Start Aesthetic and Anti-Aging Medicine Early

Our skin reflects cumulative damage from the sun and the environment and belies our general health. Underlying undesirable changes in the skin are some preventable changes in skin metabolism. The skin renews itself every four to eight weeks as new cells are generated in the deep layers. These new skin cells mature and migrate to the surface, where they are soon ready to slough off. The sloughing off is a signal to the deep layers of the skin to begin the process again, and new skin cells are created and sent the surface. As we age, this turnover of our skin cells slows, and can cause a dull, coarse appearance. Another common change seen in aging skin is a decrease in collagen and elastin production. Since collagen and elastin are important for the structure and elasticity of the skin, the loss of these two proteins causes wrinkling and sagging. Anything we can do to increase skin cell turnover and collagen and elastin production will help the skin appear more youthful and will improve the health of the skin. There is good evidence that rapid skin cell turnover via exfoliation reduces the risk for skin cancer.

The trend in aesthetic medicine and cosmetic procedures is to start non-invasive procedures early in order to keep the skin healthy and prevent some of the undesirable changes that occur as we age. One of the most popular treatments at Youthologie is Laser Genesis, which is a comfortable laser treatment that stimulates collagen production. The result is smoother, tighter, younger looking skin with less sun damage. The same treatment improves scars and prevents acne breakouts, and there is no downtime or recovery time. Patients are able to resume normal activities immediately.

Another important tool in anti-aging medicine is bio-identical hormone replacement. This is the use of hormones that are the same as those made by the human body to replace the normal decline in hormone levels that occurs as we age. It is said that we age because our hormone levels decline.  Generally, the hormones being replaced are the sex hormones estrogen, progesterone and testosterone. However, another hormone that commonly becomes deficient with increasing age is thyroid hormone. Every tissue and organ in the body has receptors for hormones, so they have a global influence on virtually every bodily process.

The goal of anti-aging medicine is to live a full, healthy, and happy life for as long as possible and to prevent the common diseases and disorders that typically increase with age. The big killers and disablers are heart disease and stroke, cancer, Alzheimer’s disease, diabetes, and, for women, osteoporosis (cause of hip fractures) and macular degeneration (cause of blindness). All of these conditions are at least somewhat preventable. It is possible to assess our risk for disease and prevent it through changes in lifestyle and nutrition and the use of bio-identical hormone supplementation.

There is widespread misplaced fear and misunderstanding regarding hormone replacement therapy. Bio-identical hormone replacement therapy (BHRT) differs significantly from hormone replacement therapy (HRT), as the latter uses synthetic hormones. Many women stopped using HRT on the advice of their doctors when the Women’s Health Initiative study was discontinued prior to its scheduled completion due to the finding of an increased risk for heart attack, stroke and breast cancer associated with synthetic hormone therapy. This risk is not seen with BHRT. 

One difference between bio-identical hormone replacement and synthetic hormone use is that bio-identical hormones are familiar to the body. The body has the enzymes necessary to metabolize hormones that are identical to those created by the body. As a result, the hormones are present for a only few hours, just as when the body manufactures its own hormones. Because synthetic hormones are unfamiliar to the body and the body does not have enzymes to metabolize them, they can remain in the body for months. This means there is a prolonged period of time during which all tissues of the body are influenced by these hormones. Another example of how BHRT differs from HRT is in the use of progesterone. This natural hormone has a protective effect on breast tissue and helps to prevent breast cancer, whereas progestin, the synthetic substitute often used, does not have a protective effect on breast tissue. 

 For more information about aesthetic and anti-aging medicine, contact Youthologie at 919-847-1495 or email lisa@youthologie.md, or visit our website www.youthologie.md.

Bioidentical Hormones: What Are They And Are They Right For You?

As we age, our hormone production declines in predictable fashion; and it begins earlier than you might think. By the time we are in our thirties and forties our production of sex hormones may be low enough to cause serious symptoms. Although both genders produce all of the sex hormones, men produce predominantly testosterone and women produce predominantly estrogens and progesterone. The sex hormones are familiar to most people as the hormones that determine our gender, our secondary sexual characteristics as we mature and many aspects of our fertility.

But did you know that virtually all of our organs and tissues have receptors for the sex hormones, which means that these tissues respond to the sex hormones. Testosterone, estrogen and progesterone have profound effects on the health of the muscles, bones, cardiovascular system, brain, eyes and other endocrine systems, to name a few. So, not only do we have unpleasant symptoms with hormonal decline, but also it is detrimental to our health.

Until 2002 women were prescribed the synthetic hormone Premarin, conjugated equine estrogens or CEEs, derived from the urine of pregnant horses; Provera, the synthetic medroxyprogesterone acetate or MPA; or Prempro, a combination of the two. Usually, this prescription was issued long after menopausal symptoms had been evident, and usually without any lab testing. One dose was prescribed for every woman.

In 2002 the Women’s Health Initiative (WHI), a study led by the National Institutes of Health looking at the effects of Prempro on cardiovascular health, osteoporosis and cancer, was abruptly terminated just 8 years into the study. The study already showed an increase in the risk of heart attacks and stroke and breast cancer. These study results were widely publicized in the popular press with the result that millions of women suddenly stopped taking their hormone replacement either by their own decision or on the advice of their doctors. Hormone replacement has come to be viewed with fear, and women are basically told you just have to “tough it out.” (Often antidepressants are prescribed.) This is much like telling a diabetic to “tough it out” without insulin.

As for men, symptoms of hormonal decline are often not discussed, not addressed and are largely ignored. Men might be given a prescription for erectile dysfunction, but this does not preserve muscle, bone, heart and endocrine health the way testosterone would.

For women, is there an alternative? And, if so, is it really any better or safer than the out of favor synthetic hormones? The short answer is yes, bioidentical hormones or hormones that are natural versions of human estrogens and progesterone are very different form the synthetics and are more safe. They are usually prescribed on an individual basis, i.e., different dosing for different needs of different women, with lab testing to determine the level of need and the response to therapy.

First of all, women feel better on the bioidentical hormones. Secondly, there are numerous studies showing that bioidentical hormones are protective for the cardiovascular system in several different ways (increased coronary artery blood flow, decreased arterial plaque, decreased arterial spasm, and a favorable influence on lipids), thereby decreasing the risk for heart attack and stroke. Additionally, the synthetic, MPA, has been shown to increase insulin resistance (type II diabetes) compared to bioidentical hormones, which adds to the cardiac risk. Also, because bioidentical estrogen is given transdermally, there is not the increase in clotting factors, inflammatory proteins and risk of thromboembolism (blood clots) seen with synthetic CEEs given orally.

Perhaps most alarming is the known increased risk of breast cancer in women on MPA and the known carcinogenic (cancer causing) components and metabolites of CEEs. The natural estrogen, estriol, has been shown both experimentally and clinically to be associated with a decreased risk of breast cancer. Bioidentical progesterone has an anti-proliferative effect on breast tissue, meaning it has an anti breast cancer effect, which is opposite to the effect of the synthetic, MPA.

The results of the WHI study make sense intuitively—one glance at the path by which our sex hormones are made reveals that small changes in the sex hormone molecules can completely change their function and effects. It should come as no surprise, then, that synthetic hormones that differ from our natural ones have completely different effects on the various tissues of our bodies.

There are many other good reasons for both women and men to be on bioidentical hormone replacement therapy including preservation of muscle and bone health, prevention of Alzheimer’s disease, prevention of eye disease, preservation of urinary tract health, and preservation of libido and zest for life!