Are Hormones Relevant In The Pursuit Of Healthspan And Longevity?
Dr Harpal Bains
MBBS DFSRH PGCAestMed (Dist)
June 4, 2024
Dr Harpal Bains
MBBS DFSRH PGCAestMed (Dist)
June 4, 2024
The science behind longevity medicine and healthy ageing as a clinical practice is fast developing. Longevity medicine is a recently developed sub-type of medicine that focuses on improving a person’s healthspan. Healthspan describes the length of time in our lives when we feel well, without chronic symptoms, illness or disease. The shift to prevention over cure has never been more prominent in the UK, and many of us are beginning to realise the importance of becoming increasingly proactive with our health, in place of simply reacting in a time of need or crisis.
Certain longevity clinical recommendations have recently gained popularity. These include the likes of medications such as:
All of which are incredibly exciting, and new research is emerging all the time on how they may be quite significant for longevity. You may have also already heard of some longevity-associated lifestyle techniques such as; cold exposure or ice baths, infrared saunas, weight training and zone 2 exercise, personalised nutrition for health optimisation, and using blue-light blocker glasses.
Many of the findings around this subject show us that this area requires a lot more research in order to provide a more definitive answer as to whether their clinical utility is warranted. Choosing to take hormones with longevity in mind is a relatively new concept. However, unlike the more recent longevity-associated recommendations listed above, hormones have been extensively medically researched, which means our understanding of them and their pharmacology (how they react in the body) is exceptionally good.
Let’s take a look at the role that hormones can play as part of longevity medicine and healthy ageing practice. If you are researching hormones and longevity you’ll likely find Human Growth Hormone (HGH) as a predominant hormone with longevity research ties; but which others are out there, and more importantly, what do we know about them and their potential benefits for improving a person’s healthspan and longevity?
To take more of a deep dive here, we’ll take a look at two key hormones often used in our own clinical practice; oestrogen and melatonin.
There has been an enormous amount of change when it comes to prescribing hormone replacement therapy (HRT) in the UK in the past year or so. The Women’s Health Strategy led by Dame Lesley Regan has helped to propel menopause to the forefront of everyone’s mind; and rightly so, as menopause-associated health complications are incredibly important when we begin to consider longevity.
Oestrogen is a well-known hormone used for alleviating menopausal symptoms, and is for the most part paired with progesterone. You may find that it is combined with testosterone as well as other prescription-grade hormones such as pregnenolone or DHEA at private hormone clinics.
Musculoskeletal health
The role of oestrogen in bone health is quite prominent. Having low oestrogen can be one of the main causes of postmenopausal osteoporosis, which weakens bones and significantly elevates the risk of having a fracture. Breaking a bone has been shown to raise mortality rates time and time again – particularly as we age. These rates differ depending on the age of the person and location of the fracture. Looking after our musculoskeletal health is important when we consider longevity because having strong bones enables us to keep sufficiently active and feeling strong – both mentally and physically.
Although not technically an organ, muscle is often described by longevity specialists as the organ of longevity! If our bones are strong, we feel more able to complete more frequent exercise which builds muscle. Worrying about breaking a bone, falling over and frailty are some of the main worries people develop as they get older and begin to think more about their health.
Brain health
Oestrogen also has an important role in our brain health. There is a higher prevalence of Alzheimer-associated dementia in women compared to men, highlighting the role that low oestrogen may have in the development of neurodegenerative diseases. When it comes to potential protective elements against Alzheimer’s disease, we suggest ensuring adequate B vitamin intake through diet, regulating blood sugar control, and moderating alcohol intake. Alzheimer’s disease is a concern that we often come across at our clinic and one that many of our longevity patients ask about when thinking about prevention.
Regulating inflammation
Regulating chronic inflammation is a well known way of supporting healthy ageing – and oestrogen plays a key role in some inflammatory processes. As the ovaries begin to slow down (producing fewer sex hormones such as oestrogen), this can enhance the inflammatory process. This can lead to an increase in more proinflammatory cytokines such as IL-6 and TNF-alpha.
Post-menopausal women may find conditions such as multiple sclerosis can worsen due to the inflammatory component of the condition. It can be speculated that supporting oestrogen levels may mitigate some of these inflammatory responses that occur as a result of diminishing oestrogen. It also seems quite apparent that tackling the causes of chronic inflammation addresses a fundamental marker of ageing, and is a key area to place our focus when it comes to longevity medicine.
Longevity genes
There have been studies looking at how oestrogen replacement may increase our internal antioxidant capacity and even impact our longevity genes. Although the human study was small, and larger studies are required to contribute to this data, these initial findings are still exciting when we begin to consider hormones for longevity and healthy ageing!
Melatonin is a neurohormone available on prescription in the UK. It is often prescribed to support good sleep architecture and to help to regulate the sleep-wake cycle. We all know how important sleep is for our health and how having a good night’s sleep can make us feel great the following day. We require sleep for many processes surrounding repair and regeneration, and so, if we have interrupted sleep or reduced hours this can have a considerable negative impact on both our short and long-term health.
Sleep deficiency, or a general lack of sleep, is associated with many chronic health conditions such as cardiovascular disease risk, chronic inflammation, kidney disease, high blood pressure, diabetes, obesity, depression and even neurological damage. Understanding the connection between sleep and chronic illness is important when looking to improve healthspan as chronic illness is a large part of why healthspan is shortening.
Melatonin is highly researched due to its beneficial anti-inflammatory effects, and its ability to act as an antioxidant. In recent literature, this has been specific to cardiovascular health. Melatonin also has the ability to protect against Alzheimer’s and Parkinson’s disease. As previously mentioned, neurodegenerative disorders can often be a main focus for many people looking to take part in longevity medicine due to their increasing prevalence.
Anti-inflammatory qualities
Chronic inflammation is associated with a number of diseases. Seemingly contradictory to this, our bodies also need inflammation. One key example of this is in our response to injury, where the inflammatory response is used as a vital defence mechanism. For example, if you fall over and hit your knee you will notice it will become sore, red and swollen – these are all reactions that are part of an adequate immune response to injury.
The issue with inflammation begins when the inflammation becomes chronic and is not found as a result of injury, but more connected with internal cellular processes in the body that we are unable to immediately see. Melatonin is complex, having both pro and anti-inflammatory actions in the body making it an immune system modulator. Its proinflammatory actions are often found in early inflammation where inflammation is needed as part of the healing process and to protect against pathogens, whilst its anti-inflammatory actions are seen during late stage inflammation. This is helpful because we do not want long-term inflammation.
Melatonin also has a very low list of drug-to-drug interactions – this is important because many older adults are more likely to be taking other medications at the time they choose to address their health conditions or concerns. Furthermore, due to its high safety profile, melatonin as a preventative tool to prevent inflammatory disorders has a wider scope of practice – enabling more people to utilise this hormone.
Given the prevalence of chronic inflammation and sleep-related issues in the UK population, melatonin has the potential to be used more widely to support healthy ageing. Many studies show that melatonin can reduce various inflammatory markers. Considering the role that inflammation plays in chronic disease and how having chronic disease can lessen a person’s healthspan – it appears that using melatonin, as part of a comprehensive treatment plan, and as a longevity-associated hormone, is showing great promise!
Cardiovascular health + antioxidant capacity
Melatonin has strong antioxidant properties that have been shown to neutralise free radicals, prevent damage and reduce oxidative stress; and significantly for longevity, its antioxidant effects on our cardiovascular health too. It has long been understood that our sleep patterns are closely connected to our cardiovascular health. Much like with brain health and exercise capacity, cardiovascular health is a common concern for many people wanting to address their health and specifically their longevity.
Advanced cardiovascular blood tests, advanced blood pressure screening as well as completing an arterial age (pulse wave velocity) non-invasive test provides a good set of information about potential cardiovascular risk factors. Although studies looking at cardiovascular health and melatonin are quite new, the majority of the studies completed so far show that melatonin has a positive impact on cardiovascular physiology. Its antioxidant capacity can specifically protect cardiac tissue and can activate antioxidant enzymes such as glutathione.
The studies looking at cardiovascular health and melatonin, both from a reactive (post-disease state) and as a preventative tool are exciting to read. More science is needed to investigate and understand the full capacity of this antioxidant for longevity and healthy ageing purposes.
As a hormone optimisation (BHRT) and longevity medicine clinic, we absolutely see the benefits that taking hormones provide, as well as how they may contribute to improved longevity and healthspan. After all, many of our patients have been with us throughout the span of our service (just over 10 years).
From our experience talking to patients, it seems that prescriptions for hormone replacement for menopause symptoms are increasing in the UK, meaning that more and more women are reaping the preventative benefits hormones such as oestrogen provide for long-term health.
Improving sleep is a huge focus in the longevity medicine space, with a lot of wearable technology available to monitor sleep quality. This is an area where lots of people have issues, which, given the data, means that it could be having an impact on chronic health conditions and subsequently, healthspan.
We are definitely of the opinion that hormones play an integral part of a longevity medicine treatment plan and health strategy. We believe that they do indeed help to support healthy ageing and we are excited to see what future research shows us for hormones and longevity medicine.
