What gets lost in all the talk about Alex Rodriguez, performance enhancing drugs, and shady Florida clinics is this: Manipulating hormones is part of the future of medicine.
This is not to say that administering HCG (Human Chorionic Gonadotropin, a protein hormone that stimulates the testes to produce testosterone), or testosterone (also known as ‘T,’ a steroid hormone) itself, or HGH (Human Growth Hormone, a protein hormone) to a perfectly healthy athlete is ethically—or even medically—correct. But it can be a legitimate medical decision. Of course, much has to happen before writing out any prescription, not the least of which is a diagnostic assessment.
In that case, though, would it really be cheating? And what if hormone optimization was open to everybody, not just athletes, thereby granting equal opportunities, not just conferring advantage to some? The story wouldn’t be about dishonest A-list athletes. Instead, it would be about a new way of making the playing field even across ages, and ensuring healthy longevity via personalized medicine.
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All of us are susceptible to the disorders of aging: cardiovascular disease, diabetes, osteoporosis, Alzheimer’s, neurodegeneration, arthritis, even cancer. Hormones underpin systemic functioning, and as they begin to tumble with age so too do we. Lean muscle declines, cells malfunction, injuries occur, repair and recovery slows—all while energy, muscle, memory, strength, and resilience become elusive. Baby boomers long feared the number 30, and it turns out they were right to worry, because that’s when our downward spiral begins, imperceptibly to some, insidiously to all.
In baseball there’s the age-27 theory, which holds some validity. Of course, every player achieves peak performance at different ages, based on their individual circumstances. But there’s something to 27. Recently, an ESPN columnist tested the age-27 theory using the stats of the top 100 hitters during a 10-year period (1998 to 2008). He determined there was a range of peak performance—26 through 32, which, it turns out, mirrors an individual’s biological apex: optimal reproductive and physiological health is between 25 and 30. That’s when our metabolism is performing at its best and our hormones oscillate in synchrony.
Optimizing hormones may give an aging athlete a fighting chance at reclaiming his peak physiological health. What that could mean is fewer injuries and the ability to bounce back quicker, along with the strength and endurance to play at the highest level. In some cases, administering exogenous testosterone or HCG appropriately may even save a player’s life.
I know because I've seen it happen. One of my patients first came to me in his early 40s and was completely rundown. He is a veterinarian on Long Island with a successful practice and three teenagers. While no A-Rod, he did use to be an avid athlete, running several miles a day and lifting weights regularly. Lately, however, he had difficulty finding motivation to exercise and the recovery time from a workout was days, almost weeks. He also had an elevated high sensitivity cardiac-CRP (c- Reactive Protein). C-Reactive Protein is an inflammatory maker, and chronic inflammation is bad for the body. If c-CRP is elevated, between the values of 1 and 5, it usually means you are at increased risk for cardiovascular disease such as a heart attack and stroke.
Further analysis revealed that my patient had high blood pressure, diabetes and gout. I also found out that cardiovascular disease ran in his family. I wanted to see his c-CRP come down, so I prescribed him Human Chorionic Gonadotropin. After I started him on HCG, increasing his natural testosterone, his c-CRP improved, as did his ability to exercise effectively. I also recommended he change his sleep habits, take supplements and tweak his diet. Before long, his risk of disorders of aging reversed, and within months, he reported feeling like “me” again. He said he began to enjoy life once more.
Which brings us back to A-Rod, who confessed to using PEDs between 2001 and 2003, when he was 25 through 27, within the window of peak physiological and reproductive health. I would not have condoned his usage of testosterone, unless clinically indicated. The latest round of accusations calls into question his actions during the past few years. They assert he took testosterone and HGH between 2011 and 2013, as prescribed at Biogenesis of America. A-Rod was solidly in his 30s during this time, and is now pushing 40. Though impossible to confirm without access to his lab results, his hormones are likely in decline. No doubt he wants to reclaim his game, but what about the rest of his health? Was A-Rod also found to be at risk for heart disease or diabetes, were his A1c or fasting blood sugar or LDL cholesterol particles elevated, along with signs of vascular inflammation or any genetic ‘SNPs’ suggesting an early heart attack? Were his risk factors, other lab metrics, personal and family history taken into account? Were any other diagnostic tests performed to rule out disorders of aging, invisible perhaps, but present nevertheless?
We don’t know the answers, but even the questions suggest that this may be more than just another steroid abuse story.
Behind the vilification of players, (and A-Rod’s manipulation of MLB, if proven, should be addressed appropriately, according to whatever his agreements or contracts dictate), there is a very real fear of using these PEDs. We're scared of medications, quick to label them as unnatural. We're scared of knowing ourselves and even getting blood work; anxious we may be in for some bad news about our health. We're scared to grow old, and yet we are faced with life spans that are the longest ever in human history.
These issues are complex and don’t easily lend themselves to tabloid headlines. Personalized or Precision Medicine, as some refer to this emerging field, will make the difference in owning our own health outcomes. It should help us address a new goal: to extend our health span to keep up with our life span. The role of hormones is critical to maintain strong muscles, joints, bones, hearts and brains as we age. Athletes have known this for a long time.
Some pundits claim that the game of baseball would be more honest and its players healthier without hormonal treatment of any kind. I will let sports experts debate the honesty question, but I can say with utter confidence that they won't all be healthier.
And without changing our attitude, neither will we. If we continue to stigmatize hormonal optimization as a legitimate path toward healthier futures, we too could face consequences far graver than being banned from the playing field at Yankee Stadium.
Dr. Comite is a graduate of Yale School of Medicine where she taught for 25 years, as an associate clinical professor. She is a noted endocrinologist with a practice in New York City, and the author of an Amazon best-seller on men’s health entitled: Keep It Up: The Power of Precision Medicine to Conquer Low T and Revitalize Your Life, published by Rodale in 2013.