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DHEA

DHEA is the abbreviation for a hormone named DeHydroEpiAndrosterone. DHEA is the most abundant hormone in the blood. It is the hormone produced in the greatest quantity throughout adult life.

The primary source for DHEA is the adrenal glands and the ovaries or testes. Prior to the beginning of adolescence, the primary source for DHEA production is the adrenal glands. Once adolescence occurs the ovaries and testes make a good deal of DHEA. Other tissues of the body, including the brain, make DHEA. DHEA is neuroprotective throughout life.

DHEA is an anabolic hormone. It supports healthy growth and repair of tissues. It balances the effect of catabolic hormones such as cortisol.  When DHEA is low relative to cortisol it suggests imbalance between anabolic and catabolic forces and it is associated with conditions that are permissive to aging and chronic illness.

DHEA levels decline with aging and stress of all types (trauma, infection, toxicity).

Many students of the aging process perceive DHEA as an important BIOMARKER of aging. DHEA has effects on all the organ systems of the body. In appropriate concentration these effects are all beneficial; supporting optimal organ function or effect. DHEA is also a pre-hormone. It is transformed into other hormones in different parts of the body.

DHEA supplementation has been used in adults. Generally, the results have been beneficial. As with many supplements there has been a great deal of hyperbole about its benefits. I see DHEA as modulating hormone. An adequate amount will help optimize health and increase resistance to disease processes. A deficiency will not be noticed as a discrete clinical syndrome or disease entity; as in hypothyroidism.

Benefits of DHEA

Studies in humans have looked at general outcomes and not specific disease processes.  These studies report a favorable effect on general processes such as well-being, energy level and libido. Animal studies have looked at benefits of DHEA supplementation on a variety of disease processes.

• Arteriosclerosis: There was an inverse relationship between 12-year cardiovascular mortality and DHEA levels in men between 50-79 years of age. That is to say that higher serum DHEA levels were associated with a lower mortality (incidence of death from cardiovascular disease). DHEA supplementation results in improvement in endothelial function (the health of the lining of our arteries). DHEA supplementation improves the fluidity of the blood. This is an important factor in reducing the progression of arteriosclerosis, heart disease and stroke. There is an inverse relationship between DHEA levels and hypertension.  There is an inverse relationship in animals fed a high fat diet between the development of arteriosclerosis and DHEA levels; DHEA provided protection. DHEA improves cardiac function in animal models.
• Cancer: In animal models, supplementation with DHEA at time of tumor induction resulted in a reduction of cancer size and a decrease in the rate of cancer formation. In human studies, patients with newly diagnosed breast cancer had lower DHEA levels than age matched controls. It is believed that DHEA provides protection from the development of breast cancer.
• Diabetes: DHEA supplementation improves blood sugar control in diabetic patients. The severity of diabetes in diabetic mice decreased with DHEA treatment. In my own experience, DHEA supplementation, when appropriate, helps diabetic patients control their diabetes more effectively.
• Immune Function: DHEA protects the thymus gland (an important immunity-mediating gland) from prolonged stress in animal models. Animals infected with deadly bacteria were able to survive in greater number when supplemented with DHEA. Certain viral infections can depress immune function. In one study, mice infected with a virus that depresses immune function had significantly less immune suppression when supplemented with DHEA.
• Neurological Disease: In animal models, DHEA supplementation has been shown to decrease inflammatory processes in the brain. This is interesting since it implies a possible protective effect from chronic inflammatory conditions such as Alzheimer’s Disease and Parkinson Disease.
• Obesity: In animal studies, DHEA supplementation has a modest benefit on the age related weight increase. DHEA supplementation had a beneficial effect on fat accumulation in animals fed a high fat diet. There is an inverse relationship between obesity and DHEA levels in premenopausal women.
• Psychological Problems: DHEA attenuates the intensity of the stress response in animal models. DHEA has been shown to make health people more relaxed and resistant to stress. DHEA supplementation has been shown to be an effective adjunctive therapy in depressed patients with low DHEA levels who were receiving medication. A DHEA derivative (7 Keto DHEA) has been shown to be helpful in treating people with Post Traumatic Stress Disorder (PTSD).

A recent review article in Endocrine Reviews (Vol 24, Issue 2) notes that DHEA has both androgenic (male hormone) and estrogenic (female hormone) like effects that are beneficial.

Beneficial Androgenic effects:

1. Maintaining and increasing bone density
2. Increasing muscle mass
3. Inhibition of mammary gland (breast) activity/growth and by inference having a preventive effect for breast cancer
4. Improving sebaceous gland functioning, thereby improving the skin dryness that accompanies aging skin
5. Improving libido

Beneficial Estrogenic effects:

1. Improvement in vaginal dryness
2. No stimulatory effect on the endometrium

General Metabolic effect:

1. Improvement in Insulin Resistance (pre diabetes)

Factors that may help normalize DHEA levels:
Reducing body weight has been shown to increase DHEA levels in men. It has not been as effective in women. Adequate amounts of animal protein, dietary fats, and Vitamin E have been shown to improve DHEA levels in men and women. Certain medications may lower DHEA levels; birth control pills, anti-fungal antibiotics.
Clinical Signs that may indicate DHEA Deficiency:
As usual, these signs may apply to many different deficiency states or disease processes.

• General Signs: fatigue that persists, depression, anxiety, hypersensitivity to noise, poor libido.
• Physical Signs: dry eyes, dry skin, dry hair, loss of body of hair, a loss of axillary (armpit), hair, a loss of pubic hair, a loss of the pubic fat, skin which inflames easily.

Clinical Signs that may indicate DHEA Excess:

These are signs and symptoms that I look for to suggest that given dose of DHEA is excessive: greasy hair, greasy skin, acne, new facial and body hair growth in women, excess body odor.

Testing for DHEA:
DHEA levels in the blood will vary with time of day, season, underlying illness and stress. Nevertheless, a spot DHEA-S level is an effective screening tool for adequacy of DHEA levels. Some clinicians use salivary DHEA levels and tests are sold directly to the public. I find salivary hormone analysis to be confusing when trying to follow the effect of therapy and do not use it.

Hormonal Interactions that may be important:
Thyroid hormone deficiency may lower DHEA levels. Low levels of DHEA may result in lowered levels of IGF-1 (a proxy for Growth Hormone).

DHEA Dosing:
Doses vary from 10 to 50 mgs per day. Factors that effect dose include age, sex and underlying health problems. I typically will follow the patient with blood levels in six to eight weeks and make subsequent dose adjustments.

Adaptogenic Herbal Formulas:
Adaptogenic Herbs support Hypothalamic-Pituitary-Adrenal Function and reduce the adverse impact of stress. Vital Adapt, Power Adapt and Botanabol (Natura) are three formulas that I have found very helpful.

It is important to avoid drawing the conclusion that DHEA is a wonder hormone that will prevent all diseases and cure all ills. In selected patients, with documented deficiency, appropriate supplementation may be useful as part of a comprehensive management program. In patients with sex hormone cancers (breast, uterine, ovary and prostate) DHEA supplementation may be harmful.

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