Estradiol-Receptor Blockade in Older Men and Women

Systemic concentrations of Te, E2, GH, IGF-I and insulin growth factor binding protein 3
(IGFBP-3) decline in healthy aging men and women. Relative sex-steroid deprivation
accentuates GH and IGF-I depletion, since Te stimulates GH and IGF-I production in older
men, hypogonadal males of all ages, and patients undergoing (genotypic female-to-male)
gender reassignment. The estrogen-receptor antagonist, tamoxifen, blocks this effect of Te,
suggesting involvement of E2 in GH's stimulation at least in young men. E2 alone stimulates
GH secretion in young and older women. Because Te is converted to E2 by aromatization in the
body, we postulate that E2 is the active moiety in both men and women. Moreover, we
hypothesize that the decline of E2 in older men and women contributes to the fall in GH
output. These basic concepts will be tested here.

Inclusion:

1. 40 healthy women and men (ages 50 to 80 y); women will be post-menopausal (clinically
defined by E2 < 50 pg/mL, FSH > 30Iu/L)

2. BMI 18-35 kg/m2

3. community dwelling; and voluntarily consenting

Exclusion:

1. recent use of psychotropic or neuroactive drugs (within five biological half-live);

2. obesity (outside weight range above);

3. Laboratory test results not deemed physician acceptable, viz potassium <3.5 mEq/L,
magnesium <1.5 mEq/L, triglycerides > 300, BUN >30 or creatinine > 1.5 mg/dL, liver
functions tests twice upper limit of normal, anemia (hemoglobin must meet Blood Bank
requirements - Hgb ≥ 12.5 g/dL)

4. drug or alcohol abuse, psychosis, depression, mania or severe anxiety;

5. acute or chronic organ-system disease, including renal failure (creatinine > 1.5
mg/dL)

6. endocrinopathy, other than primary thyroidal failure receiving replacement

7. nightshift work or recent transmeridian travel (exceeding 3 time zones within 7 days
of admission),

8. acute weight change (loss or gain of > 2 kg in 6 weeks);

9. allergy to toremifene

10. unwillingness to provide written informed consent.

11. PSA > 4.0 ng/mL in men

12. History or suspicion of prostatic disease (elevated PSA, indeterminate nodule or
mass, obstructive uropathy, or breast cancer),

13. Other carcinoma (excluding localized basal cell carcinoma removed or surgically
treated with no recurrence).

14. History of thrombotic arterial disease (stroke, TIA, MI, angina) or deep vein
thrombophlebitis.

15. History of CHF, cardiac arrhythmias, congenital QT prolongation, and medications used
to treat cardiac arrhythmias or other strong CYP3A4 inhibitors.