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DHEA, low-dose testosterone largely ineffective as antiaging therapies
Little effect seen on physical factors or on quality of life indicators.
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New research found that dehydroepiandrosterone and low-dose testosterone, which are promoted as antiaging supplements, have little effect on body composition, physical performance, insulin sensitivity or quality of life in elderly men and women.
“Levels of dehydroepiandrosterone and its sulfated form, the most abundant steroid hormone in circulation, decline from the third decade onward,” the researchers wrote in the New England Journal of Medicine. “Studies in animals have shown beneficial effects of DHEA on many age-related changes in body composition and in conditions such as diabetes mellitus and cardiovascular disease. … Moreover, longevity in healthy humans and nonhuman primates is associated with relatively high levels of DHEA, a finding that has led to extensive promotion of DHEA as an antiaging agent by the lay media.”
Data on the long-term effects of DHEA, as well as testosterone replacement therapy, is sparse. K. Sreekumaran Nair, MD, PhD, a professor of medicine at the Mayo Clinic in Rochester, Minn., and colleagues conducted a randomized, placebo-controlled, double-blind study aimed at determining the effects of DHEA replacement and low-dose testosterone replacement therapies on body composition, physical performance, BMD and glucose tolerance in elderly individuals with low androgen levels.
Study design
The researchers enrolled a total of 57 women and 87 men; 27 of the women received DHEA replacement therapy (50 mg/day) while 30 received placebo; 29 men received DHEA (75 mg/day), 27 received testosterone (transdermal testosterone patch, 5 mg/day) and 31 received placebo. Characteristics of the men and women did not differ significantly between the groups at baseline. A final group of 38 healthy young women and 37 healthy young men aged 18 to 31 were also included; this was done to obtain baseline values for a comparison of outcome measures.
After 24 months, patients in the DHEA groups experienced an increase in levels of sulfated DHEA (P<.001 vs. placebo) and total and bioavailable estradiol (P<.001 vs. placebo), and women in the DHEA group had increase in total testosterone. Men in the testosterone group had increased levels of bioavailable testosterone (P<.001 vs. placebo). DHEA levels rose to what the researchers wrote was in the high-normal range for young people.
Regarding body composition and physical performance, only fat-free mass differed significantly between treatment and placebo groups.
“When men and women in the DHEA group were considered separately, no significant changes were seen in body-composition measurements,” the researchers wrote. “When men and women were combined, the DHEA group had a slight but significant increase in fat-free mass (<0.5 kg) and a decrease in the proportion of body fat (<1.5%). Men in the testosterone group had a significant increase in fat-free mass.”
However, this small change in fat-free mass was not translated into any changes in muscle area in thigh and physical performance. Changes in patients’ peak value of maximal oxygen uptake and muscle strength measures were similar in treatment and placebo groups.
Bone mineral density
Regarding BMD, women in the DHEA group had a slight but significant increase in BMD of the ultradistal radius. Men in both the DHEA and testosterone groups had slight but significant increases in BMD of the femoral neck. BMD at other sites did not increase significantly.
The researchers used the Health Status Questionnaire (HSQ) to evaluate quality of life. “[Participants] in the DHEA and testosterone groups had no significant change in scores on the Physical Component Scale and Mental Component Scale of the HSQ,” they wrote.
Adverse events, as measured by prostate volume, prostate-specific antigen levels, liver function, electrolyte levels and hemoglobin levels, were not altered by treatment with either DHEA or testosterone.
However, it is important to understand that men with any prostate problems, active heart disease or cancer (among other exclusion criteria) were excluded.
“In all, we found little if any beneficial effect of the restoration of DHEA levels in elderly men and women to those in healthy young people of the same sex,” the researchers wrote. “Taken together, our data provide no evidence that either DHEA or low-dose testosterone is an effective antiaging hormone supplement and argue strongly against the use of these agents for this purpose.” – by Dave Levitan
For more information:
- Nair KS, Rizza RA, O’Brien P, et al. DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med. 2006;355:1647-1659.