In a boxing match, the divergent camps set themselves up in opposite corners. When it comes to the topic of anti-aging or so-called “fountain of youth” products and how they can impact emergency physicians, the camps could easily be described as combatants across the ring. In one corner we find advocates like Paul Kivela, MD, MBA, FACEP, who co-owns a boutique medical spa in Northern California that offers “age-management services” including hormone replacement. In the opposite corner we find people like Adriane Fugh-Berman, MD, director of PharmedOut, a Georgetown University Medical Center (GUMC) project whose mission includes educating healthcare professionals about pharmaceutical marketing practices, including those that push anti-aging services, such as hormone treatments.

In the middle is the question, do the benefits of hormone treatments (such as Botox injections, human growth hormone [HGH], and testosterone), skin treatments (Juvederm, laser therapy, non-surgical facelifts), and other “fountain-of-youth” products outweigh potential risks? Is the boon that can be increased vitality, faster recovery times from workouts and injuries, or potential weight loss worth the downsides reported in new studies that show increased risks for diabetes, joint issues, and heart conditions from using these products?

The muddled answer is: it depends on whom you ask. Proponents of said services say that, used correctly and under a physician’s care, they can be beneficial. Critics say the treatments—hormone treatments in particular—may have unintended long-term consequences that have not yet been fully studied, and that fighting aging is a losing battle that could have health risks.

Dr. Kivela, managing partner of Napa Valley Emergency Medical Group in Napa, Calif., and co-owner of the Elan Medical spa in nearby Fairfield, said emergency physicians have to decide for themselves if the services or products are right for them.

“I think everybody probably deserves a workup, particularly if you have any symptoms—fatigue, you’re not thinking as well, you’re not feeling as well as you think you should,” Dr. Kivela said. “It’s up to the individual to perform at their best, and I think some of these products and services can help people feel better. We blame a lot of cholesterol, high blood pressure, and depression on just getting old, and I think if you optimally manage those hormones, you can help mitigate those conditions.”

“The risk factors for me in the long term, in 20 years? I’ll be 80. If I can get a good five, 10 years of quality life, enjoying my children, enjoying my grandchildren, enjoying those around me that I care for—why not?”
—Juan Fitz, MD

Dr. Fugh-Berman, an associate professor in the Department of Pharmacology and Physiology and in the Department of Family Medicine at GUMC, said hormone treatments are not panaceas for aging and, like with all medical procedures or treatments, have potential downsides.

“All of these hormones have risks,” she said. “The concept that one can regain youth by mimicking the hormone levels of a young person is a very dangerous proposition.”

The issue of weighing risks and benefits of anti-aging products has become more important in recent years as the market has ballooned, reaching nearly $250 billion in 2012, according to a recent report from BCC Research, a publisher of technology-market research reports based in Wellesley, Mass. The report, “Antiaging Products and Services: The Global Market,” found that the services portion of the market was $38 billion, or 15 percent of the overall market. But that figure is projected to grow to $61.2 billion by 2018, a compounded annual growth rate of 8.6 percent that outpaces the overall market.

Juan Fitz, MD, assistant medical director of the Emergency Department at Covenant Medical Center in Lubbock, Texas, said that one reason anti-aging therapies, services, and products appeal to his fellow emergency physicians is that they have high-stress jobs that can physically and mentally take a toll on them.

Dr. Fitz operates Fitz Anti Aging & Wellness @ Bella Derme, also in Lubbock, which offers Botox injections, laser therapies for skin conditions, and other anti-aging treatments. Actions that reduce stress and give his patients, including other emergency physicians, a more youthful feeling or complexion are more than worthwhile, he said.

“The risk factors for me in the long term, in 20 years?” he said. “I’ll be 80. If I can get a good five, 10 years of quality life, enjoying my children, enjoying my grandchildren, enjoying those around me that I care for—why not?”

Dr. Kivela said the key to providing anti-aging services is to specialize in them. Too many physicians, he said, may self-treat without understanding the risks. By way of contrast, he said his wife, Madeline Andrew, MD, took a year off from her psychiatric practice to become a specialist.

“I think there is plenty of evidence-based medicine there to say this is another way of improving your health,” Dr. Kivela said. “I’m not telling anyone this is something they should or shouldn’t do, but I think it seems to be crazy that someone would not even consider that, given the amount of evidence-based medicine that’s out there supporting it.”

Sources: FDA.gov; Elan Medical; ACEP News Research

Dr. Kivela believes many of the critics of anti-aging services and products view them through professional athletes, who seemingly monthly make news with issues surrounding unauthorized use of hormones or steroids. The complications and problems occur in patients who are not maintained within physiologic levels.

“But we’re not treating professional athletes,” he said. “We’re treating people that have deficiency conditions, and these are medical conditions that can be treated today. These are not magic bullets but need to be done in conjunction with diet and exercise.”

Dr. Fitz adds that emergency physicians are “really informed consumers” who understand the risks of treatments and choose to accept them.

Richard Quinn is a freelance writer in New Jersey.