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Frequently Asked Questions

+ What is Age Management Medicine?

Age Management Medicine is the medical specialty that focuses on prevention and treatment of age related changes. Age management medicine, as defined by the AMMG, is preventive medicine – focused on regaining and maintaining optimal health, vigor and activity. This medicine is based on the concept that sufficient medical evidence reveals we can improve the quality of life by delaying the onset of signs and symptoms associated with aging. A fair percent of these symptoms are related to the decline in hormone levels but formulating a complete plan that includes education, medical interventions related to balancing & optimizing hormone levels, healthy nutrition, vitamin & herbal treatments, exercise programs, anti-oxidant and other cellular protective medicines and general preventative medicine is the full approach to wellness. Age Management is a focus of study, rather than a new field of medicine, information is drawn from all areas of science and medicine. Common age related changes include: increasing abdominal fat, loss of muscle mass, slower recovery from exercise & injury, declining sexual function, bone thinning, poorer skin quality, loss of strength and cardiovascular conditioning, slower brain function, decreasing energy and drive, declining memory, depressed immunity, increased susceptibility to infections, cancer, heart disease, stroke and diabetes, sleep disturbance and mild depression. Our focus is prevention before disease occurs. We are also studying stem cells, telomeres and the DNA for future treatment options.

+ What does “bio-identical hormones” mean?

Most hormones used to prevent or treat deficiencies are classified as “synthetic” when their chemical structure resembles, but is not the same as, the human hormone (as in the case of Prempro for women’s hormone replacement in the Women’s Health Study). They are “bio-identical” when they match the exact chemical structure of their human hormone. Bio-identical hormones may be safer and better tolerated than the synthetic derivatives. The goal is to use the same hormones as your body uses at levels it remembers in youth.

+ How Are the Hormones Replaced?

Testosterone can be replaced using a topical gel with individualized dosing or an injection once per week. We instruct patients with proper injection technique and supply sterile equipment for home use. Growth hormone or stimulants are injected nightly in the skin, it’s a tiny needle. Thyroid and melatonin are taken by pill orally. DHEA, Pregnenolone, Vitamin D-3 and various other nutraceuticals are available by prescription gel or oral forms. Estrogen is transdermal, as this has not been shown to increase blood clot risk like oral estrogen. Progesterone is a cream or pill (micronized prometrium).

+ What results can I expect from this program?

In general you can expect:

Week 1-4

Increase in mental sharpness, general feeling of well being, more energy and drive – which carries over into personal and professional activities. Improved confidence and competitiveness. Increased sex drive, spontaneous morning erections and improvement in mild depression that many patients experience with hormone decline. Women will start to see some reduction in menopausal symptoms.

Weeks 6-12

Increased strength and stamina. Improvement in workouts, cardiovascular conditioning and physical activity. Continued mood & energy improvements, libido/sexual performance and well being.

Weeks 12 & beyond

Measurable and significant body composition changes. Decreased abdominal fat, increased lean muscle mass, eventual increase or stabilization of bone mass. Decreased risks of diabetes, metabolic syndrome, heart disease, prevention of cognitive (brain) dysfunction and possible improvement in blood pressure and cholesterol.

+ Will hormone therapy help sexual performance, erectile function or sex drive?

Yes. Hormone therapy, particularly testosterone, has a definite effect on sex drive and improves erections in most men. Testosterone is also associated with sex drive and sexual pleasure in women. Improving deficient Growth Hormone and DHEA levels may also improve sexual function and mood. Imbalances of hormones (Too much estrogen and/or progesterone, or thyroid abnormalities) can also contribute to sexual dysfunction. Men may talk to our physician about Viagra or Cialis, which improve blood flow to the genitals and improve erections. We consider improving sexual function as part of our Age Management program. It is important to rule out other causes of sexual dysfunction first.

+ Are hormone replacement therapies safe?

Yes. Studies have been published with increasing scrutiny over the last 10 years, which have attested to the safety of natural hormone replacement for men. We use bio-identical hormones, which are the same as the body naturally produces. These tend to be safer and more predictable than synthetic hormone derivatives. Hormone therapies may have significant side effects if not properly dosed and monitored. Patients need to seek an expert in hormone replacement, general doctors do not receive in depth training in this area. Female HRT is a long discussion and there are strategies to reduce side effects.

+ What about prostate Cancer?

A great body of research has demonstrated testosterone replacement does not cause prostate cancer. Prostate cancer is mainly related to genetics, lifestyle, chemical/environmental exposure and possibly estrogen. Men with prostate enlargement should inform their physician before treatment as this should be monitored. Multiple hormones may increase the growth of pre-existing prostate cancer so that is a contraindication to treatment.

+ Are there side effects to hormone treatments?

If hormones are properly medically monitored with visits and laboratory testing, treatments are safe and effective. Most side effects occur from improper dosing and management. As long as estrogen is controlled, testosterone therapy is well tolerated. With HGH or stimulants treating a deficiency, most reported side effects are related to water and salt retention and are reversible. There may be a mild decrease in insulin sensitivity in some individuals that is avoided by proper nutrition and monitoring. Because we don’t have enough studies on HGH use in cancer patients, we would not prescribe HGH to patients who have a history of cancer, even in severe deficiency. HGH is also not used in patients with severe diabetes or proliferative retinopathy. Thyroid hormones are delicate and require frequently monitoring. This is why it’s essential to partner with a competent and certified Age Management physician. Patient safety is our primary concern.

+ When should I consider hormone replacement or at least being tested?

In the average male, hormones decline at variable rates after age 30 or 35. The best time to be tested for hormone deficiency is around age 40 if symptoms are present. However, the older, and more deficient the individual, the more benefit they will see with treatment. There is no age limit to treatment though we suggest starting as early as possible before the deficiencies have effected the patient for years. Women should be tested when they are going through menopause. Women who seek treatment early have done much better in studies.

+ How long is the program?

The Age Management program is 1 year but we encourage our patients to continue because the benefits continue as long as you continue the treatments. Once the medicines are stopped, hormones will return to deficient levels and symptoms will return. These treatments typically take 6 months for their full physical, mental and emotional effects.

+ Do health insurance plans cover Age Management programs?

Regular insurance will not cover wellness & age management programs. If your company has their own insurance with a benefit for wellness, we can look at the details with you for coverage. If you become an Age Management member, you may submit the annual program fee and any medicine expenses to a flexible medical spending plan or HSA. Most insurances will not cover the medicines or visits if the focus is Age Management and Preventive therapies. Insurance companies only pay for treating specific disease states and have standard approved treatment therapies.

+ Do advertised non-prescription hormone supplements work?

There are some products than may increase testosterone slightly but nothing remotely close to the prescription medicine. Over the counter products are basically ineffective. There may be stimulants or other ingredients at work. Product advertisements that state oral supplements can increase growth hormone levels are inaccurate. HGH is not significantly absorbed through the membranes of the mouth, skin or digestive system. Thyroid stimulants only work if the low thyroid condition is caused by a nutrient, vitamin or mineral deficiency, which is rare now.

+ Are these treatments the same as steroids abused by athletes?

No. Testosterone is an FDA-approved medication used only for documented testosterone deficiency. The testosterone used at Premier Age Management is bio-identical, the same as your body produces and physiologic doses. Although testosterone’s base molecular structure is a steroid, its indications are not the same as the illegal steroid drugs which are often derivatives of testosterone. Growth Hormone is not a steroid. Growth Hormone and stimulants are used only in patients who are deficient by laboratory analysis with appropriate symptoms. We do not prescribe hormones to bodybuilders or anyone looking for isolated improvements in sports performance.

+ Why choose Premier Age Management Clinic?

We are focused on your health, safety and results. This practice is focused on wellness, preventive & quality of life medicine. Dr. Kocka has a personal passion for age management and optimal health. Being a former national bodybuilding champion and competitive mixed martial artist, he has both the practical and medical knowledge that most physicians can’t provide their patients. He has also spent several years acquiring additional physician certifications from the American Academy of Anti-aging and the Age management medical group, in addition to board certification in family practice. Our staff will go the extra mile for you and we spend a lot of time with every patient. Our office is a friendly, professional and confidential atmosphere where the focus is on the patient and their care.

+ How can I start or make an appointment?

Please call our office at (440) 736-7500 or click the button below. We will answer all your questions and schedule your consultation as soon as you are ready.