Hormone replacement for men

Not enough evidence to recommend routine treatment with dehydroepiandosterone

Some journalists, some patients, and some doctors believe that dehydroepiandosterone (DHEA) is the fountain of youth in a bottle. Most members of the biomedical community remain sceptical. The recent publication of a report of a conference at the New York Academy of Science has provided a collection of studies relating the hormone to the disabilities and diseases of aging.1 Many of the clinicians and investigators attending the conference had more than a scientific interest in the subject—as many as a quarter of them were thought to be taking DHEA.2

DHEA is produced by the adrenal gland and circulates largely as its water soluble sulphate. Molecule for molecule, it reaches a serum concentration 10 times that of any other steroid hormone in young men, but between the ages of 35 and 70 the concentration falls to 20% of its peak value. Within populations, serum values show great variation,3 and in the only published longitudinal study 15 of 97 men actually showed an increase in their serum DHEA over the 15 years of observation.4 Little is known of DHEA's physiological functions, though it may serve as a precursor of both testosterone and oestradiol. However, epidemiological studies have indicated that a low serum concentration of DHEA is associated with an increased risk of cardiovascular disease in men over 50 years of age5 and of breast cancer in premenopausal women.6

The mass media have simplified the issues, which they have presented as making four points. Firstly, the secretion of DHEA declines with age; secondly, this decline is associated with an increasing frequency of disability and disease, …