Melatonin for women

Melatonin is a hormone produced by the body that regulates many physiological processes.

MELATONIN supplementation is a controversial issue and I hope to help readers understand the facts so that they are not misled by wild claims.

Melatonin is a hormone produced by the pineal gland, which is situated at the base of the brain. Although this hormone is best known for regulating the sleep and wake cycles, it also plays many other important roles in the body, including maintaining a healthy immune system, serving as an antioxidant, and regulating the menstrual cycle.

Functions of melatonin

Let’s look at the functions of melatonin in greater detail. Like all hormones, melatonin sends chemical messages to various parts of the body and tells the different organs or tissues to produce more hormones or carry out certain tasks. Without melatonin, other hormonal activity in the body would be interrupted.

Production of melatonin is stimulated by darkness and inhibited by light. This is what makes the pineal gland our “internal clock”, as it controls our body’s circadian rhythm – our body’s own 24-hour time-keeping system that plays an important role in when we fall asleep and when we wake up.

It may sound like a simple function, but if this internal clock is disrupted, many other neuroendocrine functions go haywire. The body’s internal functions, as well as mental well-being, can be adversely affected. For example, you may find yourself unable to think clearly, and forget key facts if your melatonin production is upset.

Children and healthy young adults have higher levels of melatonin. As they advance beyond middle-age, the amount of melatonin produced by the body decreases. This may explain why elderly adults tend to have difficulty sleeping at night.

The level of melatonin in the blood appears to trigger the adrenal glands to increase or suppress the secretion of male and female sex hormones. In this respect, it controls the timing and release of reproductive hormones in a woman’s body. It is instrumental in determining when menstruation begins, how long the cycle lasts, and when menopause occurs.

Melatonin also affects the production of pituitary gland hormones, including human growth hormone. This hormone plays a role in muscle and bone growth, as well as energy metabolism, among other essential functions.

Finally, it is believed that the immune system can be strengthened by melatonin. This is because melatonin is recognised as a strong antioxidant, which is a substance that protects your cells from the effects of free radicals. Free radicals are molecules produced when your body breaks down food, or are generated through environmental exposure to tobacco smoke and radiation.

Free radicals can damage cells, and may play a role in heart disease, cancer, and other diseases.

There is a theory that melatonin levels in the population are decreasing because of light “pollution”. This phenomenon, also called urban sky glow, is where the sky is unnaturally bright at night due to artificial lighting from highways, streets, malls, stadiums and homes.

A study published in 2007 in the Journal of Pineal Research stated that exposure to low-level incandescent lightning for only 39 minutes can suppress melatonin levels by up to 50%.

Benefits of melatonin

Sleep is as important as food and air, and the quantity and quality an individual gets is also extremely important. According to data from the Cancer Prevention Study II, individuals who average seven hours of sleep each night have a lower mortality rate than do those who sleep eight hours or more.

Interestingly, research shows that sleeping more than eight hours may have deleterious effects, although the reasons for this are less clear.

A paper recently published in Neuroendocrinology Letters says that disruption of the circadian rhythms caused by over-exposure to light at night – because of both night work and as a personal choice and lifestyle – has been associated with cancer in humans. And there’s evidence of increased breast and colon cancer risk in shift workers.

Melatonin is most popularly known in its supplement form, which is touted for all sorts of conditions, ranging from sleep disturbance to anti-cancer and anti-ageing effects.

There is still a lot of debate within medical and health circles about the safety and efficacy of melatonin supplements. As melatonin is a hormone, you should be very cautious about taking such supplements.

Below, I will describe some of the common claims made by proponents of melatonin supplements. Many are still not validated by indisputable scientific evidence, so be sure to always ask your doctor’s advice first.

Sleep disturbance is the most common reason why people seek out melatonin supplements. In many cases, it is due to external factors, such as jet lag or shift work. Jet lag occurs when you cross time zones during long-distance travel, so night becomes day and day becomes night for you.

Shift workers also have trouble regulating their circadian rhythms because they go to sleep in the daytime, but the bright daylight disrupts their melatonin production.

Some people suffer from insomnia, which is the inability to fall asleep or remain asleep for a reasonable period during the night. Melatonin supplements are believed to be able to induce sleep in these people who either have low melatonin levels or have had their internal clocks disrupted.

Melatonin supplements are also claimed to be powerful antioxidants that help protect us from infection, inflammation, and act as immune enhancers because the immune system works less efficiently as we age.

Melatonin has also been shown to be beneficial for Alzheimer’s disease, especially for coping with the period called “sundowning”, when patients become agitated during late afternoon and early evening; gastric ulcers; hot flashes in menopausal women because melatonin suppresses luteinizing hormone (LH) in postmenopausal women; cardiovascular disease, since melatonin helps regulate nitric oxide production, which plays a vital role in ensuring proper cardiovascular function; and also for attention deficit disorder and insomnia in children.

Some small studies have looked at the use of melatonin to reduce high blood pressure, enhance the efficacy of cancer treatment, and reduce radiation-induced side effects in cancer treatment.

And in studies done on animals, it has been shown to improve immunity and extend lifespan by 20%.

Practise caution

Melatonin supplementation is not to be taken without care. Aside from the fact that there is no conclusive scientific evidence to support its long-term use, it can also have unpleasant side effects for some people.

Some people have reported vivid dreams or nightmares when they take melatonin. Its sleep-inducing effects may also extend into the daytime and cause drowsiness during the day. It is best to avoid driving or operating machinery if you are taking melatonin.

You should also be aware of other side effects, such as stomach cramps, dizziness, headache, irritability, decreased libido, as well as breast enlargement and decreased sperm count in men.

A word of caution for women: melatonin could interfere with fertility. It also should not be taken by pregnant or breastfeeding women, who are already producing abundant melatonin in their bodies.

Children and teenagers also have ample melatonin in their bodies, so supplementation could lead to overdose.

If you take certain antidepressants, such as Prozac or Nardil, do not take melatonin supplements, as both medications could interact to cause a stroke or heart attack.

Going natural

Before deciding to take melatonin supplements, you can try to look for natural sources of melatonin to increase the level of the hormone in your body.

Melatonin is found in some foods, although in small amounts. Oats, sweet corn and rice are rich in melatonin, as are ginger, tomatoes, bananas and barley.

If, like many other people, you resort to melatonin supplementation for sleep problems, then you could try the following methods first to regulate your sleep cycle:

● Get eight to nine hours sleep per night.

● Get to bed by 10:30pm each night.

● Sleep in a comfortable bed – make sure the mattress is not too saggy, too hard, or creaky.

● Make your sleep and wake times the same each day, even on weekends.

● Avoid exposure to bright lights, directly before and during sleep.

● Avoid TV and reading before bed, as both stimulate the brain.

● Make your room completely dark, especially if you are a shift worker who sleeps in the daytime. Use dark curtains to block out sunlight.

● Avoid taking stimulants, like coffee, cigarettes or alcohol, before bed.

● Keep the bedroom at a comfortable temperature, not too warm or too cold.

● Avoid electromagnetic fields in the bedroom, such as TVs, clocks, radios and lights. If you must have them in the room, move them far away from the bed.

● Avoid eating before sleep.

● Move the clock out of sight and avoid loud alarm clocks.

● Try keeping a journal – write down your thoughts before sleeping, so that they are not racing through your mind.

● Limit drug use – some prescription and over-the-counter medications can inhibit sleep.

● Exercising can release stress and help you sleep better at night – but don’t exercise too close to bedtime as the body needs time to relax.

● Take a hot bath or shower before bed.

● Keep your work out of the bedroom, so that your body doesn’t recognise it as a stressful environment.

Many people will claim that melatonin supplements are safe because they are “natural”. However, everything carries potential risks and side effects, especially if you do not know whether the manufacturers are to be trusted.

Whether you need help sleeping through the night, feeling good while traveling across time zones, or just want to boost your immunity, and possibly add some years to your life, always check with your doctor before taking melatonin supplements. Tell her about your other health conditions and medications, so that you can avoid any adverse complications.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.

Hormones help in sex

The interplay of hormones in the body is crucial in enabling physical intercourse.

ONE of the things that I like to tell my patients is that the brain is the most powerful sex organ of all.

Women – and their partners who come to the clinic with them – are always taken aback by this statement.

Many of them know, of course, that hormones can affect their sexual desires, as well as many of the emotions and sensations related to sex. But few people realise just how central hormones are to every aspect of sexual desire, arousal, intercourse and recovery – never mind the penis or the vagina, it is the hormones that are doing all the work.

And the brain? Well, that’s because the brain is one of the main hormone control centres in the body. Therefore, without the brain, there would be no sex at all!

Let us take a look at how each hormone plays a role in every phase of a woman’s sex life.

Hormones that control desire

Everything to do with sex begins with desire. You start off by being physically attracted to your partner, which is a form of chemical reaction triggered by hormones like catecholamines, dopamine and noradrenaline, as well as some neurotransmitters, which sometimes behave like hormones.

Sexual desire gradually increases with the help of hormones like DHEA (dehydroepiandrosterone) and testosterone (yes, even women have testosterone, as we have previously covered in this column).

Your brain also produces a type of neurotransmitter called serotonin, which activates various areas of the brain to provoke erections of the nipples, clitoris, and penis.

During the foreplay stage of sex, your body also produces specific hormones to arouse sexual desire in your partner. These hormones are called “pheromones”, and they are secreted from the sweat glands in your armpits and your pubic area.

Pheromones produce a subtle sexual fragrance that your partner inhales, and they send a signal to his brain that you are sexually aroused.

When you are aroused, your body produces oestrogens, which stimulates certain neurons in the brain and prompts the release of more pheromones.

You may be wondering why some hormones affect the release of others. Our hormones work in a feedback system, so they are continuously sending signals to one another that say “Produce more!” or “Stop producing!” Again, this happens with two hormones produced in the pituitary gland, LH (luteinising hormone) and FSH (follicle-stimulating hormone), which stimulate the production of more sex hormones like oestrogen and testosterone to further increase desire.

After foreplay, comes…

At this point, the hormones continue on this loop, as physical contact increases. More pheromones are triggered by DHEA and oestrogens, are secreted through the skin and saliva, and further enhance pleasure.

During this stage, several hormones play a role in helping to maintain energy and endurance to prolong intercourse. Cortisol is a hormone that keeps the energy and excitement up, by maintaining a man’s erection for a longer time, and providing energy to the muscles, including the heart, for endurance.

Growth hormones also help to maintain a firmer and more prolonged erection of the penis and clitoris, so that intercourse can last longer.

Other hormones that come into play are vasopressin, which also helps to make the penis and clitoris more erect.

At the peak

As the excitement reaches its climax, the nerves and adrenal glands produce a hormone called noradrenaline, which allows the body to react quickly to unexpected stimulation. Then, the body releases adrenaline, which triggers orgasm and ejaculation.

In a woman, the uterus and vagina muscles contract due to the hormone oxytocin. This same hormone also appears when a woman is breastfeeding, as it is responsible for signaling the milk glands to release milk when the baby suckles. This may explain why breastfeeding produces a pleasant feeling, similar to the after-effects of an orgasm.

During recovery

In some novels and movies, the female character always complains that her partner falls asleep after sex. Well, women may be relieved to know that there is a perfectly good hormonal reason for this.

After orgasm, the hormone progesterone is released to subdue the levels of desire. This leads to a state of serenity, relaxation, drowsiness and passivity. In fact, as women produce much more progesterone compared to men, this effect is strong in women.

Another hormone with a similar effect is prolactin, which is also produced in greater amounts in women (just like oxytocin, prolactin also plays a role in milk production for breastfeeding mothers, so nursing mums may find their breasts leaking a bit of milk during and after sexual intercourse).

Endorphins, a type of neurotransmitter, will be released to make you feel drowsy, but good. The hormone melatonin is also produced, which causes deep sleep after sex.

Some people feel a little down after they have recovered from the orgasm phase – this may be due to a dramatic drop in all the neurotransmitters and hormones that were involved in intercourse, causing a sudden sadness.

Nutrition for better sex

What does food have to do with sex? Plenty, because certain nutrients in food have a direct effect on hormone levels in the body, and can therefore improve your sex life!

Protein and certain fats (the healthful types) increase the level of sex hormones in the body, which improves libido and erections.

Some people believe that spicy and salty foods act as aphrodisiacs, and there is some truth to this, as they enhance the effects of testosterone, DHEA and cortisol.

Animal protein, which are highest in animal meats, increases adrenal hormones, such as cortisol, oestrogen, progesterone and adrenalin.

As we have already seen above, these hormones all play crucial roles in maintaining sexual desire, excitement and function throughout intercourse.

Fruits are sexy too! They increase the level of the thyroid hormones in your body, which are believed to improve your vivacity, intelligence and reaction rate.

Now you have a better understanding of how hormones work in their subtle ways to affect sexual desire, arousal and pleasure.

If you experience problems with any aspect of your sexual relationship, the cause may lie in your hormones. Talk to your doctor to find out more.

> Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

The youth hormone

Human growth hormone maintains the health of many organ systems, and also acts as a biomarker of ageing.

THIS is the second article on hormones that are important for good health. In the first installment (Hormones for health, Fit4life, Feb 17), I wrote about insulin, testosterone, oestrogen and progesterone. I also explained about bio-identical hormones.

Today, I will share about the most important hormone in anti-ageing (maintaining our health and youthfulness) – human growth hormone (HGH).

HGH, DHEA (dihydroepiandrosterone) and pregnenolone are hormones and pro-hormones (ie hormone precursors) which maintain the health of many organ systems, and also act as biomarkers of ageing.

Their levels in the blood peak in early adulthood (around age 20-25 years) and then decline steadily as we age. The current level and rate of decline influences our overall health, as they influence many organs.

The level and rate of decline may be determined by genetic factors, lifestyle, diet, exercise and weight. They can further be modified by supplementation and medical therapy. I call them the “youth hormones”.

Of these, HGH is the most important.

The sex hormones are also youth hormones. Testosterone is a reliable bio-marker for men (if the blood sample is taken in the morning), but estradiol is not a reliable bio-marker due to its marked (menstrual) cyclical variation, although the trend (if tests are done on the same day of the cycle, usually at the end of the third week, in a woman with regular cycles) may be useful. After menopause, when there is no menstrual cycle, the level becomes a reliable indicator.

For post-menopausal women out there: most of you probably do not know that your estradiol (the main oestrogen) level is probably even lower than that of the average man of the same age who is not fit and healthy (and most men above 50 are in this category).

These men tend to have higher estradiol levels than they should (which is not good for them), in contrast to menopausal women who have lower levels required for good health.

If your estradiol level is even lower than a man’s, how can you expect to be healthy, feminine and sexy?

Human growth hormone

HGH is the “master” hormone of the body. As the name implies, it is crucial for growth in children. Children who are HGH-deficient will become stunted, while those who have excess HGH (usually due to a pituitary gland tumour) will become “giants”.

All the world’s tallest men and women recorded in the Guinness Book of World Records were likely to have suffered from this problem (acromegaly). They have a myriad of health problems and do not live long.

What we are concerned here is the role of HGH in healthy ageing. After age 25, HGH levels decline by about 13% every decade in the average person (more in the unhealthy, and less in the fit and healthy).

This means that you will have about 50% left by the age of 60.

Since HGH, as the master hormone, directly or indirectly (through increasing the production of many growth factors) influences all the organ systems, its decline is responsible for most of the signs and symptoms of ageing.

The decline in the level of oestrogen after menopause only accelerates the ageing process, which has been going on for at least three decades previously (mainly due to the HGH decline).

The different tissues and organs age at different rates. For example, while most women are wary of their bones becoming brittle (osteopenia/osteoporosis) after menopause, the bone density (and strength) actually starts to decline from about age 35 onwards, about 15 years before menopause, while their hearts usually become unhealthy only after 50 (because oestrogens are excellent protectors of the heart).

Since many men enter andropause even earlier than age 50 (if low testosterone levels are used as the criteria), their accelerated ageing also starts earlier.

In 1990, the New England Journal of Medicine published a landmark study by Rudman and colleagues on the effects of HGH (injection therapy) on men above 60 years old (NEJM July 5, 1990). They reported improvements in body composition (less fat, more muscle), strength, exercise tolerance and wellbeing in the subjects tested.

Although it was a small study, this in fact started the anti-ageing revolution. Since then, there have been over 20,000 studies on HGH. Some of the benefits of having healthy levels of HGH shown in these studies include slower senescence (ageing), reduced adiposity (body fat composition), improved blood lipids, reduced blood homocysteine (a marker of inflammation and heart disease risk), reduced atherosclerosis, improved heart function, improved diabetes, increased lean body mass, improved exercise tolerance, improved immune system, better quality of life, better sleep, less fatigue, better sexual function, improvement from depression and anxiety, improved memory, improvement from memory loss in Alzheimer’s, improved rheumatism and fibromyalgia, improved osteoporosis, and many other benefits (references available on request).


However, there are some controversies. Naturally high IGF1 (insulin-like growth factor 1, which is the marker for HGH in the blood) has been associated with some cancers (eg breast and prostate), but a causal relationship has not been established.

The higher IGF1 levels have not been shown to be the cause of the cancers, and instead, could be due to the cancer, as cancer cells are known to produce many growth factors to sustain their growth and spread.

In people with acromegaly, HGH production is 10-100 times more than normal. Yet, overall they do not have more cancers (although they have slightly more colon cancers than others). So it is more likely that in cancer patients, the high IGF1 levels is due to the cancer itself.

Another controversy is that HGH can worsen diabetes. IGF1 levels increase with HGH. Insulin-like growth factors have glucose-lowering effects like insulin, and improve insulin-sensitivity. Thus, more studies show improvement in diabetes rather than worsening.

The controversy arises because diabetes occurs more in HGH-treated children, and in those with acromegaly. There are other explanations for these.

There is no doubt that having healthy levels of HGH means better health, and those with severely low levels need treatment. What is controversial is whether those with lower levels within the “normal” range when tested (and have any of the parameters mentioned above which can be improved by HGH) should be interfered at all; and whether high HGH levels predispose to cancer (see above).

The answer is simple – if you want better health and you have low HGH, you can try to improve its level and feel the benefits yourself. Make sure your doctor explains to you all the pros and cons, including possible side-effects (eg edema, which only happens if you take excess doses in the injection form).

If you don’t get any benefit after three to six months, then you can stop. If you are convinced of the benefits (especially if there are measurable improvements in your weight, body composition, and obvious improvements in your skin texture), then you can continue.

How to improve HGH levels

There are natural ways to improve your HGH level. The best ways are:

● Make sure you have sufficient deep sleep (six to seven hours of good sleep), and go to sleep not later than midnight because the HGH is released in spurts at about 2-3am (peak spurt) and again at about 5am, provided you are in deep sleep. Those who are chronically sleep-deprived, and those who work shifts, therefore miss on these spurts.

● Have a healthy nutrient-dense, high-protein, low-calorie diet. HGH is a peptide hormone and requires amino-acids for its production. Avoid caffeinated and milk products, alcohol and the empty calories in cakes and cookies.

● Intense exercise, which must include muscle-building (weights and/or resistance) training.

● Maintain a lean body (body fat below 20% for men and below 25% for women).

There are also supplements that can improve natural HGH secretion. These are called “secretagogues” and contain the component amino-acids which also act as HGH secretion-boosters. They are available in powder form (most effective) or tablet/capsules.

There are also sublingual sprays which contain homeopathic formulas or even HGH encapsulated in patented “delivery systems” to allow for its absorption (HGH is a large peptide which cannot be absorbed when taken orally). However, the effectiveness of these formulations has not been scientifically validated.

Then there are also supplements which provide the growth factors (including IGF1) directly instead of inducing HGH secretion, which then increase the growth factors production in the body.

Medical therapy by HGH injection is given only to children and older people with proven deficiencies after appropriate tests are done. These patients must be strictly monitored by their doctors.

The older patients may first try supplementation, and switch to injections only if these fail. For the majority, injections are not necessary.

The dangers and side-effects of overdosing only apply to those getting HGH injections. You need not worry about getting any side-effects if you are taking supplements to improve your HGH levels, which is why you can continue these for as long as you like if you get the benefits, while your doctor monitors your IGF1 level at suitable intervals.

Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Hormones for health

Hormones are of vital importance for good health, both in men and women.

HORMONES are vital to our health. They instruct our cells to do important metabolic functions. Too much or too little hormones can cause cells and organs to malfunction. Since our organs are not independent of one another, any upset in one system will soon affect many or all other organ systems.

There are many hormones that regulate the body. Of these, about a dozen need to be monitored and fine-tuned if you want to be really healthy.

Unfortunately, the role of hormones has not been properly understood by many doctors. This is reflected in the fact that when you do your comprehensive medical check-up, the blood tests will only include one hormone (TSH or FT4).

How can the doctors give an accurate assessment of your health when they don’t even check the other important hormones?

Anti-ageing doctors, on the other hand, will investigate at least 10 other hormones to have a better estimation of the state of the body, and to be able to optimise these hormones should they be at sub-optimal levels.

Other doctors have written about the subject, but I would like to share my perspective on this.

How important are these hormones? And how do they function? Let me give three illustrations:


On the first day of the fasting month, most Muslims who fast get very tired, and their productivity at work suffers. Then at breaking-fast time, just a glass of syrup water or air bandung will recharge and revitalise them. Of course, they get used to the fasting in the next few days.

This is to illustrate that as we fast, our glucose (and other nutrients as well) level declines and that makes us lethargic, since glucose is the main source of energy for the body. When we consume a sugar-laden drink, the glucose level is promptly restored, and so is our energy level.

But have you ever wondered why those people with diabetes, whose sugar levels are several times higher than ours, are not also several times more energetic? In fact, they are less energetic, and are prone to many diseases (eye disease, heart disease, kidney disease, erectile dysfunction, infections, etc.) because of the high glucose level.

The reason is that while the blood is loaded with glucose, the cells are starving because of lack of instructions by the hormone insulin for the cells to assimilate (take-in) the glucose. Diabetes type 1 patients lack insulin, while type 2 patients have abundant insulin, but their cells have become insulin-resistant.

Insulin regulates glucose and lipid intake by the cells. Insulin resistance is currently believed to be the underlying reason for diabetes, hypertension, central obesity and dyslipidemia (abnormal blood lipid levels). These will in turn predispose to heart disease, stroke, kidney disease, other organ diseases, and possibly cancer, too.

The earliest step towards becoming diabetic is when your fasting insulin level is elevated even though your fasting blood glucose is normal. This may indicate insulin resistance (confirmed after repeated tests). But your doctor will not be able to advise you on this if the fasting insulin level is not tested.

The next step towards becoming diabetic is when your blood glucose becomes slightly elevated, despite the high insulin. You are now “pre-diabetic”.

When the glucose level gets even higher, you will then become diabetic. The insulin level is expected to become higher than before (though not always).


A woman may not be going through any change in her lifestyle, diet and exercise routine, but when she goes into menopause (average age 50-51), she will start ageing at a faster rate than before. Every organ in her body will be affected – especially her brain, heart, bones, skin, and sexual organs. Her libido and sexual activity will be adversely affected.

All these are due to the sudden rapid decline in her oestrogens (female sex hormones). There are three important oestrogens (estrone, estradiol and estriol), but it is sufficient to monitor estradiol only, since it is the most abundant and most important.

Some doctors monitor the “free” or active estradiol levels (usually from saliva), but I have found this unnecessary in my practice.

It is also important to monitor progesterone (the only natural progestogen, which is important for fertility and pregnancy, and also “balances” out many of the negative effects of the oestrogens at other times).

For example, vaginal dryness will become evident during the “peri-menopausal” stage (ie in the months or even years before cessation of menses). This will make sex uncomfortable if untreated.

Libido is likely to be low, and often it is the husband who complains (provided the husband also does not suffer from low libido due to male menopause/andropause).

Women rarely get heart attacks before menopause because her oestrogens protect the heart. After menopause, the woman joins the “heart attack club” because her risk starts rising.

In fact, after 10 years, her risk equals that of men; and after 15 years, her risk exceeds that of men.

So for several decades, doctors were recommending HRT (hormone replacement/replenishment therapy) to women, with the promise of reversing all those problems brought about by menopause.

However, that almost came to a halt due to damning results published by the Women’s Health Initiative (WHI, US National Institutes of Health) a decade ago and later by The Million Women Study (UK). The WHI studies showed that the most popularly prescribed HRT drug – a combination of horse oestrogen (conjugated equine oestrogen) and a progestin (a synthetic progestogen, the other group of female sex hormones) – caused more harm than good.

This HRT formulation increased heart attacks and stroke; increased breast cancer; and increased blood clots, deep vein thrombosis and pulmonary embolism. It did however, decrease colorectal cancer and fractures. Almost immediately, HRT became unpopular.

The WHI studies have since been severely criticised as being flawed. Last year, a study on over 1,000 postmenopausal women in Europe showed that there was no increase in heart disease, stroke or breast cancer among HRT users. So the debate continues.

What is clear is that women age and become diseased faster as their oestrogens decline. What is not clear is what is safe and effective to delay or reverse this. We know that horse oestrogens and synthetic hormones may cause more harm than good. So I and some other doctors resort to using natural (human) “bio-equivalent” or “bio-identical” hormones to treat our patients.

These are hormones derived from plants, which are then modified in the lab to become exactly the same as the human hormones.

Since what causes menopause (and andropause) is the decline in the natural hormones that flow inside us, it makes sense to replace them with the natural or bio-identical hormones (BIH). The benefits and risks associated with BIH are expected to be the same as in women who have late menopause (who continue to have higher levels of natural oestrogens compared to menopausal women of the same age).

However, evidence-based medicine demands that every claim must be backed by scientific study. Unfortunately, no company is willing to spend the millions to do research on BIH since the natural formula is not patentable and the money spent cannot be recouped.

So, although using natural human hormones or their equivalents makes more sense than using horse hormones or synthetics, we are not allowed to make any claims.

Those of us who prescribe BIH to our patients do so based on the collective experience of BIH experts worldwide, our own experience, and the positive results seen in our patients.

In fact the Malaysian Menopausal Society (MMS) is against doctors using BIH. In contrast, the Society for Anti-Aging, Aesthetics and Regenerative Medicine Malaysia (SAAARMM) and the Society for Advancement of Hormones and Healthy Aging Medicine Malaysia (SAHAMM) both encourage the use of BIH and conducts seminars and courses to improve the doctors’ understanding of this controversial subject.

The debate will surely continue among the doctors.


Just as oestrogens are required by women for the health of most of their organs, the same applies to androgens and men. And just as the oestrogens decline at menopause, the androgens also decline with age, but not as suddenly as the oestrogens in women.

Partial Androgen Deficiency in Ageing Men (PADAM) is the other name for andropause/male menopause.

The decline of androgens in men is gradual, starting from about age 25 onwards (after the peak growth and stabilisation stages). The rate of declines varies among men due to genetic, lifestyle, diet, body weight, exercise and other factors.

Since we are generally leading less healthy lifestyles and do less physical work than our predecessors, the decline is expected to be faster. Indeed, many men in their 40’s already have low testosterone levels.

While women know they have become menopausal by the cessation of their periods, men are clueless. They attribute their weakness, muscle loss, lethargy, obesity (especially central obesity), poor libido and poor erections to various reasons, but very few realise that low testosterone could be the main reason behind many or all of these.

The main androgens are testosterone and DHT (dihydrotestosterone). Testosterone is more abundant, although DHT is more powerful. DHT is also more responsible for male-pattern baldness, and is blamed for prostate disease. Once you have prostate disease, both will worsen it.

Andropause is defined as having low levels of testosterone accompanied by one or more of the symptoms. It is sufficient to monitor just the testosterone. I find that monitoring the free or active testosterone is also important as some men with symptoms have normal testosterone levels but low free testosterone.

Unfortunately, both free testosterone and DHT tests are expensive.

I have listed four hormones (insulin, estradiol, progesterone and testosterone) that you should get tested for if you want to know what’s really happening in your body.

Women should also test for testosterone as this may be too low (and may affect their libido) or too much (and may cause infertility, excessive hair growth, and other masculine features), and men should get tested for estradiol because this may be excessive (and may cause fat accumulation and gynecomastia or “man boobs”) in some of them.

I will continue with the other hormones in the next article.

> Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

The longevity hormones

In this third part in the series on hormones for health, we continue with other hormones that are not only ‘youth hormones’ in that they help maintain health and youthful biological age, but may also impact our lifespan.

ABOUT a year ago, I wrote about the Okinawans, who are famous for their longevity (Holistic ageing, Fit4Life, April 1, 2012). The secret of their longevity, according to Prof Emeritus Makoto Suzuki, who is the leading expert on the Okinawa longevity phenomenon, lies in their diet, culture and lifestyle.

While much has been written about their diet, culture and lifestyle, the only glaring difference in their blood tests is that they continue to have youthful levels of the hormone DHEA (dehydroepiandrosterone) as they age past 50.


DHEA is the most abundant hormone in the body. It is produced by the adrenal glands. It is required by both sexes and levels decline with age. At age 60, the level is only about 40% of its peak.

It improves sexual function, increases muscle mass, reduces fat, stimulates bone growth, improves sleep, mobility, memory, immunity and reduces pain. It may help improve arterial disease, multiple sclerosis, Alzheimer’s, lupus, and possibly cancer.

It is also the precursor for the sex-hormones (oestrogens and androgens).

While the direct effect of DHEA is relatively weak compared to the sex hormones, a healthy level of DHEA is crucial because it is needed to manufacture the sex hormones.

Strenuous physical exercise and stress increase DHEA secretion, as do high protein and high fat diets. Conversely, a sedentary lifestyle and diets high in carbohydrates, cereals and sugar reduce secretion.

In anti-ageing hormone management, DHEA is among the most important hormones monitored and corrected/optimised (if necessary).


While DHEA is the mother of the sex hormones, pregnenolone is the grandmother of all the steroid hormones, which include DHEA, the sex hormones, glucocorticoid adrenal hormones (eg cortisol and other steroids responsible for stress and glucose management), and mineralocorticoid adrenal hormones (eg aldosterone, responsible for salt and water regulation).

Pregnenolone is manufactured from cholesterol. This is one example of the vital role that cholesterol plays in the body. So cholesterol itself is not bad. It is the excess and the “bad” cholesterol that is harmful.

Even that concept (that high cholesterol is bad) is controversial and I hope to write about this in the future.

Pregnenolone level declines with age, and is indirectly responsible for the decline of the steroidal hormones. A serious deficiency in pregnenolone affects many organ systems because it is the precursor of so many hormones which influence so many organs.

While the main function of pregnenolone is as a precursor or pro-hormone, it is also a neurotransmitter. It has been used with some success to improve memory and to reduce stress/depression.

Since memory decline is a constant and worrying feature of ageing, anti-ageing doctors often use pregnenolone to alleviate the problem, and about half of the patients report some improvement.

Pregnenolone testing and supplementation are not readily available here. Therefore most of the anti-ageing doctors test for, and correct/optimise the other hormones instead as an indirect way of addressing suspected pregnenolone deficiency.


Most of you may be aware that melatonin is used to counter the effects of “jet-lag” after long-distance travel, but you may not be aware that it is also a youth/longevity hormone.

Its level also declines with age like the other hormones previously mentioned, and its impact on health goes beyond normalising the sleep rhythm.

Melatonin is a neuro-hormone produced in the pineal gland, which is a small gland almost diagonally opposite the pituitary, in the mid-brain. In the esoteric world of mysticism, metaphysics and occultism, the pineal gland is variously believed to be the “seat of the soul”; the centre of the “sixth sense”; or even the “third eye” (connected to the Ajna chakra, which is important in spiritual awakening, clairvoyance and higher states of consciousness).

Circulating levels of melatonin vary in a daily cycle, and influences the circadian rhythm of several biological systems. In animals, it even influences sexual development, hibernation and seasonal breeding.

Melatonin production decreases with age. The reduced and delayed melatonin production/release (at night) as we grow older partly explains the later sleeping and waking times.

While the sleep-inducing effects of melatonin is well known (it also improves quality of sleep by relaxing the muscles and calming the nerves), our interest here is its health and anti-ageing effects.

Melatonin improves HGH (the youth hormone) secretion and also improves thyroid function. It calms down excessive stress, and lowers the stress hormone cortisol.

Melatonin is a powerful broad-spectrum antioxidant that does not itself become a free radical once it has been oxidised, unlike other antioxidants. Each melatonin molecule, through its metabolites, can neutralise up to 10 free radicals (reactive oxygen/nitrogen species).

The other powerful antioxidant that mops up many free radicals without itself becoming a free radical is silica hydride.

Melatonin is especially useful in protecting DNA from free-radical damage. It has been shown in animal experiments to protect against brain injury and Parkinson’s disease. As a longevity hormone, it has been shown to increase lifespan by 20% in mice. Let us hope human studies will be done too.

Melatonin is readily available over-the-counter in many countries and even in some aeroplanes for the convenience of travellers. Unfortunately, it is not available here, so we have to get it from overseas to prescribe to our patients who need them.

Cortisol – the stress resistance hormone

Cortisol is the most important glucocorticoid hormone produced by the adrenal glands. It also has a circadian rhythm (highest in the morning) and decreases with age.

Cortisol is a catabolic hormone (breaks down tissues to provide energy) in contrast to HGH, DHEA and the sex hormones, which are anabolic (build and preserve tissues/body).

Cortisol allows us to respond adequately to stress by making energy available (increased blood glucose), maintaining or raising blood pressure, and fighting inflammation.

Cortisol and its derivatives are therefore widely used as anti-inflammatory drugs (for all forms of inflammation and pain), and are widely abused in sports to enhance performance and manage the stress of competitions.

The overuse and abuse can give rise to dangerous side-effects.

The abuse has given a bad name to cortisol and steroid hormones because the public only know the bad side of the story. In reality, those with low levels of cortisol can easily be helped with their health and behavioural problems such as poor memory, emotional lability, anxiety, depression, attention deficit, irritability, poor reaction to stressful situations, negativism, being quarrelsome, paranoia, excessive emotions, hair loss, being underweight, inflammatory skin conditions, muscle and joint pains, fatigue, dark eye circles, and a host of other problems.

There are many people who can benefit from cortisol therapy (if their problems correlate with low cortisol levels), but many are reluctant and aghast because the doctor prescribes a steroid (hormone) drug!

Correcting and optimising cortisol levels can result in mood enhancement, more energy, better work performance, better stress management, and improved immune system.

The natural ways to increase cortisol are by exercising in the morning sunlight and by consuming certain foods (eg licorice).

Since cortisol level decreases with age, and the aged are the ones most likely to have problems of inflamed and damaged joints and other tissues, their ability to cope with the damage is compromised. Thus many end up with chronic injuries and have to consume all sorts of anti-inflammatory and analgesic drugs.

This is worsened by the decline in the anabolic hormones that are needed to preserve and build tissues.

The right balance and synergy of hormones are required to maintain optimum health. Even during the day, there is a programmed symphony among them. The “active” hormones like cortisol and testosterone peak in the morning, while the hormones like melatonin and HGH work quietly at night while we sleep.

In the next article, I will discuss hormone therapy in more detail.

Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.