CONCEPT AND MANAGEMENT IN ANTI-AGING MEDICINE

Wimpie Pangkahila

Postgraduate Program in Anti-Aging Medicine

Department of Andrology and Sexology
Medical Faculty Udayana University

Many scientific data have reported that aging process can be slowed down,
delayed, even reversed, and healthy lifespan can be extended. Finally people can live
longer in healthy condition with optimal quality of life. Therefore aging is considered as a
disease that can be prevented, treated, and reversed. Aging is no longer accepted as a
destiny with all disability, dysfunction, diseases, debility, or cognitive impairment. This is
the principles of Anti-Aging Medicine.
Aging process actually does not occur abruptly at the time when people reach old
age, but it happens gradually through three phases as follows:

1). Subclinical phase (ages 25-35):

In this phase, most hormones begin to decline: growth hormone, testosterone, and
estrogen. Free radical formation, which can damage cells and DNA, begins to affect the
body. This damage usually is not outwardly detectable. Therefore people in this phase
may look and feel “normal” without any signs or symptoms of aging. However, sexual
complaints start to appear. This complaint is related to hormone imbalance due to
hormone substance as contraceptive agent.

2). Transition phase (age 35-45):

Hormone levels can fall by as much as 25%. Muscle is lost at the rate of a kilogram
every couple of years, which can result in loss of strength and energy, with a higher
body fat composition, leading to insulin resistance and increased risk of heart disease
and obesity. Clinical symptoms begin to appear: decline in visual acuity and hearing;
graying of the hair; loss of elasticity and skin pigmentation, decreased sexual desire and
arousal. Aging people start to feel and look older. Free radical damage begins to affect
gene expression, which causes many diseases of aging, including cancer, arthritis,
memory loss, coronary artery disease, and diabetes.

3). Clinical phase (age 45 and above):

Decline of hormones continues, including DHEA, melatonin, growth hormone,
testosterone, and estrogen, with increased risk of decline in thyroid hormone. There is
also the loss of the ability to fully absorb nutrients, vitamins and minerals. A decrease in
bone density, accelerated muscle loss (about a kilogram every three years, resulting in
the inability to burn calories), and increased body fat and weight also occur. Chronic
disease becomes very apparent, organ systems begin to fail, and chronic disease takes
over. Disability becomes a major factor with the inability to perform simpler activities of
daily living. Sexual dysfunctions become prominent complaints and disturb many
couples.
There are many factors causing aging process that are divided into two groups,
internal factor and external factors. Some internal factors are decreased hormone, free
radicals, glycosylation, methylation, apoptosis, immune system, DNA damage, genes.
External factors are unhealthy diet and lifestyle, wrong habits, environmental pollution,
stress, and poverty

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 .Considering that aging process occurs gradually by age, there is a chance for
intervention to prevent, delay, and treat it. Without intervention or treatment, many signs
and symptoms appear which decrease the quality of life.
The management based on the principles of Anti-Aging Medicine is as follows.
1. Early detection of the aging process and age-related disorders or dysfunctions.
Diagnosis should be based on signs and symptoms, physical examination and
biochemistry tests of biomarkers of aging
2. Practice healthy life style including regular exercise, diet control, enough sleep,
avoid toxic substances, manage stress, balance between activities and relaxation
3. Replacement therapy: supplement, hormone, stem cell therapy
4. In case there is age-related disease found in early detection, treatment should
follow the treatment procedure of each disease

Studies performed at the Medical Faculty Udayana University showed that

hormone treatment can recover the alteration caused by aging process. These studies
indicated that at least in certain conditions aging process can be reversed.
However, hormone replacement therapy should consider the following matters:
indication, contraindication, dosage, and regular monitoring. Hormone level should not
exceed maximum level and avoid supraphysiological range. It means that hormone
replacement therapy must not be given without above mentioned conditions.
Stem Cell Therapy for Anti-Aging purpose showed good results in signs,
symptoms, and biochemical indicators.
All intervention in Anti-Aging Medicine must be evidence based. It is not
professional when physicians use unscientific based treatment. The illegal product must
not be used since it is high risk for the patients and physicians as well.
Unfortunately there many doctors do not understand that many treatments and
tools advertised as Anti-Aging products, are actually unscientific and not evidence-
based.

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