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The Medical Management of Aging

A important part of a cosmetic surgeon's practice is devoted to reversing the effects of aging; be it aging of the face or body, surgery is the major tool used to address the ravages of time. New medical solutions on the horizon may compete with surgery, perhaps eventually making it obsolete. With genetic engineering, the body's cells may be reprogrammed to add more cell divisions before a total system failure. Present-day medical management is based upon a hormone-based theory that suggests that aging is caused by a gradual decrease in the body's hormones. By optimizing the hormone levels to those of the second to fourth decade of life, the aging process will be at least slowed, if not reversed. In its simplest form, hormones are chemical compounds produced by glands that tell cells what to do. Hormones released by the thyroid control metabolism; estrogen controls the estrus cycle; testosterone controls the libido and spermatogenesis; the list is endless. As these and other hormone levels decrease, several metabolic changes occur that affect every organ system in the body, from muscle mass to the immune system. Estrogen replacement therapy has been prescribed for years to control the effects of menopause, to slow osteoporosis, and to protect against heart disease. Interestingly, climacteric in men has not been addressed with the same level of hormone therapy and interest as that for women. However, with changing technology and more sophisticated testing, the attitude toward the helplessness of aging is about to change. Many of the antiaging treatments fall under the category of food additives and are not regulated by the US Food and Drug Administration (FDA). A popular additive a few years ago was dehydroepiandrosterone (DHEA). It was popularized and then demonized in the press and in the medical literature because people were buying it over the counter in unregulated quantity and quality. Today, the appropriate approach is to monitor pretreatment blood levels and prescribe the appropriate dosage to achieve the correct serum level according to sex. DHEA is secreted by the adrenal glands and is an important precursor to all the hormones and steroids that our bodies normally produce. It affects the immune system, cholesterol metabolism, libido, and memory. Side effects are acne and hirsutism.