Ageless: The Naked Truth About Bioidentical Hormones (52 page)

The mission of the Menopause Institute is to provide accessible, cost-effective bioidentical hormone replacement therapy for women. It is specifically priced so that anyone can afford it. At the moment, women who need bioidentical hormones are not usually covered by their insurance and certainly not by their HMOs. I didn’t want to only have an “elite” practice that provided advanced quality health care. I realized that women who need hormone replacement have to have it, and I wanted to do something that would make it affordable, personal, and advanced.

Every week at least one or two people, unprompted, say, “This is the best I have felt in as long as I can remember.” That’s what I wanted to accomplish when I went into medicine.

SS:
Let’s talk about human growth hormone. There’s been so much controversy.

RR:
I’ve been studying this in depth for eight or nine years.

SS:
Can you dispel the fear of HGH? We make human growth hormone until we’re about twenty years old, and then it starts declining.

RR:
Right. We do make some HGH all our lives. It peaks in the teenage years (fourteen to eighteen) or so. Then it stays stable from, say, twenty to thirty. Somewhere in the mid-forties, the curve takes a sharp dive south. That’s called somatopause. Every hormone has a “pause” … menopause, andropause, and so forth, but HGH is at its highest level in our youth when we are healthiest and strongest, with the least disease risk and the least cancer risk.

SS:
Who should take HGH?

RR:
You would only want to take it to treat a deficiency disease, meaning, “Are you at present deficient, do you have adult growth hormone deficiency?” When we treat with HGH, we are treating adult growth hormone deficiency, which is a known disease entity. We never treat with HGH for sports performance, bodybuilding, aesthetics,
or antiaging. Everyone is on his or her own curve, but the deficiency affects most of us sooner or later. An HGH deficiency affects brain functions, since HGH is brain food. HGH is a big molecule, with 191 amino acids, but there’s an active mechanism that imports it into the brain through the blood-brain barrier. All brains cells need HGH and IGF-1. IGF-1 is produced by the liver as a response to HGH.

SS:
Isn’t it a measure in older people that the better the brain function, the higher the growth hormone level?

RR:
Correct. The higher the HGH and IGF-1, the better the brain. We need it for our immune system. That is what guards us against the cruel world. Growth hormone is a constant stimulus to produce T-cells and B-cells (lymphatic cells that filter out invading organisms) and make the immune system work. Then there’s body composition—more bone and muscle, less fat; HGH plays a role there. Growth hormone is important for heart function. Growth hormone reverses atherosclerosis in the carotid arteries. Then there is quality of life, which is a general term and hard to measure scientifically, but surveys show that keeping growth hormone levels balanced would save lives and give a better quality of life. Adults with growth hormone deficiency are happier and healthier when treated. HGH replacement is a powerful tool to reverse the destructive course of growth hormone deficiency.

SS:
There’s a lot of controversy about HGH because there haven’t been a lot of long-term studies on this hormone. Many researchers and doctors are worried that it promotes cancer growth.

RR:
Try typing “growth hormone” into
pubmed.com
and you’ll get around 52,709 articles. It is one of the most studied compounds in medicine. There have been children on growth hormone who have been followed for twenty years at this point, so there are very long-term studies. If you look at the endocrinology literature, I could pull more than thirty studies, and the conclusions are the same. The risk of cancer, either recurrent cancer or new cancer, is not greater with growth hormone replacement therapy.

SS:
Do you think growth hormone is as essential to replace as all of the other hormones?

RR:
Well, there’s a hierarchy. I mean, growth hormone injections
are expensive, so sometimes people have to draw the line. I would start with the basics first. Assess the need for and treat deficiency of estrogen, progesterone, and testosterone in women and testosterone in men. Assess the needs for thyroid and DHEA. Look for adrenal fatigue. Once again, not everyone needs growth hormone replacement therapy.

SS:
Do you think in time the price will go down?

RR:
I hope in the future it will cost the same as insulin injections, which are relatively inexpensive. This therapy can help people with HGH deficiency in so many ways. There is a study in Denmark, patients over seventy-five years of age given growth hormone on the day of a hip fracture, treated for a couple of months, and 95 percent return to their former lifestyle. It’s incredible.

SS:
Is there any age where it would be dangerous to take HGH?

RR:
Again, growth hormone replacement therapy should be used only to treat either pediatric or adult growth hormone deficiency. It should not be prescribed if not needed. I’ve had Olympic athletes come to me asking for HGH before the last Olympics. This use is not appropriate on many levels. I wouldn’t give it to someone who doesn’t need it to treat a deficiency disease. Young adults would not be treated unless there was serious pituitary disease. No one is too old to treat with HGH for growth hormone deficiency. You could be diabetic and treat obesity-related diabetes with lifestyle coaching and growth hormone. It is an absolutely amazing way to treat diabetes in patients with growth hormone deficiency.

The theoretical concern of administering HGH is that it sounds as though growth hormone makes things grow, so if there is a cancer hiding somewhere, the thinking is that it might grow. But extensive years of study have shown that not to be the case, that this theoretical risk is nonexistent. Teenagers have sky-high growth hormone levels but have relatively low rates of cancer. You need growth hormone for cellular replication, so if you don’t have any HGH left, you are not going to be in very good shape on a physiological level. As your growth hormone increases, your IGF-1 made by the liver increases. Then a hormone and a carrier protein called IGF binding protein 3 (IGFBP-3) increases. This IGFBP-3 is an anticancer hormone.

Now, HGH doesn’t make you immortal. Could someone on growth hormone replacement therapy get cancer? Of course. Otherwise, it would be too good to be true. The medical literature discusses the theory of treating cancer patients with growth hormone in terms of immune system stimulation and better quality of life.

On the HGH package insert it says not to use it with an active malignancy. There’s an extensive discussion of this issue by the Growth Hormone Research Society published in the
Journal of Clinical Endocrinology
. The Growth Hormone Research Society concludes that the statement about not using HGH in active malignancy is not based upon any data and should be removed.

SS:
So this was just a presumption?

RR:
Right. This was the theory like the old theories on testosterone. It was thought that because men have more heart attacks than premenopausal women, testosterone must be the cause. Turns out that it is just the opposite. Testosterone prevents heart attacks in men.

SS:
Would HGH accelerate weight loss?

RR:
Yes. Women in the studies done at Johns Hopkins lost 14 percent of their fat mass, and with men it’s even more dramatic. You see, HGH is lipolytic, meaning it dissolves fat.

SS:
It dissolves fat. That’s enough right there to make people run out and get this stuff.

RR:
Yes, but then you need the correct lifestyle—here’s the other side of it. If you consume unlimited carbohydrates, things could get worse with HGH. You could become more insulin-resistant, store more fat, and get closer to diabetes. You’ve got to have the right lifestyle with it for it to work. And you need the deficiency in the first place as determined by a physician with experience in the field.

SS:
But if you’re willing to exercise, eat real food, good food, sleep, and then add HGH to this regimen, you’re ahead of the game, wouldn’t you say?

RR:
Oh, very much so, but as I continue to stress, only if you need it, only if you have adult growth hormone deficiency.

SS:
So, used properly, HGH is a wonderful addition to your hormone supplementation?

RR:
Yes, this is a hormone that sets the background vibration of
life. Some things about it are subtle. It’s not like you get a shot of it and, wow, what a rush. After you have been taking HGH replacement for years, you just live your life. You don’t even notice the feeling because you’re living on a much higher level, mentally, physically, and emotionally.

SS:
When a woman comes into your clinic for the basic sex hormones like estrogen, progesterone, or testosterone, would HGH would be a next step?

RR:
It might be. Other basic hormones to evaluate include DHEA and thyroid. We should determine if HGH is needed on the basis of history, physical exam, and labwork.

SS:
When you give someone HGH, do you give them a blood test first? Or do you just presume by their age and by looking at them that they are deficient?

RR:
We always get blood tests and sometimes twenty-four-hour urine tests. Like so much in medicine, a diagnosis is on the basis of clinical medicine, history, and physical combined with lab. The older someone is and the lower the IGF-1 test is, the more likely it is that he or she has adult growth hormone deficiency. Also, the “phenotype,” which is the physical appearance, can give you a clue. For example, someone whose skin is droopy and saggy, who has more body fat and less energy, is more likely to have HGH deficiency.

There are aesthetic effects to treating HGH deficiency. More collagen is grown under the skin, so it can eliminate fine lines and wrinkles improve. There is sometimes reversal of thinning hair and graying hair.

SS:
There’s a lot of discrepancy on how to administer HGH. Some doctors are very nervous about giving it more than once a week. That doesn’t make sense to me.

RR:
Would you treat diabetes one day a week? Of course not. People will not get the benefits injecting once a week. You administer it every day and as early in the morning as possible, or you can take it before you go to bed at night because your body normally produces HGH in your sleep.

HGH is used to treat a deficiency disease. You’re replacing an absent
hormone. If a person is to be healthy and you don’t have enough at fifty, you’re not going to start magically making more at sixty. Once the well runs dry, the well is dry. If you think you’re treating a deficiency disease, then you do it every day. You don’t give them a weekend off.

SS:
What is the lowest dose you give of HGH?

RR:
I keep it simple. I usually start treatment at 0.2 mg a day, and then after about a month, if there are no side effects, go up to 0.4 mg a day. Most men end up in that range. After another month in most women, I will increase to 0.6 mg a day. Women need more than men, and most women will end up at 0.6 mg a day. Some patients may have side effects on those doses, and I treat them with as little as 0.1 mg a day.

SS:
What are the side effects of HGH?

RR:
The four possible side effects of growth hormone replacement therapy are edema [ankle swelling], numb and tingly fingers, aching joints, and insulin resistance getting worse, not better. If a side effect develops, you decrease the dose or stop for a few days. If you stop the HGH replacement, the side effects disappear.

By the way, if a woman is on oral estrogen (which she shouldn’t be on anyway because it’s very inflammatory), it’s not even worth trying growth hormone. Estrogens given as a skin cream or gel are fine.

SS:
Why is that?

RR:
Oral estrogens stop liver production of IGF-1, which is an important component of the growth hormone effect. Even with endogenous estrogens in a premenopausal woman, or transdermal estrogens in a woman receiving the right kind of bioidentical hormone replacement therapy, HGH works, but not as effectively as it does with men. I find with some patients I have to fine-tune the HGH dose because of the side effects I just mentioned.

SS:
What is the dose that you take?

RR:
I’m on 0.4 mg per day.

SS:
And how do you feel?

RR:
I feel great. I mean, I don’t notice it anymore. At first, there was a dramatic change in energy and quality of life. I’ve been doing it
for eight years. So it’s not like, wow, here comes the growth hormone. I feel great, even though my lifestyle is not as good as it should be. I should exercise more, and my kids sometimes say, “What a hypocrite for a nutrition expert guy! You ate all the Ben and Jerry’s.”

SS:
Well, we’re all human. The messenger doesn’t always live the message. I feel you have to give yourself a little wiggle room.

RR:
Right. So I could do better, but I know I feel better. I’m operating on a healthier and a higher level mentally and physically than I was eight years ago.

SS:
You do have great vitality and youth about you. How young would you start someone on HGH?

RR:
It is very individual. We are assessing whether the patient has adult growth hormone deficiency. This would be extremely unlikely for someone in their thirties, possible in their forties, and more likely in their fifties and sixties. I would never prescribe it for bodybuilding, looking good, or athletic performance. But if there is a deficiency in patients who are in their forties or fifties, why wait for those patients to fall apart?