A 'One-Stop Shop': New Guidance on Hormones and Aging

Miriam E. Tucker

June 19, 2023

A new statement from The Endocrine Society on hormones and aging highlights the differences between normal aging and disease, and when treatment is and isn't appropriate.

The idea of the statement "is to be complete, but also to clarify some misunderstandings...We tried to be very clear in the language about what we know, where we can go, where we shouldn't go, and what we still need to learn," statement co-author Cynthia A. Stuenkel, MD, of the University of California, San Diego, told Medscape Medical News.

The document is divided into nine parts or axes: growth hormone, adrenal, ovarian, testicular, thyroid, osteoporosis, vitamin D deficiency, type 2 diabetes, and water metabolism. Each section covers natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, bulleted "key points," and research gaps.

"Hormones and Aging: An Endocrine Society Scientific Statement" was presented at ENDO 2023: The Endocrine Society Annual Meeting and published online June 16 in the Journal of Clinical Endocrinology & Metabolism.

During a press briefing, writing group chair Anne R. Cappola, MD, of the University of Pennsylvania, said the goal is to "provide a really concise summary across each of these areas...There are multiple hormonal changes that occur with age, so we really couldn't limit ourselves to just one gland or the few that we commonly think about. We wanted to cover all the axes."

The statement tackles several controversial areas, including hormone replacement therapy (HRT) for menopausal symptoms in women and hypogonadal symptoms in men, diabetes treatment goals in older adults, distinguishing between age-associated changes in thyroid function and early hypothyroidism, and vitamin D supplementation in older adults.

"Hormones have these almost mythical qualities to some people...'If I just had my hormones back the way they were, it would all work out.' What we want to do is make sure that patients are being treated appropriately and that their symptoms are being heard and managed and ascribed to the appropriate problems and not necessarily to hormonal problems when they are not...Part of what we need to do is [provide] the evidence that we have, which includes evidence of when not to prescribe as well as [when] to prescribe," Cappola said.

Not Designed to Be Read All at Once

In the menopause section, for example, one "key point" is that menopausal symptoms are common, vary in degree and bother, and can be effectively treated with a variety of therapies proven effective in randomized clinical trials. Another key point is that menopausal hormone therapy is safest for women who are younger than 60 years and less than 10 years since starting menopause.

"It's almost 20 years since the original Women's Health Initiative, and that led to an incredible falloff of prescribing hormone [replacement] therapy and a falloff in teaching of our students, residents, fellows, and practitioners about [menopausal] hormone therapy...Hopefully, by issuing this kind of aging statement it gets people to read, think, and learn more. And, hopefully, we can improve the education of physicians...Menopause is a universal experience. Clinicians should know about it," noted Stuenkel, who chaired that menopause section writing panel.

In the type 2 diabetes section, in the bullet points it is noted that oral glucose tolerance testing may reveal abnormal glucose status in older adults that are not picked up with A1c or fasting glucose levels and that glycemic targets should be individualized.

Asked to comment on the statement, Michele Bellantoni, MD, told Medscape Medical News: "This was a huge undertaking because there are so many areas of expertise here. I thought they did a very good job of reviewing the literature and showing each of the different hormonal axes…It's a good go-to review."  

"I thought it was a very good attempt to catalog and provide opportunities for policy, and particularly at [the National Institutes of Health], as they look at funding to show where are these gaps and to support appropriate research. I think the most important aspect to come of this is identifying research gaps for funding opportunities. I very much support that," noted Bellantoni, who is clinical director of the division of geriatric medicine at Johns Hopkins University School of Medicine, Baltimore, Maryland.

However, she also said that the 40-page document might be a bit much for busy clinicians, despite the bullet points at the end of each section.

"I would love to see an editorial that puts into perspective the take-home messages or a subsequent article that distills this into every day practice of care of older adults, both preventative and treatment care…I think that would be so useful."

During the briefing, Cappola noted that the document need not be read all at once.

"It ended up being a large document, but you should not be intimidated by it because each section is only about 2000 words. So, it's really a kind of one-stop shop to be able to look across all these axes at once. We also wanted people to think about the common themes that occur across all these axes when considering what's going on right now and for future research," she said.

Stuenkel, Cappola, and Bellantoni have reported no relevant financial relationships.

J Clin Endocrinol Metab. Published online June 16, 2023. Full text

ENDO 2023. Presented June 17, 2023.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.

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