One of the primary goals for the study of the aging process is to find ways to slow the gradual onset of morbidity and death. The main concern is to increase our quality of life. Although aging is inevitable, there are some things we can do to increase our health, such as living a healthy lifestyle and exercising. A problem occurs for many older adults when they near their golden years. They find themselves unable to perform as they did when they were younger. For some individuals this may be because of a decrease in hormone production. Hormone replacement therapy (HRT) may be the answer if this occurs. Current forms of HRT include testosterone, estrogen, and growth hormone replacement. All three have advantages and disadvantages that should be weighed carefully when considering HRT.
Testosterone -- In adult males, testosterone maintains muscle mass and strength, fat distribution, bone mass, and libido (Winters, 1999). Testosterone is produced by the testes and decreases with age. Below-normal testosterone production is known as androgen deficiency or hypogonadism. Androgen deficiency manifestations may include reduced body hair, decreased muscle mass and strength, increased fat mass, decreased libido, erectile dysfunction, infertility, osteoporosis, and depressed mood (Winters, 1999). As we grow older testosterone levels fall gradually. When serum testosterone level fall below normal testosterone replacement therapy may be used. Until recently, intramuscular depot injections were the most common form of testosterone replacement therapy used. Today there are also oral and transdermal patch forms of administration available (Winters, 1999). Returning testosterone levels back to normal in adult males with hypogonadism can increase their muscle mass and strength, increase their bone density, increase their sense of well being, energy, and libido. Testosterone plays a crucial role in the health of a male. During old age if hypogonadism occurs testosterone replacement therapy may be a very beneficial solution.
Estrogen -- Estrogen replacement therapy is a second form of HRT. This therapy is generally used for women during or after menopause or by women whose bodies are unable to maintain normal estrogen production because of surgery or disease. The medical world is not very clear on their position about estrogen replacement therapy. Physicians typically present the advantages and disadvantages, leaving the decision up to the patient (Zwahr et al., 1999). Whether or not women would utilize this therapy often depends on their age. Typically women around age 50 have been shown to be the most educated about estrogen replacement therapy (Zwahr et al., 1999). Zwahr believes younger and older adults make decisions about medical treatments differently, in part because of age-related changes in cognitive abilities (Zwahr et al., 1999). Assuming estrogen replacement therapy is chosen, it is easily administered orally, and presents many benefits to women with an estrogen deficiency. The short-term benefits may include the relief of hot flashes, mood disturbances, insomnia, and the restoration of sexual function. The long-term benefits are protection against cardiovascular disease, osteoporosis and colon cancer, and a possible reduction in the incidence of Alzheimer’s disease (Bertrand et al., 1998)). A possible negative side effect is a very slight increase in risk for breast cancer. Estrogen replacement therapy can be very beneficial for women with below-normal estrogen levels.
Growth Hormone -- Growth hormone is the third and newest form of HRT. Recent research suggests that the atrophy of lean body mass and its component organs and the enlargement of the mass of adipose tissue that are characteristic of the elderly result at least in part from diminished secretion of growth hormone (Rudman et al., 1990). In this study adults age 60 to 80 were used. Their plasma IGF-I levels were significantly lower when compared to men 20 to 40 years old. The findings of the study confirmed the hypothesis that the decrease in lean body mass, the increase in adipose-tissue mass, and the thinning of the skin that occur in older men are caused in part by reduced activity of the growth hormone IGF-I, and can be restored by the supplementation of growth hormone (Rudman et al., 1990). This study even goes as far to claim that the effects of six months of humane growth hormone on lean body mass and adipose tissue mass were equivalent in magnitude to the changes incurred during 10 to 20 years of aging (Rudman et al., 1990). Possible side effects include edema, hypertension, diabetes, or cardiomegaly. These problems are not very common, and mainly occur when larger-than-needed doses are given. Thus it appears that growth hormone replacement therapy has a positive impact of body composition in older adult males.
As the years pass by, we all encounter age related changes. HRT offers some viable options to older adults who want to maintain their healthy lifestyles as long as possible. Testosterone replacement for men with hypogonadism can increase strength, lean body mass, libido, bone density, well being, and energy. Many different administration forms are present that have minimal risks. Estrogen replacement is also an option, primarily used for women with low estrogen production. This therapy lessens the effects of menopause, deters osteoporosis and colon cancer, and may reduce the incidence of Alzheimer’s disease. Growth hormone replacement therapy is another promising type of HRT that can be used if deficiencies are present. Benefits of growth hormone replacement therapy include an increase in lean body mass and a decrease in adipose tissue. As with most treatments in medicine today, they all carry possible side effects. But with the correct administration under a physician's guidance the risks are minimal. Overall, the research on hormone replacement therapy appears to be very promising.
Bertrand, M., Collins, J., Derzko, C., Lalonde, A., Miller, D., Murphy, J., Reid, R., & Rosen, B. (1998). The benefits of hormone replacement therapy and counseling issues related to breast cancer. SOGC, 73, 1-7.
Morrison, M.F. (1997). Androgens in the elderly: Will estrogen replacement therapy improve mood, cognition, and quality of life in aging men and women? Psychopharmacology Bulletin, 33(2), 293-296.
Rudman, D., Feller, A.G., Nagraj, H.S., Gergans, G.A., Lalitha, P.Y., Goldberg, A.F., Schlenker, R.A., Cohn, L., Rudman, I.W., & Mattson, D. E. (1990). The New England Journal of Medicine, 323(1), 1-6.
Winters, S.J. (1999). Current status of testosterone replacement therapy in men. Archives of Family Medicine, 8, 257-263.
Zwahr M.D., Park D.C., Shifren K. (1999). Judgments about estrogen replacement therapy: The role of age, cognitive abilities, and beliefs. Psychology and Aging, 14(2), 179-191.
Contributed by Seth Vogel, December 5, 2001.