(Editor’s Note:)The role of estrogen in maintaining health has been receiving increasing attention in health reports. Recent studies, including one published in August in The Lancet, reported a link between the loss of estrogen and cognitive decline. However, it could be that elevated levels of two other hormones FSH and LH are more important as a factor in the development of Alzheimer’s Disease. If so, the drug Lupron could become the treatment of choice.
In this exclusive interview with Richard Bowen, M.D., we discuss the relationship of estrogen to Alzheimer’s disease and explore Dr. Bowen’s own theories on the role of hormones and their possible connection to the development of the disease.
AlzheimerSupport: Dr. Bowen, how did you get involved in research of Alzheimer’s disease?
Dr. Bowen: I became interested in Alzheimer’s disease (AD) research really by chance. I was espousing the benefits of hormone replacement therapy during the course of taking a patient’s history and physical.
The patient mentioned that her husband had AD and prostate cancer and had started taking a hormone, Lupron. His AD improved slightly and he had no further progression during the next four years.
If it had not been for the AD patients’ family history I would not have paid much attention. However, having four first-degree family members with AD peaked my interest. I began looking into the mechanism of Lupron and how it might relate to AD.
AlzheimerSupport: There’s been a lot of press lately on the role of estrogen and its link to AD. First, can you briefly explain how this hormone works?
Dr. Bowen: FSH (follicle stimulating hormone), LH (leutenizing hormone) and estrogen make up a ‘feedback loop.’ FSH and LH stimulate estrogen production in the normal ovary. Estrogen in turn goes back to the brain and causes a decrease in FSH and LH production. This decrease then causes a decrease in estrogen production, which goes back to the brain and causes an increase in FSH and LH. This then causes an increase in estrogen, and so on and so on.
AlzheimerSupport:What’s your own theory about these hormones, FSH, LH and estrogen?
Dr. Bowen: Lupron, the hormone used by the patient with prostate cancer, halts the production of FSH and LH. When levels of these hormones fall this in turn stops the production of estrogen and testosterone. So, the case mentioned above did not seem to be consistent with the estrogen hypotheses (that too little contributes to cognitive decline.)
However, it occurred to me that since both estrogen and Lupron inhibit the production of FSH and LH, that possibly it was not that estrogen was beneficial, but that FSH and/or Lupron was detrimental.
AlzheimerSupport: How important is Lupron as a possible treatment for Alzheimer’s?
Dr. Bowen: Lupron is important because it is currently available and any physician can administer it now.
AlzheimerSupport: So how did you test this theory?
Dr. Bowen: To test my hypothesis, I tested FSH and LH concentrations in 40 males with AD and 29 males without AD. The average FSH concentration was twice as high in the AD patients.
The Mayo clinic has a serum bank on AD patients and age matched controls. They ran the tests on their samples and received similar results. Both of these studies support the hypothesis that elevated FSH contributed to the development of AD. I must caution though that the converse is possible; AD may cause elevated FSH.
AlzheimerSupport: And how does this fit with what you know about Alzheimer’s?
Dr. Bowen: The hypothesis is also supported by the epidemiology (disease processes) of AD. Women are at higher risk than men. They go through menopause and their FSH levels increase. Men do not go through menopause and their FSH levels do not increase until much later in life. Individuals with Down’s syndrome are at high risk and the men get it earlier than the women. Women with Down’s go through menopause very early. Males with Down’s never produce any sperm and their FSH levels are elevated from puberty on.
AlzheimerSupport.com: Does this mean that post menopausal women have a significantly increased risk of AD without Hormone Replacement Therapy?
Dr. Bowen: Correct. After menopause the ovary is no longer able to produce estrogen. Without estrogen to inhibit it, the brain produces FSH and LH in very large amounts for a very long time.
AlzheimerSupport.com: Recent study results seem quite inconsistent in observing the link between serum concentrations of estradiol (estrogen) and cognitive decline. The latest study in The Lancet did find a link between higher concentrations and less cognitive decline. What is your comment on the inconsistencies?
Dr. Bowen: One reason why estrogen levels may not correlate to cognitive function is that there is great variability in the FSH response to decreasing estrogen levels. It may be that FSH remains low only in women with the very highest estrogen levels.
AlzheimerSupport.com: And what is the significance of this for Alzheimer’s?
Dr. Bowen: Women with higher estrogen levels would have lower FSH and therefore lower risk of AD. I have a hypothesis of the bio-molecular mechanism by which this may occur. It relates to how FSH affects cholesterol receptors.
AlzheimerSupport.com: Are there any ways to determine which women have what levels and exactly how the response is varying in different people?
Dr. Bowen: FSH and LH levels are standard tests that can be performed by any medical laboratory. At some point we may be able to say that if your levels are such and such, then you need to be treated. This would be comparable to how we treat cholesterol.
AlzheimerSupport.com: Tell us about the trials you are conducting and their goal?
Dr. Bowen: We are currently enrolling 60 patients (44 females and 16 males) with Alzheimer’s disease and elevated FSH levels into a prospective, double blind, placebo controlled, one year study. Participants on active medication will receive Lupron depot 22.5mg 3 month suspension. (Depot means that the injection is in a form that slowly releases the medication over a long period of time, 3 months in this case.) Participants’ cognitive function will be evaluated using the ADAS-cog. (Alzheimer’s Disease Assessment Scale – cognitive.)
The goal of the study is to determine if administering Lupron will halt or slow the progression of AD. It is important because if it does have a positive effect, the medication is already available and patients can obtain it immediately without having to wait for FDA approval.
AlzheimerSupport: How can people contact you to enroll in the trial?
Dr. Bowen: Telephone: 941-403-7460. Address: 2500 N. Tamiami Tr., Suite 116, Naples, FL. 34103. Email: firstname.lastname@example.org