Hormone Replacement: The Fountain of Youth?

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Key points

  • •
    Hormones and hormone precursors have been investigated as antiaging treatments to delay the onset or progression of age-associated changes in body composition, strength, and physical and cognitive function.
  • •
    Dehydroepiandrosterone and growth hormone have been investigated. Most studies have included small sample sizes and have been of short duration. Results have generally been mixed, at best.
  • •
    Menopausal hormone therapy (MHT) is effective in treating vasomotor and genitourinary symptoms of

Current hormone replacement therapy guidelines and research (women)

The use of hormone replacement in women is primarily indicated for the management of severe menopausal symptoms, specifically vasomotor and genitourinary, and is now referred to as menopausal hormone therapy (MHT). Clinical guidelines for MHT have been published by the Endocrine Society.44

Risks of menopausal hormone therapy

MHT is beneficial in the treatment of VMS and GSM; however it poses serious health risks. Various studies report increased risks of breast cancer, stroke, venous thromboembolic events, gallbladder disease, and incontinence with the use of estrogen plus progestin.52, 53 Additionally, increased risk for endometrial hyperplasia and cancer is seen with unopposed estrogen therapy in women with an intact uterus, as well as reported probable increased risk of developing dementia as seen in the WHI

Risk calculations

Newly added to the 2015 Endocrine Society Clinical Practice Guideline for MHT, calculations for cardiovascular risk and breast cancer risk may be referenced before considering MHT.44, 54 These tools may aid the clinician and patient in discussing risks and benefits, and facilitate shared decision-making.
When considering cardiovascular risk, the clinical practice guideline is based on the American College of Cardiology and American Heart Association cardiovascular disease (CVD) risk calculations

Recommendations for menopausal hormone therapy

The recommendation for use of MHT for VMS and GSM relief are for healthy women, without contraindications (Box 1) or excess cardiovascular or breast cancer risks, and age less than 60 years or less than 10 years after menopause onset.44 In this specific age range population, the benefits of MHT seem to outweigh the risks. The guidelines recommend choosing and tailoring MHT to the individual patient based on severity of symptoms, patient-specific factors, and risk and benefit of therapy. The

Off-label use of menopausal hormone therapy

Several studies allude to other potential benefits and preventative benefits of MHT.

Summary

As long as people continue to resist the normal aging process, there will be interest in maintaining a younger appearance and function. Although older adults with true hormone deficiencies that adversely affect their function to the degree that their daily activities and interests are compromised may be appropriate candidates for treatment, those with normal functional capacities are not. There is little evidence of benefit for treatment with DHEA or growth hormone beyond those with documented

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