Hormonal Causes of Male Sexual Dysfunctions and Their Management (Hyperprolactinemia, Thyroid Disorders, GH Disorders, and DHEA)

Journal of Sexual Medicine

Volumn 10, Issue 3, 2013, Pages 661-677

  Maggi, Mario ^a   Buvat, Jaques ^b   Corona, Giovanni ^a,c   Guay, André ^d   Torres, Luiz Otavio ^e  

^a UNIVERSITY OF FLORENCE   (Italy)

^b Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique   (France)

^c Azienda USL di Bologna   (Italy)

^d LAHEY HOSPITAL AND MEDICAL CENTER   (United States)

^e Belo Horizonte   (Brazil)

Author keywords

DHEA; GH; Prolactin; Thyroid Hormone

Indexed keywords

ANDROGEN; BROMOCRIPTINE; CABERGOLINE; GROWTH HORMONE; PRASTERONE; PROLACTIN; SOMATOMEDIN C; TESTOSTERONE; THYROID HORMONE;

ACROMEGALY; ARTICLE; EJACULATION DISORDER; ERECTILE DYSFUNCTION; GROWTH HORMONE DEFICIENCY; HUMAN; HYPERPROLACTINEMIA; HYPOACTIVE SEXUAL DESIRE DISORDER; HYPOGONADISM; HYPOPHYSIS TUMOR; HYPOTHYROIDISM; MALE SEXUAL DYSFUNCTION; PENIS ERECTION; PREMATURE EJACULATION; PRIORITY JOURNAL; SEXUAL AROUSAL DISORDER; SEXUAL FUNCTION; THYROID DISEASE;

EID: 84874702156     PISSN: 17436095     EISSN: 17436109     Source Type: Journal    
DOI: 10.1111/j.1743-6109.2012.02735.x     Document Type: Article

References (104)

1. Buvat J, Maggi M, Gooren L, Guay AT, Kaufman J, Morgentaler A, Schulman C, Tan HM, Torres LO, Yassin A, Zitzmann M. Endocrine aspects of male sexual dysfunctions. J Sex Med 2010;7(Pt 2):1627-56.
2. Balercia G, Giovannini L, Paggi F, Spaziani M, Tahani N, Boscaro M, Lenzi A, Radicioni A. GH deficiency in the transition period: Body composition and gonad function. J Endocrinol Invest 2011;34:709-15.
3. Saad F, Hoesl CE, Oettel M, Fauteck JD, Römmler A. Dehydroepiandrosterone treatment in the aging male-What should the urologist know? Eur Urol 2005;48:724-33.
4. Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)-A precursor steroid or an active hormone in human physiology (CME). J Sex Med 2011;8:2960-82.
5. Gibney J, Smith TP, McKenna TJ. Clinical relevance of macroprolactin. Clin Endocrinol (Oxf) 2005;62:633-43.
6. Wallace IR, Satti N, Courtney CH, Leslie H, Bell PM, Hunter SJ, McCance DR, Sheridan B, Atkinson AB. Ten-year clinical follow-up of a cohort of 51 patients with macroprolactinemia establishes it as a benign variant. J Clin Endocrinol Metab 2010;95:3268-71.
7. Bachelot A, Binart N. Reproductive role of prolactin. Reproduction 2007;133:361-9.
8. Bole-Feysot C, Goffin V, Edery M, Binart N, Kelly PA. Prolactin (PRL) and its receptor: Actions, signal transduction pathways and phenotypes observed in PRL receptor knockout mice. Endocr Rev 1998;19:225-68.
9. Sobrinho LG. Prolactin, psychological stress and environment in humans: Adaptation and maladaptation. Pituitary 2003;6:35-9.
10. Bancroft J. The endocrinology of sexual arousal. J Endocrinol 2005;186:411-27.
11. Buvat J. Hyperprolactinemia and sexual function in men: A short review. Int J Impot Res 2003;15:373-7.
12. Corona G, Petrone L, Mannucci E, Ricca V, Balercia G, Giommi R, Forti G, Maggi M. The impotent couple: Low desire. Int J Androl 2005;28:46-52.
13. Lenzi A, Lombardo F, Salacone P, Gandini L, Jannini EA. Stress, sexual dysfunctions, and male infertility. J Endocrinol Invest 2003;26:72-6.
14. Ciccarelli A, Guerra E, De Rosa M, Milone F, Zarrilli S, Lombardi G, Colao A. PRL secreting adenomas in male patients. Pituitary 2005;8:39-42.
15. Corona G, Mannucci E, Petrone L, Giommi R, Mansani R, Fei L, Forti G, Maggi M. Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. Int J Impot Res 2004;16:275-81.
16. Rohn RD. Benign galactorrhea/breast discharge in adolescent males probably due to breast self-manipulation. J Adolesc Health Care 1984;5:210-2.
17. Muldoon MF, Mackey RH, Korytkowski MT, Flory JD, Pollock BG, Manuck SB. The metabolic syndrome is associated with reduced central serotonergic responsivity in healthy community volunteers. J Clin Endocrinol Metab 2006;91:718-21.
18. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, Boddi V, Bandini E, Balercia G, Forti G, Maggi M. Hypoprolactinemia: A new clinical syndrome in patients with sexual dysfunction. J Sex Med 2009;6:1457-66.
19. Corona G, Rastrelli G, Boddi V, Monami M, Melani C, Balzi D, Sforza A, Forti G, Mannucci E, Maggi M. Prolactin levels independently predict major cardiovascular events in patients with erectile dysfunction. Int J Androl 2011;34:217-24.
20. Muldoon MF, Mackey RH, Williams KV, Korytkowski MT, Flory JD, Manuck SB. Low central nervous system serotonergic responsivity is associated with the metabolic syndrome and physical inactivity. J Clin Endocrinol Metab 2004;89:266-71.
21. Muldoon MF, Mackey RH, Sutton-Tyrrell K, Flory JD, Pollock BG, Manuck SB. Lower central serotonergic responsivity is associated with preclinical carotid artery atherosclerosis. Stroke 2007;38:2228-33.
22. Waldinger MD. The neurobiological approach to premature ejaculation. J Urol 2002;168:2359-67.
23. Lucki I. The spectrum of behaviors influenced by serotonin. Biol Psychiatry 1998;44:151-62.
24. Buvat J, Shabsigh R, Guay A, Gooren L, Torres LO, Meuleman E. Hormones, metabolism, aging, and men's health. In: Montorsi F, Basson R, Adaikan G, Becher E, Clayton A, Giuliano F, Khoury S, Sharlip I, eds. Standard practice in Sexual Medicine. Oxford: Blackwell Publishing; 2006:225-86.
25. Miyai K, Ichihara K, Kondo K, Mori S. Asymptomatic hyperprolactinemia and prolactinoma in the general population-Mass screening by paired assays of serum prolactin. Clin Endocrinol (Oxf) 1986;25:549-54.
26. Miyake A, Ikegami M, Chen CF, Arita N, Aono T, Tanizawa O, Yowhikawa T. Mass screening for hyperprolatinemia and hyperprolactinemia and hyperprolactinemia in men. J Endocrinol Invest 1988;11:373-84.
27. El-Sakka AI, Hassoba HM, Sayed HM, Tayeb KA. Pattern of endocrinal changes in patients with sexual dysfunction. J Sex Med 2005;2:551-8.
28. Buvat J, Lemaire A. Endocrine screening in 1, 022 men with erectile dysfunction: Clinical significance and cost-effective strategy. J Urol 1997;158:1764-7.
29. Corona G, Mannucci E, Fisher AD, Lotti F, Ricca V, Balercia G, Petrone L, Forti G, Maggi M. Effect of hyperprolactinemia in male patients consulting for sexual dysfunction. J Sex Med 2007;4:1485-93.
30. Guay AT, Sabharwal P, Varma S, Malarkey WB. Delayed diagnosis of psychological erectile dysfunction because of the presence of macroprolactinemia. J Clin Endocrinol Metab 1996;81:2512-4.
31. Fahie-Wilson MN, John R, Ellis AR. Macroprolactin; high molecular mass forms of circulating prolactin. Ann Clin Biochem 2005;42:175-92.
32. Drago F, Pellegrini-Quarantotti B, Scapagnini U, Gessa GL. Short-term endogenous hyperprolactinaemia and sexual behavior of male rats. Physiol Behav 1981;26:277-9.
33. Carter JN, Tyson JE, Tolis G, Van Vliet S, Faiman C, Friesen HG. Prolactin-screening tumours and hypogonadism in 22 men. N Engl J Med 1978;299:847-52.
34. Prescott RW, Johnston DG, Kendall-Taylor P, Crombie A, Hall K, McGregor A, Hall R. Hyperprolactinemia in men-response to bromocriptine therapy. Lancet 1982;1:245-8.
35. De Rosa M, Zarrilli S, Vitale G, Di Somma C, Orio F, Tauchmanova L, Lombardi G, Colao A. Six months of treatment with Cabergoline restores sexual potency in hyperprolactinemic males: An open longitudinal study monitoring nocturnal penile tumescence. J Clin Endocrinol Metab 2004;89:621-5.
36. Nair S, Milsom S. Anejaculation as the presenting feature of pituitary microadenoma. Fertil Steril 2008;90:2012.e21-3.
37. Corona J, Mannucci E, Petrone L, Fischer AD, Balercia G, de Scisciolo G, Pizzocaro A, Giommi R, Chiarini V, Forti G, Maggi M. Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions. J Androl 2006;27:453-8.
38. Ishikawa H, Kaneko S, Ohashi M, Nakagawa K, Hata M. Retrograde ejaculation accompanying hyperprolactinemia. Arch Androl 1993;30:153-5.
39. Tritos NA, Guay AT, Malarkey WB. Asymptomatic "big" hyperprolactinemia in two men with pituitary adenomas. Eur J Endocrinol 1998;138:82-5.
40. Guay AT, Velasquez E, Perez JB. Characterization of patients in a medical endrocrine-based center for male sexual dysfunction. Endocr Pract 1999;5:314-21.
41. Johri AM, Heaton JPW, Morales A. Severe erectile dysfunction is a marker for hyperprolactinemia. Int J Impot Res 2001;13:176-82.
42. De Rosa M, Zarrilli S, Di Sarno A, Milano N, Gaccione M, Boggia B, Lombardi G, Colao A. Hyperprolactinemia in men. Endocrine 2003;20:75-82.
43. Wolfsberger S, Czech T, Vierhapper H, Benavente R, Knosp E. Microprolactinomas in males treated by transphenoidal surgery. Acta Neurochir (Wien) 2003;145:935-41.
44. Dasgupta S, Savage MW. Evaluation of management of Graves' disease in District General Hospital: Achievement of consensus guidelines. Int J Clin Pract 2005;59:1097-100.
45. Fumarola A, Di Fiore A, Dainelli M, Grani G, Calvanese A. Medical treatment of hyperthyroidism: State of the art. Exp Clin Endocrinol Diabetes 2010;118:678-84.
46. Ross DS. Radioiodine therapy for hyperthyroidism. N Engl J Med 2011;364:542-50.
47. Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyroid disease. Ann Intern Med 1993;119:492-502.
48. Singer PA, Cooper DS, Levy EG, Ladenson PW, Braverman LE, Daniels G, Greenspan FS, McDougall IR, Nikolai TF. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA 1995;273:808-12.
49. Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, Segal RL, American Association of Clinical Endocrinologist. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002;8:457-69.
50. Corona G, Petrone L, Mannucci E, Jannini EA, Mansani R, Magini A, Giommi R, Forti G, Maggi M. Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions. Eur Urol 2004;46:615-22.
51. Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, Jannini EA. Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab 2005;90:6472-9.
52. Cihan A, Demir O, Demir T, Aslan G, Comlekci A, Esen A. The relationship between premature ejaculation and hyperthyroidism. J Urol 2009;181:1273-80.
53. Waldinger DH. Thyroid stimulation hormone assessments in a Dutch cohort of 620 men with premature ejaculation without erectile dysfunction. J Sex Med 2005;2:865-70.
54. Donatucci CF. Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med 2006;(suppl)4:303-8.
55. Meikle AW. The interrelationships between thyroid dysfunction and hypogonadism in men and boys. Thyroid 2004;14(suppl 1):S17-25.
56. Krassas GE, Tziomalos K, Papadopoulou F, Pontikides N, Perros P. Erectile dysfunction in patients with hyper- and hypothyroidism: How common and should we treat? J Clin Endocrinol Metab 2008;93:1815-9.
57. Veronelli A, Masu A, Ranieri R, Rognoni C, Laneri M, Pontiroli AE. Prevalence of erectile dysfunction in thyroid disorders: Comparison with control subjects and with obese and diabetic patients. Int J Impot Res 2006;18:111-4.
58. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010;31:702-55.
59. Krassas GE, Pontikides N. Male reproductive function in thyroid alterations. Best Pract Res Clin Endocrinol Metab 2004;18:183-95.
60. Velázquez EM, Bellabarba Arata G. Effects of thyroid status on pituitary gonadotropin and testicular reserve in men. Arch Androl 1997;38:85-92.
61. Zähringer S, Tomova A, von Werder K, Brabant G, Kumanov P, Schopohl J. The influence of hyperthyroidism on the hypothalamic-pituitary-gonadal axis. Exp Clin Endocrinol Diabetes 2000;108:282-9.
62. Ridgway EC, Maloof F, Longcope C. Androgen and oestrogen dynamics in hyperthyroidism. J Endocrinol 1982;95:105-15.
63. Owen PJ, Sabit R, Lazarus JH. Thyroid disease and vascular function. Thyroid 2007;17:519-24.
64. Carosa E, Di Sante S, Rossi S, Castri A, D'Adamo F, Gravina GL, Ronchi P, Kostrouch Z, Dolci S, Lenzi A, Jannini EA. Ontogenetic profile of the expression of thyroid hormone receptors in rat and human corpora cavernosa of the penis. J Sex Med 2010;7:1381-90.
65. Ozdemirci S, Yildiz F, Utkan T, Ulak G, Cetinaslan B, Erden F, Gacar N. Impaired neurogenic and endothelium-dependent relaxant responses of corpus cavernosum smooth muscle from hyperthyroid rabbits. Eur J Pharmacol 2001;428:105-11.
66. Hu CL, Wu YD, Liu HT, Qin WB, Wang GZ. Effect of thyroid hormone on the contents of NOS and CO in the penile corpus cavernosum of rats. Zhonghua Nan Ke Xue 2009;15:37-40.
67. Cihan A, Murat N, Demir O, Aslan G, Demir T, Gidener S, Esen AA. An experimental approach to the interrelationship between hyperthyroidism and ejaculation latency time in male rats. J Urol 2009;181:907-12.
68. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr, Rellini AH, Segraves T. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010;7:1598-607.
69. Melmed S, Kleinberg D. Anterior pituitary. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams textbook of endocrinology. 11th edition. Philadelphia: Saunders; 2008:155-261.
70. Böger RH. Nitric oxide and the mediation of the hemodynamic effects of growth hormone in humans. J Endocrinol Invest 1999;22(suppl 5):75-81.
71. Elsasser TH, Kahl S, MacLeod C, Nicholson B, Sartin JL, Li C. Mechanisms underlying growth hormone effects in augmenting nitric oxide production and protein tyrosine nitration during endotoxin challenge. Endocrinology 2004;145:3413-23.
72. Jung GW, Spencer EM, Lue TF. Growth hormone enhances regeneration of nitric oxide synthase-containing penile nerves after cavernous nerve neurotomy in rats. J Urol 1998;160:1899-904.
73. Becker AJ, Uckert S, Stief CG, Truss MC, Machtens S, Scheller F, Knapp WH, Hartmann U, Jonas U. Possible role of human growth hormone in penile erection. J Urol 2000;164:2138-42.
74. Becker AJ, Uckert S, Stief CG, Scheller F, Knapp WH, Hartmann U, Brabant G, Jonas U. Serum levels of human growth hormone during different penile conditions in the cavernous and systemic blood of healthy men and patients with erectile dysfunction. Urology 2002;59:609-14.
75. Miwa Y, Kaneda T, Yokoyama O. Correlation between the aging males' symptoms scale and sex steroids, gonadotropins, dehydroepiandrosterone sulfate, and growth hormone levels in ambulatory men. J Sex Med 2006;3:723-6.
76. Hamed EA, Meki MA, Gaafar AAA, Hamed SA. Role of some vasoactive mediators in patients with erectile dysfunction: Their relationship with angiotensin-converting enzyme and growth hormone. Int J Impot Res 2003;15:418-25.
77. Pastuszak AW, Liu JS, Vij A, Mohamed O, Sathyamoorthy K, Lipshultz LI, Khera M. IGF-1 levels are significantly correlated with patient-reported measures of sexual function. Int J Impot Res 2011;23:220-6.
78. Colao A, Marzullo P, Spiezia S, Ferone D, Giaccio A, Cerbone G, Pivonello R, Di Somma C, Lombardi G. Effect of growth hormone (GH) and insulin-like growth factor I on prostate diseases: An ultrasonographic and endocrine study in acromegaly, GH deficiency, and healthy subjects. J Clin Endocrinol Metab 1999;84:1986-91.
79. Colao A, Marzullo P, Spiezia S, Giaccio A, Ferone D, Cerbone G, Di Sarno A, Lombardi G. Effect of two years of growth hormone and insulin-like growth factor-I suppression on prostate diseases in acromegalic patients. J Clin Endocrinol Metab 2000;85:3754-61.
80. Colao A, De Rosa M, Pivonello R, Balestrieri A, Cappabianca P, Di Sarno A, Rochira V, Carani C, Lombardi G. Short-term suppression of GH and IGF-I levels improves gonadal function and sperm parameters in men with acromegaly. J Clin Endocrinol Metab 2002;87:4193-7.
81. Sherlock M, Toogood AA. Aging and the growth hormone/insulin like growth factor-I axis. Pituitary 2007;10:189-203.
82. Brill KT, Weltman AL, Gentili A, Patrie JT, Fryburg DA, Hanks JB, Urban RJ, Veldhuis JD. Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. J Clin Endocrinol Metab 2002;87:5649-57.
83. Colao A, Di Somma C, Spiezia S, Filippella M, Pivonello R, Lombardi G. Effect of growth hormone (GH) and/or testosterone replacement on the prostate in GH-deficient adult patients. J Clin Endocrinol Metab 2003;88:88-94.
84. Sattler FR, Bhasin S, He J, Yarasheski K, Binder E, Todd Schroeder E, Castaneda-Sceppa C, Kawakubo M, Roubenoff R, Dunn M, Hahn C, Stewart Y, Martinez C, Azen SP. Durability of the effects of testosterone and growth hormone supplementation in older community dwelling men: The HORMA trial. Clin Endocrinol (Oxf) 2011 Mar 4 [Epub ahead of print] doi: 10.1111/j.1365-2265.2011.04014.x.
85. Sattler FR, Castaneda-Sceppa C, Binder EF, Schroeder ET, Wang Y, Bhasin S, Kawakubo M, Stewart Y, Yarasheski KE, Ulloor J, Colletti P, Roubenoff R, Azen SP. Testosterone and growth hormone improve body composition and muscle performance in older men. J Clin Endocrinol Metab 2009;94:1991-2001.
86. Nippoldt TB, Nair KS. Is there a case for DHEA replacement? Baillieres Clin Endocrinol Metab 1998;12:507-20.
87. Oelkers W. Dehydroepiandrosterone for adrenal insufficiency. N Engl J Med 1999;341:1073-4.
88. Kroboth PD, Salek FS, Pittenger AL, Fabian TJ, Frye RF. DHEA and DHEA-S: A review. J Clin Pharmacol 1999;39:327-48.
89. Parasrampuria J, Schwartz K, Petesch R. Quality control of dehydroepiandrosterone dietary supplement products. JAMA 1998;280:1565.
90. Thompson RD, Carlson M, Thompson RD, Carlson M. Liquid chromatographic determination of dehydroepiandrosterone (DHEA) in dietary supplement products. J AOAC Int 2000;83:847-57.
91. Alkatib AA, Cosma M, Elamin MB, Erickson D, Swiglo BA, Erwin PJ, Montori VM. A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA treatment effects on quality of life in women with adrenal insufficiency. J Clin Endocrinol Metab 2009;94:3676-81.
92. Hunt PJ, Gurnell EM, Huppert FA, Richards C, Prevost AT, Wass JA, Herbert J, Chatterjee VK. Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double blind trial. J Clin Endocrinol Metab 2000;85:4650-6.
93. Gurnell EM, Hunt PJ, Curran SE, Conway CL, Pullenayegum EM, Huppert FA, Compston JE, Herbert J, Chatterjee VK. Long-term DHEA replacement in primary adrenal insufficiency: A randomized, controlled trial. J Clin Endocrinol Metab 2008;93:400-9.
94. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. J Urol 1994;151:54-61.
95. Baulieu E, Thomas G, Legrain S, Lahou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy M, Latour F, Leaud M, Mokrane A, Pitti-Ferrandi H, Trivalle C, deLacharriere O, Nouveau S, Rakoto-Arison B, Souberbielle J, Raison J, LeBouc Y, Raynaud A, Girerd X, Forette F. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge study to a sociobiomedical issue. Proc Natl Acad Sci U S A 2000;97:4279-84.
96. Reiter WJ, Pycha A, Schatzl G, Pokorny A, Gruber DM, Huber JC, Marberger M. Dehydroepiandrosterone in the treatment of erectile dysfunction: A prospective, double-blind, randomized, placebo-controlled study. Urology 1999;53:590-4.
97. Reiter WJ, Schatzl G, Märk I, Zeiner A, Pycha A, Marberger M. Dehydroepiandrosterone in the treatment of erectile dysfunction in patients with different organic etiologies. Urol Res 2001;29:278-81.
98. Schmidt PJ, Daly RC, Bloch M, Smith MJ, Danaceau MA, St Clair LS, Murphy JH, Haq N, Rubinow DR. Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression. Arch Gen Psychiatry 2005;62:154-62.
99. Morales A, Black A, Emerson L, Barkin J, Kuzmarov I, Day A. Androgens and sexual function: A placebo-controlled, randomized, double-blind study of testosterone vs. dehydroepiandrosterone in men with sexual dysfunction and androgen deficiency. Aging Male 2009;12:104-12.
100. Corona G, Rastrelli G, Monami M, Guay A, Buvat J, Sforza A, Forti G, Mannucci E, Maggi M. Hypogonadism as a risk factor for cardiovascular mortality in men: A meta-analytic study. Eur J Endocrinol 2011;165:687-701.
101. Maninger N, Wolkowitz OM, Reus VI, Epel ES, Mellon SH. Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS). Front Neuroendocrinol 2009;30:65-91.
102. Grimley Evans J, Malouf R, Huppert F, van Niekerk JK. Dehydroepiandrosterone (DHEA) supplementation for cognitive function in healthy elderly people. Cochrane Database Syst Rev 2006;(4):CD006221.
103. Nissen SL, Sharp RL. Effect of dietary supplements on lean mass and strength gains with resistance exercise: A meta-analysis. J Appl Physiol 2003;94:651-9.
104. Komesaroff PA. Unraveling the enigma of dehydroepiandrosterone: Moving forward step by step. Endocrinology 2008;149:886-8.