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Letters to the Editor |
Department of Family Medicine University of Missouri-Columbia School of Medicine Columbia, Missouri 65212
The excellent research of Araghi-Niknam and Watson (1 ) has described a multitude of biological changes in mice that were given DHEA. We agree that animal models provide important information and motivation for further DHEA research in human health. Some caution, however, must be exercised when extrapolating data across species, especially in light of the fact that only the species that undergo adrenarche are humans and some primates.
As our study design was a randomized, double-blind, placebo-controlled, cross-over design and, as such, our subjects did not know when they were receiving the DHEA or placebo treatment, we, therefore, do not agree with Dr. Watson’s comment that our study design included the chance of bias from subject knowing which treatment they received. We consider our study population a strength of our research. This well-studied cohort of men has participated in the University of Missouri Longitudinal Aging Study for over 29 years (2 3 ). Subtle clinical changes that might be missed in other less-studied populations are more evident in this group. It should also be emphasized that the DHEA used in our study was in a micronized form that reduces first-pass conversion by the liver. This reduces bioconversion to testosterone, which may account for some differences observed between studies.
Dr. Watson also wrote that our conclusions were not justified after measuring only a small number of serum constituents that were changed by DHEA replacement. Table 1 (4 ) describes extensive endocrine, hematological, and metabolic factors that were evaluated in our population. Our study of DHEA administration in humans (4 ) cited statistical changes within certain blood values. Yet, although statistical changes were observed, none of these blood values were outside normal clinically-accepted ranges in human medical or health care.
At the present time there seems to be mounting conflict in opinion and results about DHEA as a supplement. Other studies, often using supraphysiological doses of DHEA (for review see Ref. 5 ), have described clinical changes in association with DHEA supplementation. Such studies have lead to widespread use of DHEA in the United States and increasing, and perhaps inappropriate, use of this hormone before true scientific validation. While we agree that further in-depth studies in the interesting and perhaps controversial arena of DHEA supplementation research are warranted, we maintain that our data and statistical analyses support the absence of clinically significant changes in our study population.
A very recent article concerning DHEA replacement in 24 women with adrenal insufficiency reported improvement in well-being and sexuality (6 ). An accompanying editorial that reviewed this article stated "Thus, at present, there is a justification for administering DHEA to patients with adrenal insufficiency, but there is no justification for its administration to healthy elderly people"(7 ).
Footnotes
Received July 26, 1999. Accepted September 28, 1999. Address correspondence and requests for reprints to: Ronald Ross Watson, Arizona Prevention Center, The University of Arizona Health Sciences Center, 1501 North Campbell Avenue, P.O. Box 245155, Tucson, Arizona 85724-5155.
Received September 13, 1999. Accepted September 28, 1999. Address correspondence to: Margaret A. Flynn, Ph.D., Department of Family Medicine, University of Missouri-Columbia, M221 School of Medicine, Columbia, Missouri 65212.
References
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