Getting Old and Frail? Getting Frail MEANS Getting Old

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Do you ache all over? Are you weaker every year? Shorter and more bent over?   Are your clothes hanging off your shoulders? Do you walk slower and hold on to things as you walk? If you notice these signs in yourself or someone you love it means you, or they are becoming frail.

As a physician I had to become a people watcher…. or more accurately an observer of the people around me.  Even if you aren’t medical people, I am sure many of you are as well…. but being very observant is a requirement for a physician because there are many signs of illness that can be observed just from observing a patient who we I am treating.  I always pay attention to how the patient I am consulting with walks, shakes my hand (their strength), and how well they care for themselves, the quality of their speech, whether they look well nourished, over-nourished or frail.  All of these individual observations and more, become automatic to me as a doctor. They help me diagnose and treat my patients without a stethoscope or even an x-ray… Today I want to talk about frailty, what it is, and what it means to your doctor and you as a patient.

Frailty can be defined as the visible qualities of loss of muscle mass, bone mass, energy, as and strength, as well as thinning of the skin, kyphosis of the spine (standing with your head looking down and your shoulders rounded), slow movements, weakness of strength and voice.  Frailty is the visible sign of aging.

The opposite of Frailty is the Quality of being robust. When we are young we are strong, energetic, our muscles are visible, our skin is clear and taught, our posture is straight and we appear healthy and strong….when we are young we are Robust!   Frailty is the quality of being old and weak, in a catabolic state (or a state of tissue breakdown and “shrinking”).  You can equate Frailty with aging, or physically being old.

What does frailty mean to a doctor?

When we take care of a patient who comes to us for the first time in a frail state we rule in or out a list of diseases of aging and physical problems. These include:

• Arthritis
• Osteoporosis
• Sarcopenia or severe loss of muscle mass and strength
• Inflammatory diseases like arthritis
• Heart disease
• Diabetes
• Dementia
• Inability to be independent

Doctors must look for illness and decide on a treatment to remedy a disease, but frailty is not considered a disease that has a treatment.  It is a sign that a patient is going through the last stage of life.  Many studies have been done that equate frailty to a limited life span and a loss of quality of life, but no treatment has been employed by mainstream medicine to delay, avoid or treat frailty.

Up to now this is all very depressing, however it is my well founded belief that the loss of testosterone  after age 45 in women and 55 in men is the first step toward frailty, however if  adequate testosterone is replaced soon after the symptoms of T deficiency starts, then frailty can be avoided as we age, and the eventuality of loss of quality of life will be delayed or avoided all together. 

It is a fact that nothing other than the hormone testosterone can reverse frailty and stop it from progressing. With T treatment my patients increase their muscle mass, create stronger muscles, and improved their mental and physical stamina.

To me this is such an easy one-hormone-answer to actually improve my patients lives, at any stage in the aging process, however the pharmaceutical companies that control American medicine much prefer to treat each symptom with a different drug.  There are millions of aging folks in nursing homes who could have maintained their independence, and avoided the use of many drugs if they were treated with testosterone before their frailty reduced their mobility so they need help to perform daily activities of living independently.

Sadly, medicine in the US basically gives up on frail and aging patients and we doctors are taught to make frail patients “comfortable”, just treating their symptoms without hope of reversing frailty and the outcomes of that condition.  Of course, it is much healthier to prevent frailty by replacing the essential hormone testosterone early on, however your doctor will have to think out of the box to arrive at the Testosterone treatment, rather than follow the medical protocols that involve just keeping aging patients “comfortable”.

Research studies and articles to be read by doctors like the recent one in the New England Journal of Medicine that draws a direct line between aging and frailty, but only concentrates on the fact that frailty portends early death and discussed the best ways to make patients comfortable dictated by the severity of frailty.  There is no treatment other than high protein diet and vitamins with physical therapy which will not “treat” this disease.

I want to tell you about two very different patients in my practice.  The first is a very successful man in his late 70s who came to me seeking weight loss because he had been an athlete and still enjoyed playing golf, but he was complaining of weakness and other symptoms of frailty, in addition to looking borderline frail when he first came to me.  We did a body composition test, and he had a higher fat mass and a lower that ideal muscle mass which is the way frailty begins.

We discussed the fact that weight loss (fat loss) obtained by more exercise and less carbohydrate in his diet might improve his Pre-diabetes and inflammation, but would not make him stronger, or increase his physical and mental stamina, in other words reverse his beginning frailty.  He chose to embark on an exercise-based weight loss program combined with a high protein low carb diet.

In the end he did not take my advice about the best way to lose weight without losing muscle which would have been to add Testosterone and Metformin to his treatment plan, however he wanted to be the one directing his own care (he was a business man and not a doctor) without a basic knowledge of physiology, or  nutrition, or any training about aging and frailty. Let me note that if he was younger than 55, and he tried this weight loss program while he was making adequate Testosterone, he might have had a successful fat loss program and gained muscle density and strength while he lost fat, however, this gentleman is 78.

You can guess the end of the story.  He did lose weight, however he lost as much muscle as fat and was even weaker after 6 months.  This is sometimes what happens when very successful people in one area of life think that makes them brilliant in all disciplines.

Now, the flipside of the coin.  I will tell you about an 82-year-old doctor who came to me almost too late.  His much younger wife was already my patient, and she encouraged him to have a consult with me to see what I could do for him.  He had the right attitude, but was already frail, and I could feel the humorous bone of his arm, when I ushered his into my office for his consultation.  I explained what observing him and his lab told me more while he told me that he had almost every symptom of aging, and frailty.  He told me that he was an athlete in college and that he always had a lot of muscle, and he watched every day as his muscles “melted away”, despite his exercise daily.  He was frustrated and had trouble with his memory as well because he had lost his testosterone long ago and he had done well for as long as he had because he had eaten a nutritious diet, taken supplements and worked out daily. We discussed his other medical problems, and some treatments for them, additional supplements to assist in building muscle and bone strength.

He came back 5 months later after he had his T pellets inserted and he walked in with confidence, and the difference in his muscle mass was visible!  He was no longer “frail looking”.  He told me he was thinking better, not completely yet, but his mind was getting progressively better.  He had lost fat and gained muscle. He had turned the clock back 15 or more years.  Testosterone in the right dose and delivery system can erase frailty and give a quality of life back to my patients who had no help from other doctors.

Look around you if you aren’t yet at the age that carries with it frailty  or if you are without Testosterone and are experiencing frailty…look at those around you in the doctor’s office or when you are waiting to board a plane…look at the pre-borders who can’t walk the length of the ramp to the airplane and see if they have the visible characteristics I am talking about.   If you are over 45 and female or 55 and male and not on Testosterone maybe you should consider having your testosterone replaced so you can keep your muscle mass and independence as long as you live.