Thierry Hertoghe, head of the World Society of Anti-Aging Medicine, spent several years comparing the condition of volunteer patients taking conventional and bioidentical hormones. The research results showed far fewer side effects such as myocardial infarction, breast cancer and blood clots in the latter group. Bioidentical hormones have by now also been examined by the US medical research organization Women's Health Initiative, which was likewise quite satisfied with the results.
Specialists can already determine exactly which combination of bioidentical hormones a particular person needs. Monika Golková, head of the A2C anti-aging medicine clinic in Prague, told Itogi magazine that a thorough examination is required before bioidentical hormones are prescribed: a clinical blood analysis, as well as urine and saliva tests that enable laboratory specialists to identify precisely which hormones the body lacks. For example, it has actually been demonstrated that a fall in the level of the hormone dehydroepiandrosterone can cause cancer, myocardial infarction, osteoporosis and Alzheimer's disease. A lack of melatonin, the hormone of the pineal gland, leads to sleep disturbances and prevents the body from recovering. Growth hormone deficiency is associated with the risk of death from liver cirrhosis and cardiovascular diseases. An examination and analysis of a patient's hormonal status at a European clinic cost between 400 and 800 euros. A “composition” is then prepared in the clinic's laboratory according to your “individual prescription” and supplied for use as a cream. It costs approximately 200 euros to make, and the cream lasts two months. In the hands of a laboratory worker of today's generation, bioidentical hormones are something like a construction set. This is not mass production, and no pharmaceutical company can patent an individual biohormone.
A detailed genetic analysis, costing 400–800 euros, is sometimes performed alongside the hormonal assessment. It gives an idea of the possible risks to the body from using bioidentical hormones. Genetic analysis reveals the particular characteristics of your cardiovascular system. This is important because hormone therapy may, in some cases, increase the risk of blood clots. The duration of hormone therapy depends on how the patient feels. Some people may need support for two or three years to alleviate the unwanted effects of menopause, while others may feel very well and continue using bioidentical hormones after several years of treatment. Considering that maintenance therapy in Europe costs around 100 euros a month, this is quite feasible even on a modest income.
Dr. Golková described a patient whose wife brought him to the clinic by the hand. During his first appointment with the doctor, the man kept dozing off. Hormonal analysis revealed an extremely low testosterone level, and he was prescribed a course of bioidentical hormones. After three months of using the cream prepared for him, the patient began to feel better, went on a diet and started losing weight. In his words: “I could feel the fat melting when I worked out.” A year later, he returned for an examination and, after the biological age of his organs was assessed, discovered that he had effectively become ten years younger!
Another story concerns a successful businesswoman who, together with her husband, had built a financial empire over a 20-year career. Always slim, beautiful, smiling and successful in everything, she was a role model. Then menopause arrived. She gained weight, stayed at home absorbed in dark thoughts, and began contemplating suicide. Her husband and three children no longer recognized her. Her family compelled her to visit the clinic and undergo an examination, which, as expected, showed extremely low estrogen levels. She was offered a course of bioidentical hormones that helped her lose 12 kilograms in six months and return to her previous 58. Moreover, in her own words, she felt like a woman again.
Bioidentical hormone therapy is now equally popular with men and women in the United States. Insurance companies, incidentally, cover treatment costs in some cases. Their reasoning is that at 45–50, when a person is at the peak of their professional career, a hormonal imbalance can undermine their health, putting the employer at risk of losing an experienced employee.
The costs are as follows. An initial consultation at a California anti-aging clinic costs 395 dollars. The patient is then offered a three-month program including fitness training and nutritional guidance for another 275 dollars. Laboratory tests cost 540 dollars. Finally, monthly medical monitoring throughout the course costs another 100. A course of treatment may cost approximately 1,300 dollars.
Anti-aging clinics in the United States now offer programs to make up deficiencies in growth hormone and testosterone, which work more effectively together, using bioidentical injections and creams. As staff at the ReNEW MAN anti-aging clinic in Atlanta explained to Itogi, the short-term effect of growth hormone is clear: a person literally becomes younger before your eyes. However, this is very expensive therapy, costing 6,000 dollars annually, and it needs to be repeated regularly. About 1,000 people in the United States currently receive continuous replacement therapy with low doses of growth hormone combined with androgens. Bioidentical hormones are used much more widely, by several million people. Some estimates put the figure at around 20 million, or approximately one in fifteen inhabitants of the country.
What is the situation in Russia? Practically none of the hormone preparations are currently produced there. Specialists in anti-aging medicine are extremely scarce. There are no doctors certified by the World Society of Anti-Aging Medicine at all. Such certification means that a doctor in this specialty has completed practical training at an appropriate clinic in the United States or Europe, knows the latest methods in the field, has passed the relevant examinations and regularly participates in scientific conferences. Anti-aging clinics offering hormone therapy have only just begun to appear in Russia. They are not yet integrated into the global context, however, despite presenting their specialists as highly experienced. Prices in Russia also differ from European prices by at least a factor of two; probably only elite Swiss clinics are more expensive. As one Russian endocrinologist told Itogi, the standard price of a month of hormone therapy in Russia is around 2,000 dollars. Maintenance therapy, which may be prescribed 12–15 months after treatment begins, costs 800–1,500 dollars per month. It is not difficult to see that, at these prices, bioidentical hormone therapy will not become widespread in Russia for a long time. Are we still a nation growing old?
THE CREAM IS APPLIED TO THE SKIN ONCE A DAY. THROUGHOUT THE DAY, THE PREPARATION IS ABSORBED GRADUALLY AND ALMOST COMPLETELY—NEARLY 100%
There is, however, something that advocates of bioidentical hormone therapy are reluctant to discuss. The fact is that no one yet really knows what the consequences of using a particular anti-aging “cocktail” might be. In the pursuit of youth, it is probably unwise to rush after everything new. The current excitement surrounding bioidentical hormone therapy is certainly intense. Yet attitudes toward it cannot be described as unequivocal: yes, it is good, or yes, it is bad. The US Food and Drug Administration (FDA) recently criticized bioidentical hormones. More precisely, it criticized not so much the hormones themselves as the mechanisms through which they are introduced. Advertising for innovative hormone preparations is currently very aggressive. Science does not yet know how to dampen this possibly unhealthy excitement, even a little.
The FDA intends to require doctors prescribing bioidentical hormones to complete a special application for drugs under investigation. Reportedly, this application is complicated to prepare, expensive to register and almost 40 pages long. After accepting and reviewing it, the FDA will issue a verdict stating that it is unaware of any harmful side effects from taking the bioidentical hormone in question. Opponents of the FDA, however, have claimed that bioidentical hormones are being attacked only because it remains advantageous for the FDA itself to promote synthetic forms of hormones. The sums involved in this business are substantial. In the mid-2000s, tens of billions of dollars a year were spent on hormone replacement therapy in the United States. Part of that flow has now been redirected toward bioidentical replacement therapy.
Whatever the case, bioidentical hormone therapy remains largely “tabula rasa,” even for endocrinologists. Otherwise, doctors would long ago have been handing out prescriptions for “apples of youth” left and right. Synthetic hormones are gradually being abandoned in the West because people have heard about their side effects. The main problem is that, when taken orally, they necessarily pass through the liver, increasing its workload. Bioidentical hormone creams could become an alternative. There is, however, a view that imprecisely dosed bioidentical hormones tend to accumulate in fatty tissues, creating an excess in the body. This, in turn, affects other hormones, leading to an imbalance. A double-edged sword, then?…
…It is tempting to look twenty-five again at forty-five. But could that diminish one of life's most important qualities—its length? No one has yet succeeded in outwitting nature.
