The passing of the years is the cause of testosterone decline at a rate of 1% to 5% annually after 35 years. But because aging is not treated as a disease, rather as inevitable, the possibilities for research and application of these drugs, which are so beneficial to health, are limited.
The traditional conception that medicine is reactive contributes to these type of therapies not being considered, because testosterone is used as a preventive treatment. Traditionally you went to the doctor when the symptoms had already begun, but prevention should begin well before they appear. There is no sense in replenishing vitamin D to prevent hip fractures in elderly people who are already in a nursing home! Similarly, low testosterone levels predispose individuals to be more likely to have prostate cancer, muscle deficit, as well as uncomfortable sexual, psychological, and somatic symptoms.
Dr. Iván Moreno – Neolife Medical Team
One of the mechanisms behind aging is the hormonal decline we suffer over the years.
Aging is associated with a multi-systemic deterioration based on many different mechanisms, which end up conditioning the deterioration of our tissues, our functions and our quality of life, contributing to the appearance of chronic illnesses.
There is no such thing as “healthy aging”; this expression is an oxymoron (it includes both an idea and its opposite). The healthy thing is to delay aging by using however many weapons we have at our disposal (those which have shown a good balance between benefits and risks). Nobody wants to be 30 years old forever; what we want is to mature with quality of life, and grow old (diseases, limitations, etc.) as late as possible.
There are many aging mechanisms that we have come to understand in recent decades, and the hormonal decline that we endure over the years is one of them.
In both men and women, this decline is characterized by lower levels of androgens (DHEA and testosterone), which facilitate the progressive deterioration known as aging.
In general, after 40-45 years there is a gradual decrease in androgen levels, which is behind (although not the only factor):
- Loss of muscular mass and performance.
- The gaining of visceral fat (a toxic organ that produces pro-inflammatory substances that cause resistance to insulin, risk of diabetes, atherosclerosis and finally increased cardiovascular risk).
- Mood alterations, with greater tendency towards depression and despondency.
From this perspective, using a holistic approach towards health and prevention, in addition to promoting the main basic foundations of health (optimal nutrition, exercise, sleep and stress management), we will also assess the optimization of hormone levels. The goal is to maintain levels more similar to those we had during our youth. This will not make us magically young again, but it will allow us to minimize the effect these hormonal changes have on aging. Specifically, today we will talk about the replacement of testosterone in men.
Testosterone has been shown, in both males and in women with diminished levels due to aging or other causes, to improve parameters such as:
- Percentage of muscle mass and physical performance.
- Decreased visceral fat.
- Improved mood.
- Improved libido and sexual performance.
This should not lead to any false assumptions: testosterone improves the hormonal context in which we are going to make certain healthy lifestyle changes (exercise, diet, etc.), improving the rewards for our efforts…but these efforts must be made. Young people with poor diets and a sedentary lifestyle are obese, regardless of how optimal their hormone levels are. At the moment, nothing has been discovered that is more powerful than well-managed exercise and optimal nutrition.
So why is there no unanimous agreement among physicians that men or women with low levels should use it?
In medicine we tend to give definitive answers when in reality the answers regarding certain issues are not fully conclusive. This particular issue, the replacement of testosterone, ignites passions between defenders and detractors, and it is striking even for a professional (as is my case) to see how colleagues with little knowledge on the subject have such close-minded views, which they vehemently defend even when the person they are talking to has much more thorough knowledge of the scientific evidence in question.
In my opinion, there are many factors contributing to the fact that a strategy, which – used well – could improve the health and quality of lifeof many people, is not part of the current medical routine.
This is an extensive topic, which we will discuss throughout a series of newsletters to facilitate their understanding and comment on the different aspects of this issue. Today we will talk about the general undercurrent that does not consider aging as an area in which to focus diagnostic efforts and the problem behind reactive medicine.
Aging is not a disease.
And it cannot be considered as such, regardless of individual convictions, because of the statistics: too many people suffer from it. The International Classification of Diseases (ICD) does not consider aging a disease, limiting the possibilities of research, the use of resources for that purpose and the development of new drugs with the purpose of preventing or treating aging. It has traditionally been said that there are no known mechanisms or genes of aging, and that this phenomenon occurs in all individuals of all species: that is, it is the law of life.
We can enter into philosophical considerations, whether we should age and die or not…. but we cannot ignore that, in the closest definition of the terms, medicine has always been focused on avoiding aging (delay the onset of disease and disability, decreased mortality, etc.). The problem is that nowadays it only achieves mediocre results.
In general, the debate that arises is not one of immortality, but of improving the quality of the last third of life. It’s not that people want to be immortal… what they do not want is to live a long time with a poor quality of life.
Fortunately, this lack of perspective in order to head off a social and health crisis, such as the unhealthy aging of the population, is beginning to change, and there is growing interest in the medical and scientific collective in this regard.
A few years ago, a study was approved for the first time in which the results researched concerned the prevention of aging and its effects with metformin.
Currently there are many studies in this area, though they do not directly look at “aging” but rather some of its side effects such as arthrosis, loss of muscle mass, pulmonary fibrosis… It is a way of “making progress”, but we must not lose sight of the underlying approach. When we work to prevent a disease, we are simply gaining time until another one appears… aging is the disease.
Reactive medicine of the 19th century
Medicine has been defined less and less based on disease and more on health. The first hospitals were hospices for palliative care attended by the clergy. Little by little we have advanced towards prevention, towards public health and only very recently towards health understood as an optimal state and not as the absence of disease.
Traditionally, you went to the doctor when problems began, and there were often few alternatives for the cure so they had to “remedy” the situations as much as possible. This approach, the result of the urgency that disease imposed on overloaded systems and a more reactive culture (both in physicians and in patients), continues to drag on.
The problem with prevention is that it needs to begin before the problems appear. There is no sense in replenishing vitamin D to prevent hip fractures in elderly people who are already in a nursing home! Similarly, testosterone requires maintaining optimal levels that make diet and exercise more efficient to keep us in optimal condition or, if we have neglected our health, to reverse these effects little by little. If we want to continue maintaining a good percentage of muscle mass and bone, we must begin working out now and improve the hormonal environment. When push comes to shove, having strength or lack thereof can determine whether we survive pneumonia by being able to cough effectively, or whether we can continue to live independently when we are 80 years old.
In this first newsletter we have introduced the issue and we have looked at the limitations in conventional medicine to confront aging with a more proactive attitude. In the next installment of this series we will discuss the fallacy of “being within normal range for your age” and myths associated with hormones among both patients and physicians.
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