MARCO ISLAND — Hormones, or the lack of them, drew a packed house Wednesday evening for the Iberia Bank “In the Round” presentation. The 39th in the long-running series drew what might have been a record crowd, said host Keith Dameron, with 92 reservations and more showing up.
Ever since Ponce de Leon in the 1500s, Florida has been the site of searches for the fabled Fountain of Youth, and it clearly was a subject near to the hearts, and other organs, of the attendees on Wednesday. With an enthusiastic endorsement from Dameron, Iberia Bank vice president and branch manager, Robert Korolevich, M.D. laid out the case that the key to youthfulness lies in maintaining the optimum balance of hormones in the body.
Dameron introduced Dr. Korolevich as his and wife Barbara’s personal physician, who is also board-certified by the American Academy of Anti-Aging Medicine. Since announcing the topic, said Dameron, he had seen an outpouring of interest.
“I’m stopped on the street by ladies who stop me and tell me they’re on hormones,” he said.
His specialty, said Korolevich, is not fully understood, even by many doctors, and is called by a variety of names.
“People call it functional medicine, regenerative medicine, restorative, or anti-aging medicine.” The most accurate description, he said is age management.
“We age because our hormones are out of balance, not vice versa,” said the doctor, arguing for a paradigm shift. “In traditional medicine, we’re taught to treat a problem.” Blood insulin levels decrease over time, blood sugar goes up, and “by the time we diagnose diabetes, it’s been going on for years.”
Hormone replacement therapy is much more common for women than men, and Korolevich mentioned one explanation. “When women go through menopause, we know it,” he said, garnering laughs from both men and women in the audience. His list of females’ symptoms wouldn’t fit on one of his PowerPoint slides.
With males, he said, the symptoms are more subtle. “That’s part of the reason I went into this. I was in my mid-40s, and I just wasn’t feeling well.” Increased body fat, decreased bone density, loss of muscle, anemia, and cancer risk all flow from lower levels of testosterone, said Korolevich. He cited studies showing a simple correlation; high testosterone levels equal low mortality, particularly from cardio-vascular disease and cancer.
Doctors tend to focus almost solely on LDL, the “bad” cholesterol, and use statins to bring it down, he said. But 50 percent of people with heart attacks have normal LDL levels. He urged a broader look at a range of hormones, including testosterone, estrogen – of which he identified three different variants – and progesterone.
There has been a spotlight on estrogen for older women, with fluctuations in the perceived benefits and risks, with Korolevich seeming to believe most would benefit from the therapy, if administered appropriately. To simplify, he favored creams applied to the skin, versus oral estrogen.
But the most dramatic results he spoke of concerned the much less explored field of supplementing testosterone for men. Results from hormone ingestion can be too dramatic – Korolevich showed before and after slides of a slender man who perhaps overindulged in human growth hormone.
But another telling slide showed how the body’s natural production of testosterone decreases with age, and Korolevich said he personally wants to maintain his level at the 75th percentile, twice what could be considered a borderline low level.
The program ran long, although the audience was clearly riveted by the presentation. One effect of aging was apparent, as a procession of attendees headed in to use the restrooms – remember, the ITRs feature an open bar. At the end of Korolevich’s talk, the first question came from a woman in the front row: “Where can I get some testosterone?”
John Tolliver, 61, asked the same question, since his testosterone level is high, but he wants to raise it more to build muscle mass in conjunction with weightlifting. Doctors are reluctant to give the hormone unless the level is low, and Korolevich noted that reimbursement from insurance companies is an issue, unless an existing malady is being treated.
“You have to have a disease to get reimbursement,” he said. Korolevich, who is also board-certified as a family practitioner, maintains a concierge practice in Naples, but also takes patients for consultations on age management questions.
If nothing else, it is certain that Wednesday’s lecture raised curiosity levels concerning hormones and their benefits in those who listened to the talk.