Treatments with dehydroenpiandrosterone (DHEA) and testosterone were evaluated in elderly people in this two-year study. Both the men and the woman in this study had low levels of sulfated DHEA and the men had low levels of bioavailable testosterone. Normally, blood levels of sulphated DHEA decline beginning in the third decade of life and previous studies have shown improved health and increased longevity with high levels of DHEA.
The debate has been whether to treat patients who have low levels of testosterone with supplementation. There is some indication that taking testosterone by mouth may be associated with increased risk of prostate cancer and worsening of prostatic hypertrophy.
This study was done to see if there were any benefits or adverse effects to DHEA treatment in women or treatment of men with either DHEA or testosterone. The men received either placebo or 75 mg. DHEA , or a placebo or 5 mg. daily testosterone patch. The women received a placebo or a 50 mg. DHEA tablet.
The study lasted for about 23 months. Every 3 months, the men were tested for prostate specific antigen (PSA) levels and referred to an urologist when necessary. The PSA is a blood test that indicates the possibility of prostate cancer when the level is elevated.
Bioavailable testosterone blood levels and bioavailable estradiol blood levels were tested. The women showed increased levels of DHEA, estradiol, and testosterone. Men who received testosterone had increased levels of testerone. Men and women who received DHEA had reductions in high-density lipoprotein (HDL) cholesterol.
The results of the study were measured as physical performance as measured by both muscle strength and aerobic capacity. No changes were seen as the result of the treatment.
In regard to body composition, men under testosterone treatment had a mild increase in fat-free mass. Men and women who received DHEA had a significant increase in fat-free mass.
Bone mineral density (BMD) was evaluated. The women who received DHEA had an increase in BMD at the radial bone at the wrist. Men who received DHEA or testerone had an increase in BMD at the femoral neck. This total effect was less than that seen with the use of current pharmaceuticals for osteoporosis.
Glucose tolerance was evaluated and there was no change in the treated patient’s insulin sensitivity with DHEA or testosterone.
No change in quality of life was observed as a result of this study.
PSA blood levels were done to monitor for prostate cancer. Ultrasonography of prostates were done as needed. No adverse reactions were seen as the result of DHEA or testosterone therapy.
CONCLUSION: The authors conclude, “neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life.”
NOTE: It could be argued that the increased bone mineral density seen in men at the femoral neck and in women of the radial bone at the wrist are beneficial effects, though not strictly physiological. Also, the increase of fat-free mass in DHEA treated women and in men treated with DHEA or testosterone could be considered a benefit. In view of the absence of adverse effects, perhaps, the study should be repeated using higher doses.
It could be argued that the lowering of the HDL-cholesterol was an adverse reaction.