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In Reply: Dr Dhatariya has pointed out that there is evidence for de novo biosynthesis of DHEA within the brain¹ and that peripheral levels of DHEAS may not reflect brain tissue concentrations. The intention of our study was to highlight that the biosynthesis and metabolism of C19 steroids is complex and that measurement of circulating androgens and pre-androgens does not necessarily provide an accurate guide to the hormonal milieu in different target tissues.

With respect to referring to DHEA and DHEAS as androgens, we acknowledge that there is still considerable uncertainty as to whether DHEA has any significant physiological androgenic actions independent of its conversion to other androgenic steroids. Dehydroepiandrosterone is a C19 steroid, as is testosterone, and in recent competition binding studies, Chen et al² demonstrated that DHEA exhibits affinity to the androgen receptor. Although we have included DHEA and DHEAS in the term androgen in our article, as . . . [Full Text of this Article]

Susan R. Davis, MD, PhD
susan.davis@med.monash.edu.au

Sonia L. Davison, MD; Susan Donath, MA; Robin J. Bell, MD, PhD
Women’s Health Program
Department of Medicine
Monash Medical School
Alfred Hospital
Prahran, Victoria, Australia

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