Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue Etienne-Emile Baulieua,b, Guy Thomasc, Sylvie Legraind, Najiba Lahloue, Marc Rogere, Brigitte Debuiref, Veronique Faucounaug, Laurence Girardh, Marie-Pierre Hervyi, Florence Latourj, Marie-Ce´ line Leaudk, Amina Mokranel, He´ le` ne Pitti-Ferrandim, Christophe Trivallef, Olivier de Lacharrie` ren, Stephanie Nouveaun, Brigitte Rakoto-Arisono, Jean-Claude Souberbiellep, Jocelyne Raisonq, Yves Le Boucr, Agathe Raynaudr, Xavier Girerdq, and Franc¸oise Foretteg,j aInstitut National de la Sante´et de la Recherche Me´dicale Unit 488 and Colle`ge de France, 94276 Le Kremlin-Biceˆtre, France; cInstitut National de la Sante´et de la Recherche Me´dicale Unit 444, Hoˆpital Saint-Antoine, 75012 Paris, France; dHoˆpital Bichat, 75877 Paris, France; eHoˆpital Saint-Vincent de Paul, 75014 Paris, France; fHoˆpital Paul Brousse, 94804 Villejuif, France; gFondation Nationale de Ge´rontologie, 75016 Paris, France; hHoˆpital Charles Foix, 94205 Ivry, France; iHoˆpital de Biceˆtre, 94275 Biceˆtre, France; jHoˆpital Broca, 75013 Paris, France; kCentre Jack-Senet, 75015 Paris, France; lHoˆpital Sainte-Perine, 75016 Paris, France; mObservatoire de l’Age, 75017 Paris, France; nL’Ore´al, 92583 Clichy, France; oInstitut de Sexologie, 75116 Paris, France; pHoˆpital Necker, 75015 Paris, France; qHoˆpital Broussais, 75014 Paris, France; and rHoˆpital Trousseau, 75012 Paris, France Contributed by Etienne-Emile Baulieu, December 23, 1999 The secretion and the blood levels of the adrenal steroid dehydro- number of consumers. Extravagant publicity based on fantasy epiandrosterone (DHEA) and its sulfate ester (DHEAS) decrease pro- (‘‘fountain of youth,’’ ‘‘miracle pill’’) or pseudoscientific asser- foundly with age, and the question is posed whether administration tion (‘‘mother hormone,’’ ‘‘antidote for aging’’) has led to of the steroid to compensate for the decline counteracts defects unfounded radical assertions, from superactivity (‘‘keep young,’’ associated with aging. The commercial availability of DHEA outside ‘‘life extension’’) to insignificant activity or even deleterious the regular pharmaceutical–medical network in the United States effects. These controversies are particularly irrelevant because creates a real public health problem that may be resolved only by most are not based on controlled trials in humans or relevant appropriate long-term clinical trials in elderly men and women. Two animal data. The latter, in fact, will never be obtained because hundred and eighty healthy individuals (women and men 60–79 no endogenous circulating DHEA(S) in laboratory animals, years old) were given DHEA, 50 mg, or placebo, orally, daily for a year allowing its role in aging to be examined, has been described (6). in a double-blind, placebo-controlled study. No potentially harmful The biomedical community is currently under the pressure of accumulation of DHEAS and active steroids was recorded. Besides the a growing number of requests from elderly individuals, and in the reestablishment of a ‘‘young’’ concentration of DHEAS, a small in- absence of scientifically and ethically conducted studies, a num- crease of testosterone and estradiol was noted, particularly in ber of physiological and possibly medical points are unanswered. women, and may be involved in the significantly demonstrated Uncertainties on the effects of DHEA administration, preven- physiological–clinical manifestations here reported. Bone turnover tive as well as therapeutic for age-associated diseases, and the improved selectively in women >70 years old, as assessed by the difficult patent position for protecting the use of the molecule, dual-energy x-ray absorptiometry (DEXA) technique and the decrease have precluded most drug companies from envisaging appro- of osteoclastic activity. A significant increase in most libido parame- priate investments in effort and money to attempt to solve the ters was also found in these older women. Improvement of the skin basic problem: Does the deficit of this natural compound during status was observed, particularly in women, in terms of hydration, aging merit being compensated, and under what conditions? The epidermal thickness, sebum production, and pigmentation. A number sociobiomedical complexity of the prerequisite for designing and of biological indices confirmed the lack of harmful consequences of undertaking meaningful trials and getting results accepted by this 50 mg͞day DHEA administration over one year, also indicating commercial interests deserves a study in itself. Here we present that this kind of replacement therapy normalized some effects of some results obtained in this perspective. aging, but does not create ‘‘supermen͞women’’ (doping). We have recently performed preliminary studies in healthy elderly men and women, orally administering DHEA daily for a ͞ week, and measured the blood levels and turnover of DHEA(S) and urrently, many strategies for delaying diminishing physio- ␣ logical deficits associated with aging are offered to a public, metabolites, in particular testosterone (Testo), 5 -androstan- C 3␣,17␤-diol glucuronide (ADG), and estradiol (E ): 25- and 50-mg whose mean life expectancy is increasing, without appropriate 2 ͞ doses were chosen on the basis of previous work estimating the scientific justifications and or medical precautions. Because of MEDICAL SCIENCES secretory levels of DHEA(S) in young adults of both sexes.s The the profound age-related decrease of blood levels of the steroid absence of accumulation in the body of steroids under these dehydroepiandrosterone (DHEA; prasterone) and its sulfate conditions has permitted a double-blind, placebo-controlled, one- ester (DHEAS), both essentially secreted by adrenals in human year trial of oral DHEA 50 mg͞day with 280 men and women, beings (1–5), it has been suggested that there is an ‘‘adreno- 60–79 y old, to be set up safely: the so-called ‘‘DHEAge Study.’’ We pause’’ characterized by low value of blood DHEA(S) with maintenance of cortisol level. If this condition is involved in some impairment of health, the compensatory administration of Abbreviations: DHEA, dehydroepiandrosterone; DHEAS, DHEA sulfate; Testo, testoster- DHEA may be of benefit, as is estrogen in women after one; ADG, 5␣-androstan-3␣,17␤-diol glucuronide; E2, estradiol; PSA, prostate-specific an- menopause. The commercial availability of DHEA outside the tigen; M0, M6, and M12, months 0, 6, and 12; IGF-1, insulin-like growth factor 1; HDL, high density lipoprotein; BMD, bone mineral density; Oc, osteocalcin; baP, bone alkaline phos- regular pharmaceutical–medical network in the United States phatase; CTx, C-terminal telopeptide of type I collagen. (because of passage of the Dietary Supplement Health and bTo whom reprint requests should be addressed. E-mail: [email protected]. Education Act of 1994) creates a real public health problem. Not sS.L., Christine Massien, N.L., M.R., B.D., Bertrand Diquet, Gilles Chatellier, Michel Azizi, V.F., only may the quality of, and sometimes the very presence of, Herve´Porchet, F.F., and E.-E.B., unpublished work. DHEA in some samples on sale in supplement stores or super- The publication costs of this article were defrayed in part by page charge payment. This markets be questioned, but the usage of a product in the absence article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. of medical indication and supervision could be improper for a §1734 solely to indicate this fact. PNAS ͉ April 11, 2000 ͉ vol. 97 ͉ no. 8 ͉ 4279–4284 Downloaded by guest on September 26, 2021 Downloaded by guest on September 26, 2021 carried out by usingϾ the Wilcoxon rank sum or assay (4.5%) and of estrone and estrone sulfate in the E (0.6%). Results are given, unless otherwise stated, as mean Results DHEAS distribution in thewhose corresponding baseline age–sex group. DHEASary were analyses below were0.05 the level. performed To lowest further on investigate quartile DHEA the supplementation, of second- subpopulation the of subjects old (W groups of subjects: womenmonths 60–69 were y old assessedof (W age class, separately sex, and within geriatric center. each The effects of of treatment at the 12 following 4280 Steroid Metabolism. Statistical Analysis. Subjects. Methods domains studied. We shallreport soon publish a other summaryfirst data. describe of the method results of the obtained trial as in it was some conducted, and of then the specific other steroids, except thatIn of a 5 given steroid assay, there was no significant crossreactivity of men over 70) werecular carried exploration out by at(BMD) M0 noninvasive by and ultrasound dual-energy M12. x-ray methods absorptiometry (only (DEXA) in and vas- patic function, DHEAS, and(HDL) other cholesterol, hormones triglycerides, were(IGF-1), measured. glycemia, homocysteine, creatininemia,biomarkers cholesterol, he- for high boneimmunological density metabolism, parameters insulin-like lipoprotein (only growth in men factor and 1 sured women by over hand 70), grip,psycho-affective and state, skin and exploration(GWB) libido. was Muscular scale performed. strength ofSeveral was mea- autoquestionnaires, Dupuy, including wereformed. the used General Cognitive to Well functionmonths Being assess of was quality treatment evaluated a of thorough by life, clinical aand examination psychologist. a was blood per- sampleof for DHEA determination administration. of Complianceby DHEAS was the levels. checked