DHEA and testosterone in the elderly.

To the Editor: In their report on the effects of dehydroepiandrosterone (DHEA) and testosterone when used as antiaging supplements, Nair et al. (Oct. 19 issue)1 conclude that low-dose testosterone replacement in elderly men has no “physiologically relevant beneficial effects on body composition, physical performance, [or] insulin sensitivity.” However, this conclusion is premature, since the testosterone replacement administered failed to achieve physiologic testosterone levels throughout the study period (Fig. 2 of the article). Moreover, despite the marginal increase in testosterone levels achieved, improvements in fat-free mass, fasting insulin levels, and bone mineral density were observed. Other studies of testosterone replacement, including those cited to support the authors’ conclusions,2 have shown a decrease in fat mass (12.5%) and an increase in lean mass (4%) when physiologic testosterone levels are achieved in elderly men. Studies of standard doses of testosterone in the treatment of testicular failure3 have shown additional positive effects on muscle strength, physical performance,4 and bone mineral density.5 Large, long-term trials are clearly needed to assess the risks and benefits of testosterone replacement in elderly men, and caution should be exercised regarding the treatment of andropause in men. However, the serum testosterone level achieved should be within the normal range to assess the effect on outcome measures adequately.