Growing Old Series: Interview with Dr. Kent Holtorf on HGH and Testosterone Replacement Therapy

May 15, 2009

(ChattahBox) — Interested in aging gracefully and with good health and vigor?  Diet and exercise are crucial but let’s face it nature is working against us as our bodies decline with age.  One option that is controversial in the medical field is hormone therapy.  We spoke with Dr. Kent Holtorf board certified endocrinologist and founder of The Holtorf  Medical Group about HGH and testosterone replacement series.

1. Are HGH and testosterone viable treatments for anti-aging supplementation?

Yes, the studies clearly demonstrated that HGH and testosterone replacement prevents and reduces risk for cardiovascular disease, diabetes, age related mental decline and dementia, weight gain and obesity, muscle mass loss, bone loss, fatigue, loss of libido, and depression.

2. How does one find a knowledgeable doctor?

This can be difficult as endocrinologists and urologists typically rely on what they learned in medical school and on outdated consensus statements (Why Doesn’t My Doctor Know This). Alternatively, there are many doctors that dabble in testosterone replacement. To find a doctor that is significantly trained and up-to-date on the current literature, would recommend finding a doctor that is Board Certified in Anti-aging Medicine.

3) How does one determine if this might be a useful treatment and should it only be taken if there is a diagnosed deficiency?

This is not a black and white question as there are many variables. Firstly, total testosterone is a poor measure of active testosterone levels and the free testosterone assays are shown to suffer from huge variability and accuracy problems. Saliva tests are inaccurate, as well. Also, the average testosterone level for age has been shown to be significantly lower than even just 10-20 years ago, likely due to environmental toxins, including plastics, fire retardants and pesticides. The labs have adjusted down the “normal” ranges to compensate. So it is like saying, because many people now have diabetes, it is now normal to have diabetes and should not be treated. Additionally, individuals with previously higher levels may have a dramatic drop in testosterone and suffer with significant symptoms but still be in the “normal” range. Supplementation to more optimal levels can have dramatic results and reduce the risk of many age-related illnesses. Thus, withholding treatment until someone is outside the normal range, meaning the lowest 2.5% of the population is inappropriate and poor medicine.

Unfortunately, many doctors are more comfortable treating the wide ranging effects and symptoms of growth hormone and testosterone deficiency with multiple medications instead of fixing the source of the symptoms. Bringing the growth hormone and testosterone levels to more optimal levels is a safer and potentially more effective means of treatment and can eliminate the need for numerous medications with the associated risks.

In regards to growth hormone deficiency, the standard tests used to determine a deficiency are terribly inaccurate. I discuss in the paper Diagnosis of Growth Hormone Deficiency.

4. What are the benefits?

As above, the studies clearly demonstrated that HGH and testosterone replacement prevents and reduces risk for cardiovascular disease, diabetes, age related mental decline and dementia, weight gain and obesity, muscle mass loss, bone loss, fatigue, loss of libido, and depression.

5. What are the treatment protocols?

Treatment protocols vary depending on the individual. Testosterone can be given as gels or creams, sublingually (under the tongue), or by injection (subqutaneous or intramuscular). All have pluses and minuses. Some men will convert testosterone into too much estrogen, limiting the effectiveness and increasing the risk of side effects.

If this is the case, the gels should be avoided or alternately other substances, natural or prescription, can be added to decrease the formation of estrogen. Combining different forms of testosterone that do not aromatize (convert to estrogen) is another option.

For GH, typical dosing is 0.5 to 2 iu subcutaneously per day.

6. What are the costs?

For testosterone, costs are generally between $50-$150/month, depending on the route of delivery, type of testosterone used.

For GH, costs are between $200-$500/month.

7. What of medical reports of HGH side effects reportedly seen in previously healthy mature patients after taking HGH including:

    • Edema (retention of fluids) in extremities
    • Arthralgia (joint pain)
    • Carpal tunnel syndrome
    • Hypertension
    • Diabetes and other glucose metabolism imbalance?
    • Gynecomastia (enlargement of male mammary glands)

Growth hormone increases hydration (water) in the tissues, which is why is reduces wrinkles and has an esthetic anti-aging effect. In a small percent of individuals there can be edema (water retention), arthralgia (water retention in the joint space), CPS (water retention in carpal tunnel) and HTN (fluid retention) occasionally seen is merely a side effect of water retention. This is easily remedied by decreasing dose.

There can be a clinically insignificant reduction in insulin sensitivity for the first several months on growth hormone. When continued, there is a significant improvement in insulin sensitivity and is an effective treatment for diabetic patients and reduces the risk (not increases) the risk of DM.

The gynecomastia is from increased estrogen, as discussed above, and is easily monitored and prevented.

8. What of NIA finding that testosterone supplementation remains a scientifically unproven method for preventing or relieving any physical and psychological changes that men with normal testosterone levels may experience, as they get older?

As with most consensus statements, they are outdated almost as soon as they are published. Since the publication of that consensus statement many years ago, numerous studies have demonstrated that replacement of relative testosterone deficiency can have dramatic benefit without the risks once thought to be associated with such treatment.

9. And of reports that testosterone might fuel the growth of prostate cancer?

That is what we were taught in medical school and it became dogma. The studies have, however, shown that low testosterone, not high, is a risk of developing prostate cancer and that higher levels of testosterone do not fuel existing prostate cancer.

About Dr. Holtorf founder of The Holtorf Medical Group (www.holtorfmed.com):

Kent Holtorf, M.D. is an expert in natural bioidentical hormone replacement and optimization for women and men, endocrinology, thyroid dysfunction (difficult thyroid cases), fatigue syndromes, adrenal insufficiency, growth hormone replacement, chronic fatigue syndrome, fibromyalgia, chronic infections and multiple endocrine dysfunction.

Dr. Holtorf is diplomate and a board examiner for American Board of Anti-Aging Medicine (ABAAM). As a board examiner, Dr. Holtorf is responsible for administering the oral portion of the board exam and evaluating the physicians’ responses to determine if their knowledge base in endocrinology and natural hormones is high enough to receive board certification in this field. Dr. Holtorf received his doctorate of medicine from St. Louis University with residency training at UCLA. He has personally trained physicians across the country in the use of bioidentical hormones, hypothyroidism, complex endocrine dysfunction and innovative treatments of chronic fatigue syndrome, fibromyalgia and chronic infectious diseases, including Lyme disease. He was the founding medical director and developed the protocols for Fibromyalgia and Fatigue Centers and other centers across the country.


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