DHEA in elderly women and DHEA or testosterone in elderly men.

Randomized placebo-controlled intervention study in elderly men and women with low sulfated DHEA, and low bioavailable testosterone in men. For the DHEA arm in elderly men, 29 participants were randomized; for the testosterone arm in elderly men, 27 were randomized; and for the DHEA arm in elderly women, 27 were randomized.

Elderly men received oral DHEA 75 mg/day for about 2 years (median 23.2 months), and a separate men’s arm received transdermal testosterone 5 mg/day for about 2 years. Elderly women received oral DHEA 50 mg/day for about 2 years (median 23.0 months). Active treatments were compared with placebo in randomized arms.

Overall, DHEA or low-dose testosterone did not produce physiologically relevant improvements in body composition, physical performance, insulin sensitivity, or quality of life. In elderly men, DHEA increased sulfated DHEA by a median of 3.4 μg/mL (9.2 μmol/L) versus placebo and increased estradiol, but did not significantly improve body-composition measures, peak VO2, muscle strength, or insulin sensitivity; HDL cholesterol decreased and femoral-neck BMD increased. In elderly women, DHEA increased sulfated DHEA by a median of 3.8 μg/mL (10.3 μmol/L), increased bioavailable estradiol, decreased HDL cholesterol, and increased BMD at the ultradistal radius. In elderly men, testosterone increased bioavailable testosterone by a median of 30.4 ng/dL (1.1 nmol/L), increased total testosterone and fat-free mass, and increased femoral-neck BMD, with no major adverse effects reported.

Sample sizes were modest within each active arm, which limits power to detect clinically meaningful changes and adverse events. Findings are also specific to older adults with low baseline sex-steroid levels, and several outcomes were null despite clear hormonal changes, limiting the practical interpretation of the small BMD and body-composition effects.