Dehydroepiandrosterone Supplementation in Elderly Men: A Meta-Analysis Study of Placebo-Controlled Trials

Context: Age-related dehydroepiandrosterone (DHEA) deficiency has been associated with a broad range of biological abnormalities in males. Object: Our objective was to meta-analyze all double-blind, placebo-controlled randomized trials (RCTs) investigating the effect of oral DHEA (DHEA supplementation) in comparison with placebo on sexual and metabolic outcomes in elderly men. Data Source: An extensive Medline Embase and Cochrane search was performed including the following words: DHEA, RCTs, and males. Study Selection: Only double-blind placebo-controlled trials performed in elderly men were included. Data Extraction: Data extraction was performed independently by 2 of the authors (A. S. and V. G.), and conflicts were resolved by the third investigator (G. C.). The quality of RCTs was assessed using the Cochrane criteria. Results: Of 220 retrieved articles, 25 were included in the study. The available RCTs enrolled 1353 elderly men, with a mean follow-up of 36 weeks. DHEA supplementation was associated with a reduction of fat mass (standardized mean difference of -0.35 [-0.65 to -0.05]; P = .02). However, the association with fat mass disappeared in a multivariate regression model after adjusting for DHEA-related metabolite increases such as total testosterone and estradiol. In contrast to what was observed for fat mass, no effect of DHEA supplementation in comparison with placebo was observed for various clinical parameters including lipid and glycemic metabolism, bone health, sexual function, and quality of life. Conclusions: The present meta-analysis of intervention studies shows that DHEA supplementation in elderly men can induce a small but significant positive effect on body composition that is strictly dependent on DHEA conversion into its bioactive metabolites such as androgens or estrogens. (J Clin Endocrinol Metab 98: 3615-3626, 2013)