Panelists Marc Blackman, Andrea Dunaif, Ginger Constantine, Sara Rosenthal, Adrian Dobs, Michael Thorner.
Photography by Mackenzie Stroh
For video footage of the entire roundtable discussion please click here
In most of the world, people are living longer than ever, and one consequence is that they are living old longer than ever—more frail, less mobile, less mentally acute. Hormones seem central to the process. Muscle atrophies as growth hormone declines; bones get fragile as estrogen declines; sex drive dwindles as testosterone declines. More and more evidence suggests that returning those hormones to the blood can turn back the biological clock. So DISCOVER brought together six leaders in hormone research at the 2007 meeting of the Endocrine Society in Toronto to explore whether hormone therapy could halt or even reverse the aging process.
Participants were Marc Blackman, chief of the endocrine section at the National Center for Complementary and Alternative Medicine at NIH; Andrea Dunaif, chief of endocrinology at Northwestern University; Ginger Constantine, vice president of women’s health and bone repair at Wyeth Research; Sara Rosenthal, bioethicist and medical sociologist at the University of Kentucky; Adrian Dobs, professor of medicine at Johns Hopkins University; and Michael Thorner, professor of medicine at the University of Virginia. DISCOVER executive editor Corey S. Powell moderated the discussion.
Let’s start with the fundamentals: What role do hormones play in controlling, and potentially preventing, the aging process?
Dunaif There are a lot of endocrine processes that have an aging component. For women, the most striking one is gonadal hormone: Women stop menstruating. Interestingly, in both women and men, adrenal function starts to go down with age. The question that we get into is, if you replace those hormones, are you going to prolong life? And is it appropriate to do?
Dobs I see a lot of men who, as they get older, don’t have the same kind of sexual function they had when they were younger, and the same thing goes for women. And of course the question is, “Well, how much of that is natural and should be left alone?” One can look at it in different ways. One can say that sexual function is an important component of quality of life, and we should try to preserve it as long as possible. The other side of the coin is that there are other aspects of life. I think it was Socrates who that said that he was glad he didn’t have the same libido that he had when he was younger; he could finally get some work done.
Blackman I would step back and define the difference between biological aging and chronological aging. We all know that there are people who are youthful folks in their seventies, eighties, and even beyond, physically and mentally, and people who we feel are prematurely old, either from disease or just because the ravages of time have worked more quickly on them. It’s the loss of functional independence, whether for hormonal reasons or complex other reasons, that is the adverse consequence of aging.
Dobs It’s a tough balance how much can be medically treated and how much is lifestyle oriented. So many of the diseases that we talk about—being overweight, getting diabetes, a lot of the chronic diseases—we think about in terms of taking a magical pill. But in reality, many of the diseases can be treated and prevented from a lifestyle point of view.
Thorner There’s a study now being done of older minority women. Half of them have been asked to go to school five days a week to help children learn to read and so on. Their health outcomes are better and their life expectancy is better than for the other half. And so an involvement in society is important in influencing aging. Physical exercise is important. You can’t just say there’s one magic bullet. It’s got to be part of a whole program.
Blackman One of the leitmotifs of this discussion is that aging is not really about hormones; it’s about more complex issues. Hormones are a part of the mix, but hardly the whole story.
Dunaif I think that one of the major reasons the antiaging industry is so appealing is precisely because it promotes taking a pill instead of changing a lifestyle. People are so drawn to the quick fix that you could probably spend the next 50 years trying to get them to do the crossword puzzle and walk around the block, and that’s not going to happen.
But there still has to be a fundamental biological process behind aging, so can’t endocrinology find ways to let us live longer, better lives?
Constantine I think we can perhaps affect aging, but can we affect life span? That’s a huge question. Estrogens definitely prevent osteoporosis. Osteoporosis is one of the most debilitating and disabling diseases that we know of. In the Women’s Health Initiative —a massive study of 161,808 women over 15 years—there was a decrease in mortality among the women in the 50- to 59-year-old group who took estrogen alone or with progesterone. There was also a decrease in cardiovascular disease, though there’s some debate as to whether it’s statistically significant. But we have to look at what we’re doing with our hormones. Are we treating disease? Are we preventing disease? Are we preventing aging?
Thorner I think of aging as a process which probably is inevitable but almost certainly can be slowed—and the objective is not to extend life but to be able to do whatever we want to do until the day that we drop, rather than becoming increasingly dependent. Endocrinology has the tools right now to be able to have a huge impact on aging and on being able to allow people to remain vibrant for as long as possible.
Dunaif But you don’t want the bogus stuff. You don’t want this big industry that’s playing on all these fears, hyping this [hormone therapy] stuff and doing harm.
