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Replacement of Dehydroepiandrosterone in Adrenal Failure: No Benefit for Subjective Health Status and Sexuality in a 9-Month, Randomized, Parallel Group Clinical Trial

Haukeland University Hospital (K.L., O.L.M., E.S.H.), N-5021 Bergen, Norway; University Hospital Uppsala (G.G.-M., O.K.), SE-75185 Uppsala, Sweden; Rogaland Central Hospital (S.U.), N-4068 Stavanger, Norway; Haugesund Hospital (B.G.N.), N-5504 Haugesund, Norway; St. Olav’s Hospital, University Hospital of Trondheim (K.J.F.), N-7003 Trondheim, Norway; and University Hospital of Northern Norway (T.S.T.), N-9038 Tromsø, Norway

Address all correspondence and requests for reprints to: Dr. Kristian Løvås, Division of Endocrinology, Institute of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway. E-mail: kristian.lovas{at}haukeland.no.

The physiological role of dehydroepiandrosterone (DHEA) is not well understood, but studies suggest positive effects on subjective health and bone metabolism. We have conducted a clinical trial with DHEA replacement in adrenal failure with the primary aim of evaluating effects on subjective health status and sexuality. Thirty-nine women with adrenal failure were randomized to 9 months of treatment with 25 mg DHEA (n = 19) or placebo (n = 20). Treatment effects were assessed by validated questionnaires of subjective health and sexuality. DHEA replacement yielded a wide variation of effects on the subjective health scales, which were not different from the effects of placebo. Almost all patients receiving DHEA obtained normal androgen levels. Eighty-nine percent of the patients receiving DHEA experienced side-effects, in particular increased sweat odor and scalp itching. DHEA replacement did not significantly change the levels of blood lipids, IGF-I, and markers of bone metabolism. In conclusion, we do not find evidence of beneficial effects of DHEA on subjective health status and sexuality in adrenal failure. However, DHEA may be beneficial for subgroups of patients with adrenal failure, but these remain to be identified. Premenopausal androgen levels can be restored with 25 mg DHEA daily in most female patients, but side-effects are frequent.

This work was supported by the Norwegian National Research Council.

Abbreviations: DHEA, Dehydroepiandrosterone; DHEAS, dehydroepiandrosterone sulfate; SF-36, Short Form-36.

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