For the Love of Aging

With my birthday right around the corner I decided to write an entry that focuses on the aging process. For the majority of us the period around our birthday is a time of reflection and analysis of our lives. Everyone hopes that their future is bright and good health is a huge component of this wish.

For all of us that have spent time around women going through peri-menopause and menopause, or for those that have lived it, it is apparent that this is a difficult process. The initiation of hot flashes, mood swings, and weight gain are likely not pleasant symptoms of one of life's natural courses. For years, we all heard about hormone replacement therapy (HRT) with the replacement of estrogen that is lost during menopause. However, it has been revealed that HRT is a potentially dangerous therapy since it has been correlated with increased breast cancer, blood clots and heart disease in women. For the purpose of this blog I will discuss potential new therapies on the horizon to manage the weight gain that many women struggle with while getting older. Men, you are not in the clear from this whole estrogen as we age phenomenon and I will get to that soon so keep reading.

The hypothalamus is the region of the brain that controls energy regulation, thirst, hunger, etc. Remember that from high school science? Well, it is no surprise that this area of the brain is the focus of ongoing research to combat the battles of menopause. Research by Deborah Clegg at the University of Cincinnati demonstrated that is ESTROGEN receptors in the hypothalamic region of the brain that control energy regulation and body fat distribution. When these ESTROGEN receptors were destroyed in animals they began to eat more food, burn less energy and gain more weight. Therefore, it is reasonable to draw the parallel to the decrease in estrogen levels during menopause.

Estrogen receptors called ER-alpha are now being investigated in the ventromedial region of the hypothalamus (also involved in temperature regulation). Since we now realize the potential adverse reactions of supplementing estrogen in all receptors of the body researchers are hoping to determine a way to only stimulate the receptors in the hypothalamus. By achieving this goal, essentially the hypothalamus will still function at its pre-menopausal level. Thereby, helping to alleviate some of these difficult symptoms that women face during menopause. While many men experience these struggles of menopause vicariously through our partners we are not free from our own fight against hormonal changes with aging.

Men have the benefit of testosterone, at least while we are young. Testosterone helps to maintain muscle and aids metabolism. However, just as women have decreasing levels of estrogen as they age, testosterone levels also diminish in men. Interestingly, it is not just about this drop in testosterone but the mismatch with estrogen in older men that may cause problems. Yes, men have estrogen. At younger ages the testosterone levels are peaking so estrogen levels are lower in comparison.

The main active estrogen metabolite is estradiol. The main source of estradiol in men is aromatization, which is the conversion of testosterone to estrogen. The issue is that despite decreased production of testosterone from the adrenal glands and testes as men age the aromatization process continues which can result in a higher estrogen to testosterone ratio. One of the reasons that aromatase activity is persistent with age is an increase in belly fat. Estradiol levels correlate with subcutaneous abdominal fat. Some of the symptoms of excess estrogen in men include development of breasts, fatigue, having too much abdominal weight, loss of muscle mass and emotional disturbances. Research has always demonstrated (some conflicting) that excess estrogen in men may increase the incidence of stroke, heart attacks and prostate cancer. As always, I want to inform you all of possible solutions that exist to these problems.

As we have previously discussed, abdominal fat (visceral) is never protective. So first things first, try to lose the mid-section abdominal fat via methods that we have discussed in previous entries.

Estradiol is not the only culprit that may cause health problems. Specific estrogen metabolites may also initiate and promote hormone related cancers. Daily consumption of cruciferous vegetables such as broccoli, cauliflower and brussel sprouts convert dangerous estrogen metabolites to safer ones (always good to eat your greens). For those that actively avoid eating these types of green vegetables there are supplements that contain similar constituents to aid this process called indole-3-carbinol and sulphoraphane.

Just as there is estrogen hormone replacement for women there is also testosterone replacement for men in the form of an absorbable cream. Testosterone levels can be checked in the blood and if the level is much lower than the age matched average supplementation can be used. However, a follow up blood test within 30-45 days is required for dosing and also to ensure that the PSA (prostate specific antigen) has not increased. Estradiol levels can also be checked in the blood but this is definitely not routinely done by most doctors (as far as I know).

There are also now medications that are aromatase inhibitors (e.g. Arimidex) that lower the level of estrogen produced from testosterone. These medications are used primarily in breast cancer patients and I don't feel there is enough research out there yet to support using them in aging men.

Life is about balance and these hormones are no different. Too much estrogen can lead to heart attacks, stroke, etc. and too little can lead to osteoporosis and weight gain. It seems like there are some exciting research studies on therapeutics currently being done in this area so maybe aging will become even more pleasant in the future.

As always, comments and questions are appreciated. Don't forget to recommend the blog to your friends and family.