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From the January 13th, 1997 issue of Smart Drug News [v5n6]. Copyright (c) 1997, 1998. All rights reserved.

Book Review:

The Super Hormone Promise

review by Thomas H. Nufert

The Super Hormone Promise: Nature’s Antidote to Aging
by William Regelson, M.D. and Carol Colman
with a foreword by Walter Pierpaoli, M.D., Ph.D.
Simon & Schuster, 1996 (ISBN 0-684-83011-6).

It takes a lot of courage for a clinician to write a book which makes the following claims on its cover: 1) grow younger at any age; 2) add decades to your life; 3) invigorate your sex life; and 4) maintain vigor, health and energy into your 80s, 90s, even 100s.

Not only does one risk peer-group rejection from fellow scientists and physicians, but one must consider the interests of regulatory agencies (like the FDA) and partisan private institutions (like the “quack busters”) in maintaining the status quo. The bright future that Dr. Regelson sees may be perceived as threatening by some. Those with power to regulate medicine and commerce may be tempted to exercise that power with the likes of such “upstart” doctors as Dr. Regelson, if they “go too far out on a limb” and treat patients with unapproved drugs, approved drugs with unapproved indications, or, worse yet, dietary supplements.

And then there are critics closer to home. These might include life-extension advocates who know the published literature well enough to find flaws in books like The Super Hormone Promise—flaws that support criticisms of how scientific literature can be misconstrued or inappropriately represented to extend the subject at hand beyond the science at hand. Some readers may recall T. Michael Hardy’s critical review of Dr. Regelson’s prior book The Melatonin Miracle (Simon & Schuster, ISBN 0-684-81335-1), coauthored by Dr. Walter Pierpaoli with Carol Colman, published in Smart Drug News [see v4n6]. Some of the flaws and failures in The Melatonin Miracle have been effectively redeemed by The Super Hormone Promise, as will be discussed in this review.

There is a historical context, of which the public may not be aware, which might be used by critics of Dr. Regelson (and other advocates of such “super hormones” as DHEA and melatonin). Neophytes to endocrinology may be unaware of the tremendous hoopla that occurred in the late 1940s and 50s with the introduction of the “miracle drugs” or “miracle hormones” cortisone (and its derivatives) and ACTH (adrenal corticotrophic hormone). Doctors were astounded by quick, measurable, clinical improvements in numerous clinical syndromes by corticosteroids, particularly in the areas of inflammatory and autoimmune conditions like rheumatoid arthritis, lupus, and a wide variety diseases and syndromes. Patients felt better, looked better, and objective measurements such as hand grip strength improved in the face of crippling arthritis. Literally thousands of patients went back to their physicians to enthusiastically proclaim, “Doctor, look! It’s a miracle. Look what’s happened to me.”

It took the better part of two decades for clinicians to fully appreciate that they were buying short-term results at the expense of long-term consequences. While many of these consequences were subtle, some effects were devastating with even deadly results—all related to catabolism and inhibition of protein synthesis. Corticosteroids augmented such aging-related conditions as 1) loss of muscle mass, 2) hair loss, 3) thinning of skin, 4) impaired immune function, 5) decreased wound healing, and 6) various Cushing’s disease-like conditions (related to insulin resistance and syndrome X-type conditions associated with increased LDL cholesterol, hypertriglyceridemia, abdominal obesity, hypertension, and the general phenotypic expression of non-insulin-dependent diabetes mellitus).

Another historical context familiar to many women has been the adverse effects of birth control pills and hormone replacement therapy.

Such experiences may engender a degree of skepticism about the utility of using hormones as a therapeutic modality. Dr. Regelson’s advocacy of a new set of “super hormones” in the face of this historical context is certainly a difficult uphill battle. It is not a battle that can be easily won with simplistic assertions like, “if it’s natural, it can’t hurt.” ACTH and cortisone are quite natural. Yet it would appear that they are principal endocrine players in our “natural” demise.

Dr. Regelson is well aware of this historical context and makes a number of well-reasoned arguments as to why the “new” super hormones—namely DHEA, pregnenolone, progesterone, testosterone, estrogen, thyroid hormone, growth hormone and melatonin—actually counteract the effects of the catabolic hormones cortisone and ACTH.

Dr. Regelson states that his reasons for writing this book is “first and foremost to inform you about the super hormone revolution, but... also... to stimulate interest in the scientific research community.” He states “I am hoping that consumer demand will force the government to fund some of the studies that the drug companies will not. For those who wonder why I’m writing this book now and why I don’t wait until all the studies are done and all the results are in and the FDA has approved each and every hormone for each and every use, here is my answer: I cannot afford to wait that long, and neither can most of you.”

The essential rationale behind Regelson’s advocacy is probably well known to SDN readers: 1) as we age, we lose function; 2) the loss of biological function is associated with decreased hormonal levels and/or decreased hormonal receptors; 3) restoring certain hormones to normal physiological levels is associated with increases in biological function in animals; and 4) maintenance of these biological functions in animals (and humans) is associated with longer life. Therefore, logic dictates that we should restore deficient hormones to normal if we want to extend our lives.

In advancing these premises, Regelson and Colman do a reasonable job of documenting and interpreting the literature. The book is fairly well written and readily understandable for the educated lay person. However, there are certain inaccuracies which may be forgivable but might mislead the reader into embracing certain simplistic notions. For instance, the statement on page 75 that insulin “breaks down sugar or glucose so it can be utilized by the body cells” implies that insulin performs a digestive function rather than signalling the cell to admit glucose. While such language might prompt a biochemist or diabetologist to wince, it nevertheless succeeds in getting the essence of a complicated point across for the lay person.

While there are other minor inaccuracies, these are far outweighed by the important perspective and wisdom that only an expert can bring to the subject—as Dr. Regelson has. Any book written primarily for non-scientists must in some way compromise scientifically precise language for readability and comprehensibility. I hope that scientists and physicians reading this book do not become so frustrated with the scarcity of footnotes, data tables, and statistical analyses that they put the book down before reading Appendix 2. This appendix presents an article by Regelson and associate Mohammed Y. Kalimi, Ph.D., entitled “DHEA (Dehydroepiandrosterone): A Pleiotropic Steroid. How Can One Steroid Do So Much?” which is exactly the type of scientific review I enjoy reading. It succinctly summarizes important advances up to 1995. Because of the inclusion of Appendix 2, one could comfortably give this book to a physician, pharmacist, or skeptical biochemist brother and direct them to read this appendix (and not say anything more). Their natural curiosity will likely entice them through the rest of the book, with a potentially positive result.

The authors include nine chapters on the various hormones, with separate chapters for men and women’s particular needs. They also include a tenth chapter entitled “How to Take Super Hormones: The Right Dosages and Where to Find Them.” In Appendix 1, the authors also provide lists of various resources including compounding pharmacies, mail-order suppliers and diagnostic test laboratories. A referral list of physicians who utilize the super hormones would have been a nice addition (but probably politically unrealistic with the FDA and “quack busters” on the job overtime). Physicians can probably be found through phone calls or World Wide Web searches of the various resources that are listed (or CERI’s listings).

One problem I have with The Super Hormone Promise is that it does not make it crystal clear to readers the full extent of the risks of using super hormones. In the case of DHEA, there are two well established relationships between cancer and two of the super hormones which the authors affirm: 1) pre-existing breast cancer can be worsened by estrogens, and 2) prostate cancer can be worsened by testosterone. In light of these relationships, the authors recommend a variety of medical tests before beginning a super hormone program. These include a prostate exam and a PSA (prostatic specific antigen) test for men, and a mammogram, breast exam, pap smear and thorough gynecological exam for women.

While these recommendations are prudent, the lay reader is not effectively warned about other risks. For instance, we are told by Regelson and Kalimi on page 280 of Appendix 2 that “DHEA is the precursor for... testosterone, dihydrotestosterone, estrogen...” and on page 288 that “DHEA levels are reported to be elevated in patients with benign prostatic hypertrophy...” (with two peer-reviewed journal articles cited in support). Should this be a concern? Not according to Regelson and Kalimi who state, “In contrast, we believe that DHEA should be looked at for possible inhibition of prostate cancer, but it is risky in view of the conversion of DHEA to androgens.” And then this backhanded acknowledgement of prostate cancer risk is immediately undercut by “there are reports that DHEA may lower prostatic testosterone receptors, and IL-6, which may be DHEA inhibited, and may be a growth promoting influence on prostatic tissue.” No reference is provided. Our concerns are also allayed by discussion of their “prolonged clinical study involving some 25 of our male patients with cancer or multiple sclerosis” in which they “have not seen stimulation of prostatic hypertrophy and its symptomatology or the appearance of prostatic cancer although this was closely looked for. These studies antedated PSA as a study indicator of prostate neoplasia.” This statement is also unreferenced.

Could DHEA worsen prostatic hyperplasia or prostate cancer? Yes, it might. Could DHEA improve prostatic hyperplasia and prostate cancer? Certainly, it’s possible. We don’t know enough to say how many men may be affected one way or the other. With clinical and research findings pointing in both directions at the same time, DHEA (and the other super hormones) should be considered experimental medicine. I think that Regelson and Colman could have made this more clear.

I think that self therapy with super hormones should be done very consciously, very thoughtfully, and very systematically, with the guidance of professionals who are monitoring blood levels and tracking on-going changes in biological condition. One can postulate that certain types of adrenal derangements could convert DHEA into certain estrogen or testosterone derivatives and thereby augment estrogenic-sensitive breast or endometrial cancers or aggravate prostatic enlargement or testicular and prostate cancer. Although the trends in the literature do not yet support these hypotheses, and Regelson is willing to assert that DHEA does not appear to worsen these conditions, we are each individuals with a unique biochemical make-up. Some of us might be exposed to such problems.

On the other hand, it is also true that the medical profession has a terrible track record with most cancers. Given the extraordinarily primitive technologies that have become the standard of medical practice—surgery, radiation and chemotherapy (referred to by patients as “slash, burn and poison”)—one should equally consider these accepted modern medical treatments as fundamentally experimental.

Given this caveat about experimental medicine—even if it may be called “standard medical practice”—I agree with Regelson’s reasons for writing this book now. I think that the intelligent readers of The Super Hormone Promise are much more likely to achieve life extension and the benefits of modern science than the person who simply delegates their health to their physician.

Will you “add decades to your life” as the cover jacket promises? If you work with a physician and/or other health professional to analyze some of the basic measurements of aging on an ongoing basis as delineated in Dr. Ward Dean’s book Biological Aging Measurement, then at least you’d know where you stand and if hormone replacement therapy, as advocated by Dr. Regelson, is making biological sense for you.

If you have already purchased Dr. Ray Sahelian’s book DHEA: A Practical Guide (ISBN 0-9639755-8-7), should you buy The Super Hormone Promise? The answer is yes. Each book has its own audience and should be on the shelf of any serious anti-aging aficionado. Do consider buying Dr. Regelson’s book and giving it to your doctor with a note to start with Appendix 2. But first, read the book for yourself and decide whether you want to undertake the process of educating your doctor. This may not turn out to be as easy as you might first think.