Hormonal Optimization: Bio-HRT, HGH, Testosterone, and Adrenal Function

Understanding the complexities of hormonal optimization for both men and women remains a subject filled with abundant information, often conflicting and confusing with plenty of “dysinformation” on both sides. Decades of debates, from the WHI trials to recent developments, continue to shape our understanding. Now let’s dive into the latest insights gleaned from the Journal of Endocrinology and Metabolism, 2023* to shed light on this intricate topic.

* Anne R. Cappola; Richard J. Auchus; Ghada El-Hajj Fuleihan; David J. Handelsman; Rita R. Kalyani; Michael McClung; Cynthia A. Stuenkel; Michael O. Thorner; Joseph G. Verbalis. J Clin Endocrinol Metab. 2023;108(8):1835-1874

Complexities of Hormonal Optimization

The article covers a wide array of pivotal questions that have persisted over time such as:

  1. What defines the normal decline of hormones with age, and when does it signify a potential health issue?
  2. What evidence supports the effectiveness of hormonal replacements?
  3. How safe are these replacements?

In my opinion, as expressed in my books (for men and women), it’s crucial to consider the “convergence of evidence.” When a majority of articles—say, 90 out of 100—align on a viewpoint, it’s likely a reliable direction, although careful scientific analysis is essential (given that data can sometimes be manipulated).

Specifically, the article explores Human Growth Hormone (HGH) replacement for men and women, a controversial topic, and Adrenal Function, commonly addressed in aging by medical and holistic practitioners.

Human Growth Hormone Replacement (HGH)

GH secretion peaks during mid-puberty, declining by roughly 50% every 7 to 10 years. By the eighties, levels resemble those of young adults with GH deficiency. This decline is linked to increased body fat, reduced muscle mass, weakened immunity, and hormonal changes. Whether this drop directly causes these changes is debated.

In simpler terms in my books, I explore when reduced HGH is normal versus a sign of “premature aging” or deficiency. This falls under Geroscience, but there are research gaps, and animal studies might not directly apply to humans.

There are no approved treatments for age-related GH decline. Recombinant human GH is for specific conditions like growth disorders, GH deficiency, and HIV/AIDS wasting. GHRH and GH secretagogues aren’t approved as “anti-aging” agents.


The good news is there are natural methods to boost HGH levels! In our Unison Pro-Youth (UPY) Evaluations, we can customize these approaches to enhance your health and well-being from home, safely and affordably. Here are a few to consider:

  • Exercise: Being inactive in older age is linked to lower HGH levels. Physical activity helps maintain ‘younger, healthier’ levels, especially in men who also maintain optimal testosterone levels. The type of exercise matters for hormonal optimization.
  • Diet: Following a Calorie-Restricted but Adequate Nutrition (CRAN) diet is associated with higher HGH levels. This doesn’t mean cranberries, but rather a diet that limits calories while ensuring proper nutrition. High glycemic-index diets impacting insulin and cortisol levels can affect HGH negatively.
  • Sleep: Most HGH is released during sleep. Poor sleep reduces both the intensity and frequency of HGH release. Improving sleep quality can optimize these spikes.
  • Hormonal Optimization: Balancing hormones like testosterone and DHEA is important. For instance, certain hormone replacement therapies (HRT) can decrease HGH levels in women. Harmonizing all hormones is essential for optimal function; it’s better than solely replacing one or two.

Adrenal Function: Exploring Cortisol & DHEA


Ah, the natural morning cortisol surge that makes you feel alive and kicking – like a young, energetic soul. When exaggerated due to sudden stress, it’s your body’s ‘fight or flight’ response kicking in, a helpful survival mechanism. But in prolonged stress, your adrenal glands get exhausted, and cortisol levels become flat or low. This leaves you feeling numb, down, disengaged – a far cry from your vibrant self. Testing and balancing these levels can help restore your vitality.

“Several studies have provided evidence that even mild cortisol excess is not benign and is associated with hypertension, glucose intolerance, cardiovascular events, and vertebral fractures. Consequently, occult and smoldering hypercortisolemia could predispose to common disorders in older persons.”


This hormone, a precursor to many sex hormones in both genders, shares similarities with testosterone, albeit to a lesser extent. Its impacts range widely: mood, body composition (skin, muscles, bones), and sex drive. In women, DHEA comes from the adrenal gland since they lack testes. Adrenal issues can reduce DHEA and other sex hormone levels. While supplementing DHEA can marginally raise free testosterone, it’s not the dramatic fix some claim.

“Some studies of DHEA supplementation in women with adrenal insufficiency, in whom production of DHEA, DHEAS, testosterone, and all adrenal-derived androgens is low, have reported improvements in sexual satisfaction and interest, but similar results have not been obtained in trials with older women.”


Tweaking cortisol signaling could benefit various age-related conditions. However, systemic DHEA supplementation hasn’t shown significant benefits in older individuals.

My research, echoed in my books (for men and women), suggests hormonal optimization of DHEA and cortisol can ease symptoms of premature aging, especially effective in midlife. It’s a safe, straightforward approach, outshining many pharmaceutical options.

Key Takeaways

In summary, the article highlights the absence of universally accepted recommendations for HGH, DHEA, and cortisol replacements in combating aging or as definitive “anti-aging” solutions. The data is inconclusive, leaving significant gaps in mainstream medical understanding. However, my steadfast opinion, echoed in the article, asserts that hormonal optimization, as part of a holistic lifestyle approach, can yield safe and beneficial effects.

The reality is, there’s no singular magic fix—a pill, injection, or cream—for eternal youth. Achieving and maintaining health while feeling youthful demands a comprehensive, personalized, and proven approach. Each individual’s goals, treatment preferences, and responses differ. This necessitates proactive collaboration between an individual and a qualified, experienced doctor well-versed in these modalities. Ongoing monitoring and adjustments are crucial.

A Personalized Path to Enduring Vitality

At UPY, we specialize in providing this personalized care and expertise, tailored to both men and women. Stay tuned for our next blog where we will be diving into Bio-HRT for women, testosterone optimization for both men and women, and the critical role of thyroid health.

For further inquiries or to explore these topics in-depth, reach out to us via email at [email protected], or visit our website. Lastly, don’t hesitate to schedule a meet-and-greet to continue the conversation. Chris Rao, MD, FAAFP


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Man and woman in intimate embrace