Hormone Optimisation

With age, hormone production slows — affecting energy, sleep, muscle, cognition and more. In modern longevity medicine, hormone optimisation — safely restoring deficient hormones to optimal ranges — is one of the most powerful tools to extend healthspan. The aim is not to mimic the levels of a 20-year-old, but to bring values into the optimal — upper-normal, non-pathological range for the patient's age and sex.

Growth Hormone (GH) and Peptides

Pituitary-secreted GH and its liver effector IGF-1 govern musculoskeletal health, skin elasticity, cellular renewal and metabolism. GH declines about 14% per decade after age 30 — a process called somatopause — contributing to muscle loss, fat gain, lower bone density and low energy.

Direct recombinant GH (somatropin) is reserved for documented GH deficiency under endocrinology supervision. In longevity practice, the more common approach uses GH-releasing peptides: sermorelin, ipamorelin, CJC-1295 and ibutamoren (MK-677). These stimulate the body's own pulsatile GH release, preserving negative feedback and offering a safer profile than direct GH.

Testosterone Optimisation (Men and Women)

Testosterone governs energy, libido, muscle mass, bone density, mood and cognition in both sexes. In men, it declines about 1% per year after 30. "Late-onset hypogonadism" presents as fatigue, low libido, depressive symptoms, abdominal weight gain and disturbed sleep.

TRT is considered in men with documented clinical symptoms and laboratory deficiency. Forms include topical gel, intramuscular injections (testosterone cypionate or enanthate) and subcutaneous pellet implants. Baseline and follow-up testing — total and free testosterone, oestradiol, PSA, haematocrit, haemoglobin and liver enzymes — is required. Aromatase inhibitors (anastrozole) or hCG may be added for oestrogen balance and fertility preservation in selected cases.

In women, testosterone decline becomes prominent after menopause and is linked to low libido, fatigue and mood changes. Low-dose topical testosterone (~1/10 of male dose) can substantially improve quality of life in selected patients — always with gynaecological evaluation and appropriate cancer screening.

DHEA, Pregnenolone and Melatonin

DHEA, an adrenal-derived precursor of other steroids, peaks at 25 and falls to 10–20% of baseline by the 70s. Low DHEA-S is associated with weakened immunity, lower bone density and mood changes. Oral replacement (women 10–25 mg, men 25–50 mg/day) with DHEA-S monitoring is used in selected cases.

Pregnenolone — the "mother hormone" — may be added for cognitive support. Melatonin, beyond sleep regulation, is a powerful antioxidant and mitochondrial protector; longevity protocols use night-time doses (0.3–3 mg, individualised) — higher is not always better.

Thyroid and Adrenal

Subclinical hypothyroidism and chronic-stress-related adrenal dysregulation are often overlooked sources of longevity complaints. A panel including TSH, free T3, free T4, reverse T3, anti-TPO and anti-Tg catches subclinical dysfunction. When clinically appropriate, thyroid optimisation (including T3 when indicated) can transform quality of life.

Safety, Monitoring and Limits

Hormone optimisation is never blind prescribing. Pre-treatment: comprehensive laboratory and history, contraindication review (hormone-sensitive cancer, active thromboembolism, uncontrolled hypertension) and appropriate imaging (e.g. prostate evaluation in men, gynaecological screening in women). First follow-up at 6–12 weeks; thereafter every 3–6 months.

The philosophy targets optimal, not maximum. Over-dosing can cause erythrocytosis, gynaecomastia, acne, mood changes, worsened sleep apnoea and long-term cardiovascular risk. Hormone optimisation must be conducted by an experienced physician with personalised protocols.