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Dehydroepiandrosterone Replacement in Older Patients
Am Fam Physician. 1999 Oct 1;60(5):1538.
Dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) have been praised for their beneficial effects on health and aging. DHEA, a steroid produced in the adrenal cortex, is thought to have weak androgenic activity. Because body changes associated with aging, such as reduced protein synthesis, decreased lean body and bone mass, and increased body fat are accompanied by a decline in DHEA and DHEAS, daily replacement of these chemicals has been recommended. Metabolism of DHEA and DHEAS includes formation of active androgen and estrogen steroids, which are then further metabolized. These active sex steroids may affect cells with androgen or estrogen receptors, including adipose tissue, prostate, brain, breast, muscle and liver. DHEA, although not labeled by the U.S. Food and Drug Administration for treatment of any condition, has been reported to promote a sense of well-being. Flynn and associates studied DHEAS replacement in aging persons using patients recruited from a longitudinal aging study that tracked physical and physiologic changes biennially over time.
A group of 39 healthy, nonsmoking men participated in a double-blind, placebo-controlled, cross-over study receiving either DHEA (100 mg daily) or a placebo for three months. The subjects then crossed over to the other replacement for three months, followed by a three-month washout period. At study entry and after each three-month period, all subjects underwent blood testing, urologic analysis, analysis of dietary records and body composition, and assessment of activities of daily life and sexual functions; subjects were also given a sexual score.
Serum DHEA and DHEAS levels increased along with estradiol and free testosterone levels while subjects were taking DHEA. Body composition did not change at any phase of the six-month replacement period. Small blood changes were found, such as decreased uric acid level, blood urea nitrogen/creatinine ratio, alanine aminotransferase level, total cholesterol and high-density lipoprotein cholesterol level. Mean corpuscular hemoglobin volume and serum potassium levels were increased when DHEA was taken for three months, but none of the changes were outside the normal range or biologically significant.
The authors conclude that reports of health enhancement brought about by use of DHEA are not documented by this study. No significant biologic responses to the three-month replacement of DHEA were apparent. The study subjects did not report a sense of well-being or improved sexual function, as has been previously reported.
Flynn MA, et al. Dehydroepiandrosterone replacement in aging humans. J Clin Endocrinol Metab. May 1999;84:1527–33.
Copyright © 1999 by the American Academy of Family Physicians.
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