Has Age Management Medicine Saved Lives in the Era of COVID-19?
Jeff Morris
The COVID-19 virus has confounded doctors and researchers for months due to its varying symptoms, ease of spread, and inconsistent outcomes. It has been the subject of innumerable studies conducted in a very short amount of time, with the result that none have yet had an ideal number of subjects or sufficient length to be conclusive.
With that said, there are however certain clear observations that can be made, and conclusions that can be drawn from what is known, and they are the basis for an upcoming digital lecture by Cesar Pellerano, M.D. Dr. Pellerano is a preventive cardiologist and age management medicine physician in Miami, Florida. He has been practicing for over 30 years, and is the president, founding partner and chief medical officer of Hillstar Health LLC in Miami. You can probably guess from the title of the lecture, “COVID-19 and Inflammation: The Role of HRT” the direction in which Dr. Pellerano is heading. But let’s hear how he made his deductions.
“As you know, COVID is probably the number one conversation point in the U.S., if not the world, right now,” said Dr. Pellerano. “COVID is an inflammatory virus; everything it does is through inflammation. It comes in through your nose or eyes—any mucosal surface—and eventually goes to the lungs.”
Many young people get the virus but are asymptomatic carriers; that is because in most cases they have efficient immune systems. “When our immune systems are compromised,” said Dr. Pellerano, “the virus goes into the cell and creates what is called a cytokine storm. All of the inflammatory markers start festering in the cell, then burst the cell and spread throughout the body. This produces inflammation in the lungs, and from there it spreads to other organs. That’s why we get inflammation in the heart, sometimes in the brain, in the kidneys, or we get blood clots.”
The bottom line, Dr. Pellerano said, is that the worse your immune system is, the worse the symptoms and the attack of the virus is going to be. “It all boils down to how good your immune system is and how much inflammation you have,” he said. One of the main risk factors for the virus is obesity, and as Dr. Pellerano notes, we have a lot of obese people.
“When we looked at the data, people with BMI greater than 40 really got sick,” Dr. Pellerano said, noting that he usually does not hold to the accuracy of using BMI, but that in this case, BMI is a pretty good indication that the person is overweight. When you’re obese, he said, you have a lot more inflammation, and we’ve known for a long time that obese people have diminished immune symptoms. As a general rule, he said, “if a fat guy gets a cold, and a skinny guy gets a cold, the fat guy is going to get it worse. He’s going to have more symptoms, he’s going to feel worse. So if you have an inflamed individual, and you add an inflammatory virus, you’ve got the perfect storm—you’re adding fuel to the fire.”
Other things that cause inflammation in people, and a diminished immune systems, said Dr. Pellerano, are all of the other risk factors that we’re now seeing with COVID: hypertension, diabetes, and heart disease. “All of these people, from their illness, already have a diminished immune system. It stood to reason that maybe, if we tackle inflammation, we could help people with the virus.”
One of the things we know for a fact tackles inflammation, said Dr. Pellerano, is testosterone—it improves muscle mass, and it helps you burn body fat. “There are two studies that have looked at this, and they both showed the exact same results,” Dr. Pellerano said. One, by a Dr. Rastrelli in Italy, published in May 2020, looked at 31 men with the virus in the respiratory intensive care unit. Briefly, the six patients who died were the six with the lowest testosterone levels. Higher testosterone and free testosterone levels were proportionate to degree of recovery.
In a second observational study, there was a group that had fortuitously had their testosterone levels measured before they came down with COVID. Again, their outcomes correlated with their testosterone levels. “Nobody is using testosterone yet as part of the protocol, but I think at some point we’re going to need to look at it,” said Dr. Pellerano.
An even more startling anecdotal discovery related by Dr. Pellerano is this. “I’ve spoken to a couple of other doctors who have decent sized age management practices,” he said. “Nobody has had an age management patient hospitalized for COVID.”
Dr. Pellerano has other observations based on some of his own patients that also seem to point to testosterone improving their immune response and preventing serious illness. “Obviously we can’t draw any conclusions, and I think we’re going to be looking at this in greater depth in the future,” he said.
“What we can say about our age management patients,” said Dr. Pellerano, “is they all put emphasis on a good diet, on being fit, on taking their hormones, and they overall have a healthier lifestyle than the average population. I do think these people are ahead of the curve, in a better position to deal with the virus and have a better immune response.”
The first priority for his patients, emphasizes Dr. Pellerano, is to avoid getting the virus in the first place, by continuing strong mitigation—face shields, gloves, masks, washing hands—and to avoid being in crowded places in the first place. “If you can’t control the environment, you shouldn’t be there,” he said. He then recommends adhering to a low glycemic diet, to exercise, and to take supplements that are known to lower Interleukin-6. “A colleague told me they’re looking at Interleukin-6 because people who are sick with COVID have been found to have crazy high levels—and we know that testosterone blocks Interleukin-6,” Dr. Pellerano revealed. “So maybe testosterone needs to be looked at as part of the treatment.”
Dr. Pellerano will go into the studies, observations, and discuss the implications in much more depth in his upcoming digital lecture, part of AMMG’s Digital-on-Demand Conference beginning November 14th. To learn more about the conference and how to register, visit www.agemed.com.