Chasing Youth, Many Gamble on Hormones
December 22, 2002
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
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
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
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.
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
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
Dr. Alvin Matsumoto, a geriatrician at the Veterans Affairs
Puget Sound Health Care System, sounded a similar note of
"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."
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