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  Which creates a bit of a dilemma. Do you try to hang on for the longevity pill, if it ever comes, and keep yourself together as much as possible? Or should we go out for more hot dogs? (Or cigarettes, even—let’s dream big.)

  Obviously not—nobody wants to be the last one to miss out on the Fountain of Youth, the cure for aging and the defeat of death for which humankind has yearned for literally thousands of years. But whatever it is, it had better come quickly, because many of the people who are trying hardest to beat aging—people Emanuel called “the American immortals”—are really only making things worse for themselves.

  Chapter 3

  THE FOUNTAIN OF YOUTHINESS

  Nothing makes you look older than attempting to look young.

  —Karl Lagerfeld

  One wonders what Professor Brown-Séquard might have thought of Suzanne Somers. The hot-pantsed blonde who played Chrissy on Three’s Company during the late 1970s and early 1980s has evolved into a popular health guru and author of more than twenty books, many of them detailing her own, often elaborate battle with the demons of age. “I am my own experiment,” she told a rapt audience of doctors and others at the twentieth congress of the American Academy of Anti-Aging Medicine (A4M) in Orlando, in May 2012.

  And how: Every morning, as she revealed to Oprah in a widely viewed 2009 interview, she chokes down no less than forty different supplements, followed by a shot of pure estrogen, administered directly into her vagina. On top of all that, she also takes a daily injection of human growth hormone, which she claims keeps her feeling young. Dinner is served with another twenty pills, which likely resemble the “Restore Sleep Renew,” “Bone Renew,” and “Sexy Leg Renew” formulas she sells on her website. That’s nothing compared with the two hundred supplements ingested daily by her mentor Ray Kurzweil, the futurist and inventor, who has said he plans to live long enough to see the Singularity, when the human brain can be uploaded to a computer—but it’s a pretty good start.

  Somers was the keynote speaker at the biannual A4M conference, and she remains the best-known celebrity champion of anti-aging medicine, which is one of the fastest-growing areas of medical practice in the United States. She herself had recently turned sixty-five, but from my seat, in about the fifteenth row, she looked stunning, from her backlit blond mane to her toned shoulders to her blazing crescent smile that made you think that anything was possible.

  A few paces behind and to the right of her well-maintained derriere stood Drs. Ronald Rothenberg and Robert Goldman, two of the leading figures in the A4M, which Goldman, a competitive weight lifter, osteopath, and graduate of Belize Medical College, cofounded in 1993. Back then, the organization’s annual meetings drew a handful of renegade doctors and longevity enthusiasts, sitting on folding chairs under a tent; this morning, more than two thousand medical professionals packed the ballroom of the Marriott World Center resort and conference center in Orlando, and there would be an even bigger meeting in December in Las Vegas. Worldwide, the A4M claims more than twenty thousand members.

  Not bad, for a specialty that barely existed twenty years ago—and that, in fact, still isn’t actually recognized by the American Board of Medical Specialties, the arbiter of such things. Anti-aging medicine remains extremely controversial in the medical profession. A few years ago, Olshansky and his colleague Thomas Perls awarded Goldman and his A4M cofounder (and fellow Belize Medical College graduate), Dr. Ronald Klatz, a mock “Silver Fleece” at a conference in Australia. Klatz and Goldman responded by suing Olshansky and Perls for $150 million, but the case was eventually dropped. “There’s no such thing as ‘anti-aging medicine,’ ” Olshansky had insisted, over hot dogs. The secret to aging, in his view, is that there is no secret. “There is no drug, hormone, or supplement, or cream that has been shown to reverse aging, period.”

  Many A4M attendees clearly chose to believe differently. In addition to Somers’s keynote, practitioners could attend lectures on how to prescribe testosterone to aging men (led by the sixty-seven-year-old Rothenberg, who proudly admits pumping himself up to the T levels of a twenty-year-old, so he can keep surfing). Also popular were business seminars that explained how to convert to an all-cash practice. Anti-aging treatments are rarely covered by insurance, and needless to say, Obamacare was a dirty word. In the expo hall, adjacent to the ballroom, the aisles were prowled by statuesque forty-year-old women who turned out, on questioning, to be more like sixty. They were busy perusing the wares, from a scale that told you what to eat to a $6,000 hyperoxygenated sleeping pod. Olshansky had warned me to beware of “anyone who is selling something,” and almost everyone there seemed to be peddling some kind of supplement, special diet, hormone regimen, fancy test, or gadget that would beat back the relentless advance of time. My favorite was an herbal supplement, supposedly derived from Chinese medicine, called Virgin Again.

  “We’ve got a long history in this business,” sighed Olshansky, “and it’s mostly sordid.”

  Somers was selling books, mostly. Unlike most Hollywood types, who keep quiet about their struggles with age, Somers has been extremely public about hers, documenting the battle in a series of literary opuses, starting with 2004’s The Sexy Years. Much of her advice was basic common sense (eat fresh vegetables, get some exercise, sleep well, and manage your stress), and it was hard to argue with her critique of modern American medicine, which keeps older women “all pilled up,” in her words. But it all appeared to hinge on those replacement hormones. “I feel so great, I’m loving my life, I have a sex drive,” she told the A4M crowd, laughing girlishly. “It’s so great! My friends, none of ’em are having sex, none of ’em! And you can see it.”

  She and her eighty-something husband get busy twice a day, as she informed a squirming Sean Hannity on Fox News.

  Professor Brown-Séquard would have been blown away, and not by Somers’s red-sheathed curves; he didn’t care much for sex, subscribing to the common nineteenth-century belief that it sapped one’s vitality. But his intuition that the testicles produce some substance that gives males their vitality was proven correct when scientists in Nazi Germany identified the hormone testosterone in 1935 (and won the Nobel Prize for it a year later). Adolf Hitler himself reportedly combated tyrant fatigue by injecting an extract of bulls’ testicles called Orchikrin, which was remarkably similar to Séquard’s elixir. (He didn’t like the side effects, so he soon quit.)

  Brown-Séquard had also speculated that there had to be an equivalent for women, and he was right about that, too: estrogen, also identified in Germany in the ’30s. Millions of women have used estrogen-replacement therapy, starting about fifteen minutes after the FDA approved its use in 1941, to beat back what Somers calls the Seven Dwarfs of menopause—“Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful, and All-Dried-Up.”

  Whether they knew it or not, most of the doctors in his hall owed a huge debt to the brave French pioneer, the first modern physician to attempt to combat aging with medicine. But today, Ms. Somers was soaking up all the glory. For a decade, she has been the A4M’s leading celebrity spokesperson, the one putting out the hormonally recharged message to the public. Her books have sold more than ten million copies, and each time a new one comes out, she’s booked all over the cable dial. The journalists used to give her a hard time for proselytizing on behalf of renegade cancer doctors like Stanislaw Burzynski and Richard Gonzalez, both of whom have long, controversial pasts. (Burzynski has run afoul of both the FDA and the Texas Medical Board, while Gonzalez treats pancreatic cancer patients with a bizarre nutritional regimen centered around twice-a-day coffee enemas.) In 2009, Newsweek lambasted her and Oprah for their “Crazy Talk,” as the cover headline put it. Now the media mostly lay off, and Somers keeps on keeping on. At the A4M meeting she announced that she had just signed another three-book deal with her publisher. “They can’t get rid of me!” she crowed.

  But while the publishing industry loves her and her Oprah-esque sales, many experts have a problem with the aggressive
hormone treatments that Somers advocates, cranking her estrogen and testosterone levels up to those of a thirty-year-old in her sexual prime (say, Chrissy in Three’s Company). After Ageless came out in 2006, seven prominent women’s health experts—three of whom she had quoted in the book—wrote an open letter criticizing her for pushing the “Wiley Protocol,” an intensive hormone regimen devised by a writer and actress whose medical credentials consisted of a bachelor’s degree in anthropology. “Is it healthy to be dosed like a thirty-year-old when you’re sixty?” asks Dr. JoAnn Pinkerton, director of the Midlife Health Center at the University of Virginia Health System. “Show me the evidence.”

  Hormone therapy is an attempt to solve one of the most obvious problems of aging: We sag. We lose our juice. Men become less manly, women less womanly. Estrogen is a wonderful substance that keeps female bodies fertile, their skin thick and smooth; testosterone builds muscle and gives men the confidence they crave. Both hormones decline in middle age—gradually for men, precipitously for women. Without them, we get dumpy, lumpy, and sometimes Grumpy. So putting them back should solve the problem, right?

  You’d think, but in fact the evidence now suggests that solving one problem may create other, worse ones. Hormone therapy for menopausal women was extremely popular and heavily promoted by the pharmaceutical industry until 2002, when the massive Women’s Health Initiative (WHI) study was stopped because women on estrogen replacement were getting breast cancer—as well as heart disease, blood clots, stroke, and even dementia—at higher-than-expected rates. If anything, asserts Nir Barzilai, the hormone was effectively accelerating their aging.

  Overnight, sales of the most popular hormone-replacement drugs collapsed, as did the share price of Wyeth, their manufacturer. Another thing that tanked was breast-cancer rates, which plunged nearly 9 percent in the two years after the WHI study was stopped. Many scientists think those two things are related: Fewer women on hormone-replacement therapy led to fewer cases of breast cancer. But some women remained desperate for a fix, understandably, and so Somers stepped into the breach two years later with The Sexy Years, in which she offered an alternative: so-called bioidentical hormones, which are chemically identical to the hormones produced by the female body. She claimed these were safer than Wyeth’s products, which were synthesized from pregnant mares’ urine (hence the name, Premarin). Somers has been pushing bioidentical hormones relentlessly ever since, claiming they are less dangerous and more “natural.”

  “Bioidenticals are a natural substance and cannot be patented,” she writes in Ageless. “Therefore, there is no money to be made from selling the best solution for menopausal women.”

  Actually, not true: bioidentical hormones are custom-mixed by compounding pharmacies, which presumably earn a profit by selling them. (Also, they’re rarely covered by insurance, so they cost women more.) They generally contain not only estrogen, but balancing hormones such as progesterone and sometimes testosterone, among others. The upside is that this allows a doctor to prescribe a precise mix for each patient. The downside has to do with how they’re made, and what might be in them: Compounding pharmacies are lightly regulated, unlike pharmaceutical manufacturers who are subject to strict FDA rules. Studies of compounded drugs have found that the actual dosages can vary enormously, and in 2012, contamination at a compounding pharmacy in Framingham, Massachusetts, caused an outbreak of fungal meningitis that killed sixty-four people and sickened more than seven hundred. The pharmacist was indicted in September 2014.

  “In my practice I end up picking up the pieces from people who believed [Somers],” says Dr. Nanette Santoro, an expert on menopause at the University of Colorado in Denver. “I’ve had a woman bring in her hair in a Baggie because a compounding pharmacy screwed up her prescription.”

  Women don’t have to go to compounders: There are now several FDA-approved bioidentical hormone treatments on the market, a fact Somers never mentions. FDA-approved means a drug has been tested for safety, efficacy, and dosing and absorption; just as important, your doctor knows how much you are really getting. But unlike the compounded drugs, the FDA-approved hormones are required to carry a scary “black box” warning label.

  By her own account, Somers has been using hormone therapy for at least twenty years, even after surviving her own brush with breast cancer. In her latest book, I’m Too Young For This!, she recommends hormone therapy for still-younger women, beginning as early as their late thirties. So she essentially endorses hormone use for more than half a woman’s life—despite evidence that such long-term use is clearly unsafe. In fact, says UVA’s Pinkerton, the evidence shows that hormone use is safe only for short periods of three to five years—and that after age sixty, the risk rises dramatically. “The current theory is there is a critical window, where if women [are] given hormones for a short period around the time of menopause, they may have a benefit for heart and brain,” says Pinkerton. “But once you have plaques in your arteries, or aging neurons, giving estrogen may accelerate those problems.”

  “Women are unusually susceptible, because they have this abrupt change in their lives,” Santoro observes. “Other than the wisdom it brings, everything else is a problem.”

  Just as women have been catching up to men in all areas of life (except for equal pay, domestic abuse, and reproductive rights), men can now claim equality in one important respect: Now we get to go through menopause, too. It’s called andropause, and it refers to the long-term decline in testosterone that becomes noticeable around age forty. It’s nothing like menopause, obviously—women’s hormones nose-dive off a cliff, while male testosterone levels descend on a gentle glide path—but nevertheless, testosterone replacement for men has become almost as big as estrogen replacement was before the WHI study ruined the party. According to some estimates, “Low T” therapy is now a $2 billion business, and could nearly double by 2019.

  Certainly, Brown-Séquard would be amazed by the progress we’ve made. Instead of his nasty old bull’s-testicle brew, aging men can now deploy a convenient underarm gel, which is advertised during every NFL game (but which their wives mustn’t touch under any circumstances, according to the warning label). In the ads, pudgy sad middle-aged men are transformed into confident, smiling satyrs, although the reality isn’t quite so simple. In smaller, short-term studies, testosterone has been shown to increase muscle mass, improve mental sharpness and overall well-being (and enhance libido, although that part is surprisingly controversial among scientists). There is even a study that purports to show that testosterone administration makes men less prone to lying. But there is little data about its long-term safety. The most common concern, that it feeds prostate cancer, is not supported by evidence; the notion actually stems from a single case, reported in 1941. (In recent studies, doctors tried to use testosterone to prevent or treat prostate issues, but with limited success.)

  There are other serious issues, however. A 2010 study of testosterone in men with heart problems had to be stopped because it seemed to increase the risk of cardiac events. Another study also reported an increase in stroke risk. Other studies funded by manufacturers showed little to no increased risk, but as the authors of one review put it, tartly, “The effects of testosterone on cardiovascular-related events varied with the source of funding.”

  Many of these questions will hopefully be answered by a major NIH clinical trial of testosterone in men older than sixty-five, comparable to the Women’s Health study, which is finally under way after more than a decade of delay, but results are not expected until late 2015. Meanwhile, though, the FDA has been investigating reports that testosterone replacement has caused heart attacks, strokes, and deaths—and the plaintiffs’ lawyers are not far behind. But doctors are writing prescriptions even faster, driven by advertising and promotion rather than actual medical need, according to the Australian testosterone researcher David Handelsman. Handelsman says testosterone is being drastically overprescribed, and dismisses the very concept of andropause itself as a “fa
lse analogy” to the very real, very severe life change that is menopause.

  Whatever the outcome of the testosterone trials—legal or clinical—it seems doubtful that a bad result would slow down Somers or her A4M followers one bit. On stage, she radiated confidence, mesmerizing the audience with her passionate delivery. She was most excited about the advent of “nanoparticles,” tiny little entities that will travel in our blood, collecting information and dispensing treatment to us from within. Ray Kurzweil had told her about them.

  “I can’t believe how great the view is from sixty-five!” she gushed. “Ray Kurzweil asked me how long I thought I would live, and I said, ‘Honestly, Ray, I can wrap my arms around 110. Honestly. With the way I feel. With strength.’ ”

  As I sat there in the audience, admiring the giddy-blond sex symbol of my teenage years, I tried to imagine what a 110-year-old Suzanne Somers might look like. Answer: probably pretty good, for 110. She certainly wasn’t going to go down without a fight. But I had doubts as to whether her chosen methods would get her there.

  Intellectually, my curiosity was piqued by something that she only glancingly mentioned, but which underlay much of what went on at the A4M conference: human growth hormone, or HGH, prescribed by many if not most of the anti-aging doctors in attendance. The very name itself is almost talismanic: human growth hormone. Who wouldn’t want that?

  Not only does Somers take it daily, but one of the foundational texts of the anti-aging movement is a 1997 book called Grow Young with HGH: The Amazing Medically Proven Plan to Reverse Aging, written by A4M cofounder Ronald Klatz. The book touted the amazing powers of human growth hormone, a potent drug mainly used only by stunted children and aggressive body builders. Since then, the HGH market has taken off. Based on my chats with several doctors present, it was clear that HGH and hormone replacement injections were a major profit driver for their practices. The shots, and the attendant blood work, can cost patients upward of $2,000 a month. “It’s changed my life,” said one male physician from Florida, a former family doctor who says his income tripled when he started selling hormones to aging Boomers.