Controlled studies of DHEA administration in older adults
In recent randomized, placebo-controlled trials of 1 to 2 years’ duration, DHEA replacement alone in older men and postmenopausal women did not result in significant changes in fat or muscle mass, lipid profiles, glucose levels, mood, or cognitive performance. Studies of DHEA combined with an exercise stimulus (e.g., endurance, resistance, or both) have shown mixed effects. In postmenopausal women, 12 weeks of DHEA was not more effective compared with placebo at potentiating the effects of endurance and resistance exercise on body composition, glucose levels, or lipid metabolism. In contrast, 16 weeks of DHEA improved muscle volume and strength compared with placebo when combined with high-intensity resistance exercise in older women and men.
RCTs on the effects of long-term (i.e., 1–2 years) DHEA (50 mg/day) on BMD in older adults have shown trends for BMD increases at the hip, but improvements at other sites appear to be more study specific and gender specific. Increases in BMD in response to short-term DHEA therapy have generally been small (1%–2%). One study evaluated the effects of DHEA therapy or placebo combined with vitamin D and calcium on BMD in older patients. Compared with placebo, spine BMD increased by 1.7% after 1 year and by 3.6% after 2 years in DHEA-treated older women; there was no effect on hip BMD in postmenopausal women or on spine or hip BMD in older men. The 2-year increment of 3.6% in the spine observed in women was comparable with that seen with bisphosphonate treatment. There have been no RCTs assessing the effect of DHEA on fracture risk.
In general, DHEA replacement trials have not shown significant adverse events (e.g., increases in prostate-specific antigen [PSA]), but much larger trials would be needed to establish safety and efficacy. The most common reported adverse effects have been dermatologic or androgenic symptoms in postmenopausal women.