The Life Plan (63 page)

is produced in the adrenal cortex of the brain as well as the testes. It is then converted to estrogen and testosterone. Reestablishing DHEA balance to more youthful levels can enhance sexual desire, performance, and overall mood. It is also used for increasing production of your own growth hormone,

combating chronic fatigue syndrome, depression, memory loss, and osteoporosis, and protecting the body from the ravages of age. This can be purchased over the counter as a supplement, but I recommend pharmaceutical-grade DHEA to make sure you are really getting what you are paying for. I have tested many of my patients taking inferior DHEA products and found surprisingly low blood levels.

Some men experiencing sexual dysfunction may actually have underlying thyroid disease, and feel better on a combination of the hormones T4 and T3. Your thyroid produces T4 and then your body converts it to T3, a more active form. These hormones can also help relieve depression, brain fog, fatigue, and other age-related symptoms. They can be obtained with a doctor’s prescription after determining a deficiency by a simple blood test.

You may have heard that supplementing with melatonin helps regulate sleep patterns, but it also has antioxidant properties for overall health. Melatonin can help you relax, so it may also improve sexual performance. This can be purchased over the counter as a supplement.

I believe that most older men could benefit from this therapy, as could many younger men in their 40s and 50s, and even some in their 30s. You will need to work with your current physician to come up with a program that optimizes your hormone levels. A total serum testosterone test done first thing in the morning is necessary to determine your current levels. Some specialists believe that they also need to know the free or unbound testosterone level to get a true estimate of testosterone status. The normal range for total testosterone is between 300 and 1,000 nanograms per deciliter. Levels between 200 and 300 ng/dl are considered to be borderline, and levels below 200 ng/dl indicate a clear deficiency.

If your test comes back with a testosterone level in the 100 to 200 range, a traditional doctor may say, “Well, Joe, you’re okay . . . you’re in the normal range.” What he or she isn’t saying is that low-range normal is the equivalent of getting a D-minus on your report card. I don’t want to be a low-grade anything. I want to be at the top of my game, especially when it comes to two very important parts of my life: my health and sex. Staying in the upper normal range means having a testosterone level of 900, 1,000, or even 1,100.

If you have borderline or even very low testosterone levels, you can first try to raise your levels through exercise, weight loss, proper nutrition, supplementation, avoiding smoking, minimizing the use of alcohol, and controlling the stress in your life before going to testosterone therapy. Get rid of excess body fat, especially your belly, since this elevates your estrogen levels and pushes testosterone levels down. Make sure, however, that you don’t lose body fat too fast (more than two pounds per week), because if your body thinks you are starving, testosterone levels will plummet and your muscles will shrink.

If all of these efforts fail to restore your healthy levels of testosterone, find a knowledgeable doctor who will help you. I must emphasize that a skilled, experienced practitioner who monitors blood testosterone levels and performs digital rectal exams along with PSA tests to screen for prostate cancer must administer your therapy. In my office, every man undergoes a highly comprehensive evaluation to first determine if a clinical hormone deficiency exists. Any man needing a correction of hormone deficiencies has blood work done at six weeks, and again every three to four months after that to ensure that levels stay in the healthy range.

Because every man’s hormone level is unique to him, it’s impossible to know exactly how high your levels were before they declined. For this reason, most men require some fine-tuning of their treatments until the best results are achieved. You should notice that your symptoms begin to improve in three to six weeks after you start treatment.

Not every man is a good candidate for testosterone therapy. Discuss your current health status with your doctor, especially if you have a history of obstructive sleep apnea or heart failure. If you have one of these you need to see an appropriate specialist before starting therapy.

H
uman growth hormone (hGH) has been the subject of magazine covers, federal investigations, and television exposés. It has been abused by sports figures and celebrities as well as adamantly dismissed by many conventional physicians. And yet, research tells a different story: When hGH is correctly used, it has been clinically proven to improve health in men who have a documented clinical deficiency.

I have strong feelings about human growth hormone therapies because I have witnessed remarkable reversals in aging and disease by using it myself. I also want to make it very clear that like any type of medicine, it should not be abused, and it should be used only when it is determined to be absolutely necessary. This chapter is meant to give you all the information you need to help you decide with your doctor if growth hormone therapy is right for you.

The practice of age management medicine began in the 1990s when Dr. Daniel Rudman published a landmark article in the
New England Journal of Medicine.
Dr. Rudman looked at the effects of supplementing growth hormone in healthy men between the ages of 61 and 81. In this group of 21 men, Dr. Rudman managed to increase their lean muscle by 8.8 percent, decrease their fat mass by 14.4 percent, increase their skin thickness by 7 percent, and increase lumbar bone density by 1.6 percent, simply by giving injections of human growth hormone three times a week over a six-month period. The results of Dr. Rudman’s study were confirmed and even extended in a study recently completed by the National Institute on Aging and Johns Hopkins University, headed by Doctors Mark Blackman and Mitch Harmon. Similar findings have been demonstrated with several other studies.

Since then, age management medicine physicians have embraced growth hormone as a treatment option for adults. Previously, it was used to extend growth for children. Until 1986 human growth hormone was harvested from cadavers and carried a risk for transmission of disease to its recipients. Since 1986, however, growth hormone has been commercially produced in the laboratory and the problem of disease transmission is no longer applicable. Today the supply of hGH is safe, available, and easy to administer. Unfortunately, hGH is expensive, though the costs of treating the diseases associated with untreated growth hormone deficiency over your lifetime far outweigh this expense.

Just as with unregulated testosterone use, we know that some athletes abuse this treatment when they take hGH to increase strength and improve their performance. It’s important to know that hGH treatments are completely legal if you’re diagnosed as being deficient and an FDA-approved formulation is obtained with a doctor’s prescription after appropriate clinical testing proves your deficiency.

Another myth that has captured public attention is that growth hormone replacement therapy may put individuals at increased risk for developing a cancerous malignancy. The literature, however, does not support this notion. Current clinical guidelines from the Endocrine Society state that there is no evidence that the incidence of tumors is increased by growth hormone therapy. In 2001, the Growth Hormone Research Society extensively reviewed the question of whether growth hormone therapy is associated with tumor growth. Their final statement was quite telling: For patients receiving growth hormone therapy, “No additional monitoring for other malignant tumors (such as tumors of the prostate, breast, or colon) is currently suggested beyond the accepted standard of care for the patient’s age and sex.”

Human growth hormone is naturally produced by the pituitary gland in your brain and is critical for repair throughout your body. Its ability to reverse many of the major effects of aging, including muscle loss, weakness, skin tone and texture, excess body fat deposits, energy depletion, and declining immune function, is unparalleled in today’s medicine. It can also help boost your sex drive as well as sexual potency.

As we age, our growth hormone production decreases. Adult hGH levels decline by half from age 20 to age 60, and the loss accelerates thereafter. The following are some of the signs that you may be experiencing a decline of growth hormone:

Decreased energy and vitality

Decreased libido

Decreased muscular strength