Doctors who have established practices in longevity, or anti-
aging medicine, say they perform extensive evaluations of a
person's health and "biomarkers" before designing individualized
treatment. Part of each workup involves determining biological
age, as opposed to chronological age.

For $1,750, Alan P. Mintz, M.D., chief medical officer and
CEO of Cenegenics, based in Las Vegas, puts his patients
through a battery of blood tests and completes detailed
histories that look at mental health, nutrition, exercise
and other lifestyle issues. Patients also undergo cognitive
testing, agility testing and strength testing. Some screenings
create a baseline to measure progress; others are used to
determine which conditions can be treated hormonally.

Blood levels are monitored quarterly, and patients -- some
of whom fly in from other states or overseas -- return at
least once a year for follow-up. The goal of treatment is
to "stay as close to the physiology of a 30-year-old as
possible," said Mintz.

Replacement therapies for estrogen, testosterone and human
growth hormone play a major role. Human growth hormone,
produced in the pituitary gland, is responsible for a wide
range of youthful attributes, such as increased muscle and
bone mass, decreased body fat, strengthening of the immune
system and a greater sense of well-being and energy.

Testosterone can improve mood, alertness, libido, and skin
and muscle tone in both men and women. For most people, hGH
levels drop dramatically by age 30. Testosterone levels
also decline.

"Testosterone and natural estrogen and natural progesterone,
when used correctly and safely, are cornerstones of anti-aging
therapies," said Karlis Ullis, M.D., an anti-aging doctor in
Santa Monica, Calif.

Ullis has treated more than 500 patients with hGH but now
believes "it's not the wonder drug that the public has been
led to believe." Other methods can work as well, such as
intensive weight training, caloric restriction, moderate
cardiovascular workouts, moderately high protein intake,
deep sleep and positive social relationships, he said.

Some doctors have raised concerns about the widespread use
of human growth hormone because it stimulates the liver to
increase production of the insulin-like growth factor, which
normally declines with advancing age.

Samuel S. Epstein, M.D., a professor of environmental medicine
at the University of Illinois School of Public Health in
Chicago, has warned fellow doctors of the potential dangers
of widespread use of hGH, which include increased risks of
colon, prostate and breast cancers.

"For these reasons, anti-aging hGH medication, compounded by
failure to explicitly disclose its grave risks, constitutes
medical malpractice," Epstein said in a statement in September.

Studies have found that when used to treat patients, testost-
erone can cause fluid retention, stimulate aggressive behavior
and raise red blood cell counts.

Both hormones are indicated only for actual deficiency, said
Paul S. Jellinger, M.D., president of the American Association
of Clinical Endocrinologists.

The issue gets complicated in the context of anti-aging
medicine. Does natural decline usually suggest the need
for treatment?

"The biggest problem in this field is to separate those people
with true deficiency and those with normal declines that come
with aging," Jellinger said. "There is no strong evidence that
everyone who has the normal decline of testosterone from aging
is a candidate for replacement therapy."

Nearly nine of 10 endocrinologists polled in a recent survey
said they were concerned that increased availability of
testosterone replacement therapies, combined with widespread
publicity about potential benefits, could lead to inappropriate
prescribing by doctors and serious health consequences for
male patients.

Questions about the safety and validity of hormone replacement
underscore the uncertainties about anti-aging medicine.

"Some doctors think they can take a weekend seminar and
become a specialist in anti-aging medicine," said Ullis,
who has been practicing it for about 10 years. "You can't
learn endocrinology and exercise physiology over a weekend.
Patients are asking about supplements and hormones, and
doctors have to be well-informed."

Distributed by Los Angeles Times Syndicate