Remember "raging hormones," those glandular gremlins responsible for every embarrassing act of youth? Not only have they become respectable, they're all the rage.
Estrogen, testosterone, DHEA and melatonin are seen by millions of Americans as capsule versions of the fountain of youth. Best-selling books like "The Melatonin Miracle" and "The Super Hormone Promise" tout the ability of hormones to ward off the effects of aging. Even testosterone, so often blamed for aggressive behavior in men, is getting better press. Newsweek recently devoted a cover to hormone therapy, asking "Can It Keep Men Young?"
But little is known about the effects of taking most hormones. Only the benefits of estrogen replacement therapy have been clinically proven: It guards against heart disease and osteoporosis in post-menopausal women.
You still need a prescription for estrogen and testoterone. But DHEA and melatonin are available over the counter as nutritional supplements.
Although DHEA and melatonin are not approved by the Food and Drug Administration and no long-term research exists on their effectiveness, many people are reaching for them as if they were extra-strength vitamins. They are eager to try anything they hear will boost their immune system, vitality and libido. Some are even chewing DHEA gum.
But even those who are profiting from the hormone craze urge caution.
"I don't believe in people in their 20s and 30s taking hormones, or in people using them to build muscles," says 71-year-old physician William Regelson, co-author of the best-selling books "Melatonin Miracle" and "The Super Hormone Promise."
"My whole emphasis is hormone replacement," says Regelson, who takes hormones himself and believes they've made him more vigorous. "I signed a book recently for one young fellow who thanked me for writing the book and told me he was taking 300 milligrams of DHEA a day -- that's a pharmacologic dose larger than what you give in the clinical group to treat lupus. But what do you do with stupid people?"
Physicians worry that such "more-must-be-better" use of over-the-counter hormones may ultimately increase the risk of hormone-sensitive diseases such as cancer of the breast, ovaries, uterus and prostate.
"Somebody wouldn't go to the health food store and buy indeterminate levels of estrogen and testosterone," says Ronald Parks, a Baltimore physician who specializes in nutritional and preventative medicine. "If used at all, over-the-counter hormones should be used carefully and conservatively in consultation with a physician. People shouldn't look for a magic pill."
"People do feel that hormones have magical properties, that it's youthful to have them," says reproductive endocrinologist Marion Damewood, director of the Women's Health Center at Greater Baltimore Medical Center. "The thought is more prevalent in women, I think, because there's a time framework in which women lose hormones whereas the decline in men is much more prolonged."
Produced by various endocrine glands, hormones are chemical substances that regulate growth, metabolism and reproduction. Their increasing desirability is based on the unproven belief that losing hormones is always bad and replacing them is always good.
"The underlying assumption is that gradual hormonal decline is bad because some physical functions decline at the same time. But there's no proof of a causal link," says Richard Sprott, associate director of the National Institute of Aging and head of the biology of aging program.
At the moment, many physicians and scientists worry most about melatonin and DHEA, the hormones which share supermarket shelves with vitamins.
"We have no idea who's taking these hormones and what's happening to them," Sprott says. "You're not going to take over-the-counter hormones and drop dead next week, but we're concerned about the kind of harm which might take months to years to develop."
Lynne Lamberg, author of "Bodyrhythms: Chronobiology and Peak Performance," says that people taking melatonin, the popular hormone often used to induce sleep, are unwitting subjects in a large-scale, uncontrolled experiment.
"A lot of claims have been made about melatonin in a host of popular books but that doesn't mean that they mean anything," says Lamberg, who recently reported on melatonin for the Journal of the American Medical Association.
Stephen Busky, head of urology at Greater Baltimore Medical Center, believes the quest for hormone replacement is often spurred by articles "based on enthusiasms."
"There is a concept in the popular press that there are things out there that doctors know about and aren't telling the rest of us," he says. "There's a feeling that doctors won't share this information because it won't make money for us. Or that we're too conservative and have blinders on while these gurus are really in touch with things.
"We don't get any money for telling people to take aspirin prophylactically or for telling them to stop smoking and to exercise. And these are things that make sense for making people stay fit and feel better."
Busky says people already possess a magic formula to make them feel younger and more vibrant: decreasing their consumption of saturated fats and alcohol, stopping smoking and increasing aerobic exercise, which stimulates the body's own production of hormones.
"Those things will have a much more profound effect on well-being -- and on a sense of well-being -- than anything you can get in a bottle," he says.
The hormones in question
For those taking hormones or considering taking them, here is a description of some of the hormones being used -- and studied -- in replacement therapies.
Estrogen is a "female" hormone produced by ovaries, which cease production at menopause. Estrogen replacement relieves such symptoms of menopause as hot flashes and night sweats, reduces bone loss and relieves vaginal dryness. It is also believed to reduce the risk of heart disease, to reduce mood swings, to keep skin more youthful and to improve memory.
The risks of taking estrogen include an increased incidence of endometrial cancer -- unless taken with progesterone -- and a return of premenstrual symptoms. Long-term use may also put women at greater risk for breast cancer. It is usually prescribed for women after their physicians determine levels of hormones to see if they are in menopause.
Testosterone, usually produced in the testes, is a "male" hormone available only through prescription. Because men do not undergo the dramatic hormonal changes that women do, their testosterone declines gradually.
Traditionally, physicians have reserved testosterone replacement for men who are severely hormone deficient. Now some are studying its benefits for men whose levels have declined. After blood tests establish that testosterone therapy is warranted, treatment is usually given through skin patches or regular injection; testosterone pills have been shown to damage the liver.
While researchers look for evidence that the hormone increases lean body mass and libido, many physicians worry that testosterone therapy may increase the risk of heart disease, aggravate prostate problems and promote tumor growth. Men receiving testosterone should have their cholesterol and PSA checked regularly.
DHEA (dehydroepi- androsterone), available over the counter, is a weak male hormone produced by the adrenal glands located on the kidneys. In the body, it changes into estrogen and testosterone. Humans usually produce the greatest amount of DHEA from the ages of 25 to 30.
According to animal studies, some of the benefits of this hormone may include strengthening the immune system, building muscle and lean body mass, increasing libido, improving memory and boosting energy. It appears to be useful in treating the auto-immune disease of lupus in humans.
But no large, long-range clinical trials have been completed.
Scientists and physicians caution that high levels of DHEA can ++ cause liver damage in the short term and may also be linked to an increased risk for breast and prostate cancers. Some side effects of high doses include acne, oily skin and insomnia. High doses in women can lead to facial hair and deepening voices.
Melatonin, available over the counter, is a hormone produced inside the brain by the pineal gland. Researchers are investigating its ability to induce sleep and combat jet lag. Some animal studies suggest the hormone can increase libido, lessen the risk of cancer and work as a form of birth control. No large, long-range clinical trials in humans have been conducted.
Pub Date: 2/11/97