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The body makes its own dihydroepiandosterone (DHEA) in the adrenal glands; we get very little in our diets. DHEA production peaks from the age of puberty to young adulthood and then begins to decline after age 30. By age 60, our bodies produce just 5 to 15% as much as when we were 20. DHEA is the primary androgen for post-menopausal women. Exercise in the elderly women tends to increase DHEA. DHEA for sale in stores is made from soybeans. DHEA is helpful for the autoimmune disease lupus, at least in women. DHEA might also help prevent osteoporosis, although many other interventions are better proven to help. A typical therapeutic dosage of DHEA is 50 mg per day in mood studies and 200 mg daily in lupus studies. A cream containing 10% DHEA may also be used; it is typically applied to the skin at a dosage of 3 to 5 g daily. Physicians sometimes check DHEA levels and adjust the daily dose to achieve blood levels of 20 to 30 nmol/L. DHEA is available over-the-counter. It has been found to be of some help for depression although the research is still limited. DHEA looks beneficial primarily in women, especially older women. DHEA was found to have beneficial mood, skin, sexual, and bone mineralization effects found in one large study of women over 60 years of age. While some reports of benefit in men exist, most studies in men finding no benefits at all. Normal testosterone in men appears to already be supplying the benefits that women receive from DHEA. The lowest price I found for DHEA was from Vitanet (800-807-8080) at $21.95 for 360 25mg tablets to be taken two a day or $3.50 per month. I would consider a cautious trial in depressed women over the age of 45, women with premature ovarian failure, women who might benefit from replacement therapy, and women with lack of sexual arousal. It may even be of value, at least theoretically, in women becoming depressed on birth control pills, although there is no research on this issue. Androgenic side effects (greasy skin, acne, increased growth of body, but not facial, hair) occur in over 10% but are mild and reversible by decreasing the dosage. Unfortunately, for both DHEA and estradiol, there is a real concern that these supplements could increase breast cancer in women, especially obese post-menopausal women. Women who naturally have higher levels of both of these hormones have higher rates of breast cancer. One treatment for advanced breast cancer tries to block the effects of naturally occurring DHEA. While there is some evidence of DHEA decreasing breast cancer, the clear majority of the evidence is in the other direction. For men, the concern is on prostate cancer. Helps Erections in Deficient Men: Reiter WJ, Pycha A, Schatzl G, et al. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective double-blind, randomized, placebo-controlled study. Urology. 1999;53:590–595. DHEA is very low in children and increases markedly at puberty. Hypoadrenal Women Helped: DHEA prevents diabetes in animals. In a DB PC study of 28 hypoadrenal women, those who took 50-mg dose of DHEA daily for 12 weeks had increased DHEA-S (sulfated ester of DHEA), bioavailable testosterone, and androstenedione and reduced sex hormone-binding globulin levels. Fasting plasma insulin and glucagon were lower with DHEA (42 vs. 53 pmol/l [P = 0.005] and 178 vs. 195.04 pmol/l [P = 0.02], respectively). DHEA also reduced total cholesterol (P < 0.005), triglycerides (P < 0.011), LDL cholesterol (P < 0.05), and HDL cholesterol (P < 0.005). It increased insulin sensitivity in hypoadrenal women. Effect of dehydroepiandrosterone replacement on insulin sensitivity and lipids in hypoadrenal women. Dhatariya K, Bigelow ML, Nair KS. Mayo Clinic. Diabetes. 2005 Mar;54(3):765-9. Lupus: DHEA Helps Lupus: van Vollenhoven RF, Morabito LM, Engleman EG, et al. Treatment of systemic lupus erythematosus with dehydroepiandrosterone: 50 patients treated up to 12 months. J Rheumatol. 1998;25:285–289. van Vollenhoven RF, Park JL, Genovese MC, et al. A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus. Lupus. 1999;8:181–187. Mease PJ, Merrill JT, Lahita R, et al. GL701 (prasterone, dehydroepiandrosterone) improves or stabilizes disease activity in systemic lupus erythematosus. Presented at: The Endocrine Society's 82nd Annual Meeting; June 21–24, 2000; Toronto, Canada. Lupus: DHEA DB Helps Lupus:DB PC 120 women 24 weeks 200mg/d. Improved CGI and reduced number of flares (18% of patients vs 34% with placebo). Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Chang DM, Lan JL, Lin HY, Luo SF. Arthritis Rheum 2002 Nov;46(11):2924-7 DHEA DB Single Dose Increase Sex Arousal: 16 normal post-menopausal women given 300mg and watched erotic video. DHEAS increased 2-5-fold following DHEA administration in all 16 women. Subjective ratings across DHEA and placebo conditions showed significantly greater mental (p < 0.016) and physical (p < 0.036) sexual arousal to the erotic video with DHEA vs. placebo. Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. Hackbert L, Heiman JR. J Womens Health Gend Based Med 2002 Mar;11(2):155-62 DHEA No Effect on Male Bone Turnover: DHEA does not affect bone turnover in middle-aged to elderly men when used for a 6-month period at doses (909mg/d) targeted to restore circulating levels of the steroid to that seen in young adults. UCSF, Dehydroepiandrosterone supplementation and bone turnover in middle-aged to elderly men. Kahn AJ, Halloran B. J Clin Endocrinol Metab 2002 Apr;87(4):1544-9 DHEA Helps Sex Dysfunction in Women: series of patients who underwent androgen replacement therapy with dehydroepiandrosterone for treatment of androgen insufficiency and sexual dysfunction. This study revealed that there was a significant decrease in sexual distress, a significant increase in sexual function in the domains of desire, arousal, lubrication, satisfaction, and orgasm, and a normalization to values within the physiologic range in the following androgens measured: total testosterone, free or bioavAilable testosterone, DHEA, DHEA-S, and androstenedione. Side effects included increased facial hair (11%), weight gain (7%), acne (5%), temporary breast tenderness (1%), loss of head hair (1%) and skin rash (1%). Preliminary results suggest that androgen replacement therapy with dehydroepiandrosterone is a safe and effective treatment for androgen insufficiency and female sexual dysfunction. Boston U, Androgen replacement therapy with dehydroepiandrosterone for androgen insufficiency and female sexual dysfunction: androgen and questionnaire results. Munarriz R, Talakoub L, Flaherty E, Gioia M, Hoag L, Kim NN, Traish A, Goldstein I, Guay A, Spark R. J Sex Marital Ther 2002;28 Suppl 1:165-73 No Clear Benefit in Older Men in DB: 22 50-69yo men given 50mg/d x 4 months which increased blood levels to youthful range. no obvious benefit of 4 months of dehydroepiandrosterone supplementation in healthy men with a physiological decline of dehydroepiandrosterone production. Circulating androgen levels did not change; however, androgen metabolites increased, indicating enhanced peripheral androgen synthesis. At baseline, psychometric assessment revealed normal well-being and sexuality scores. After 4 months of dehydroepiandrosterone, no effect on sexuality was observed, whereas some mood scores improved slightly, but were not significantly different from scores after placebo. Compared with placebo, dehydroepiandrosterone had no effect on serum lipids, bone markers, body composition, or exercise capacity. Germany, Dehydroepiandrosterone supplementation in healthy men with an age-related decline of dehydroepiandrosterone secretion. Arlt W, Callies F, Koehler I, van Vlijmen JC, Fassnacht M, Strasburger CJ, Seibel MJ, Huebler D, Ernst M, Oettel M, Reincke M, Schulte HM, Allolio B. J Clin Endocrinol Metab 2001 Oct;86(10):4686-92; No Benefit Normal Older Men in DB: When treatment effects were analysed, no significant effects of DHEA were observed on any of the trial outcomes, providing no support for benefits of DHEA supplementation for cognition or well-being in normal older men in the shorter-term. DB study of 46 men 50mg/d 13 weeks. Salivary cortisol and DHEA: association with measures of cognition and well-being in normal older men, and effects of three months of DHEA supplementation. van Niekerk JK, Huppert FA, Herbert J. Psychoneuroendocrinology 2001 Aug;26(6):591-612 100mg/d No Benefit Men: DB 39 males crossover 3-6 months on 100mg/d. Dehydroepiandrosterone replacement in aging humans. Flynn MA, Weaver-Osterholtz D, Sharpe-Timms KL, Allen S, Krause G. J Clin Endocrinol Metab 1999 May;84(5):1527-33. Improved sense of well-being or sexual functioning were not found in this study. 1600mg/d No Benefit Men: DB DHEA (1600 mg/day) for 4 weeks each in a double blind cross-over study. DHEA treatment caused a 9-fold increase in mean plasma DHEA sulfate concentrations, but had no significant effect on body weight or on two indices of lean body. Failure of dehydroepiandrosterone to influence energy and protein metabolism in humans. Welle S, Jozefowicz R, Statt M. J Clin Endocrinol Metab 1990 Nov;71(5):1259-64 Men & Women Helped in Small DB:Only 13 men and 17 women in PC DB 50mg/d 6 mo. Remarkable increase in perceived physical and psychological well-being for both men (67%) and women (84%) and no change in libido. In conclusion, restoring DHEA and DS to young adult levels in men and women of advancing age induced an increase in the bioavailability of IGF-I, as reflected by an increase in IGF-I and a decrease in IGFBP-1 levels. These observations together with improvement of physical and psychological well-being in both genders and the absence of side-effects. UC La Jolla, Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. Morales AJ, Nolan JJ, Nelson JC, Yen SS. J Clin Endocrinol Metab 1994 Jun;78(6):1360-7 Beneficial for Older Women in DB: 280 women 60-79yo in DB 50 mg/d x 1 yr. Bone turnover improved selectively in women >70 years old, as assessed by the dual-energy x-ray absorptiometry (DEXA) technique and the decrease of osteoclastic activity. A significant increase in most libido parameters was also found in these older women. Improvement of the skin status was observed, particularly in women, in terms of hydration, epidermal thickness, sebum production, and pigmentation. A number of biological indices confirmed the lack of harmful consequences of this 50 mg/day DHEA administration over one year, also indicating that this kind of replacement therapy normalized some effects of aging. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Baulieu EE, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy MP, Latour F, Leaud MC, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharriere O, Nouveau S, Rakoto-Arison B, Souberbielle JC, Raison J, Le Bouc Y, Raynaud A, Girerd X, Forette F. Proc Natl Acad Sci U S A 2000 Apr 11;97(8):4279-84 DHEA Helps Hypopituitarism: Thirty-eight women, aged 25-65 yr, with androgen deficiency due to hypopituitarism were treated with oral dehydroepiandrosterone (DHEA; 30 mg/d if <45 yr of age and 20 mg if > or =45 yr of age) for 6 months in a randomized, placebo-controlled, double blind study, followed by a 6-month open treatment period. The administration of DHEA raised the serum levels of DHEAS to normal age-related reference ranges and increased androstenedione and T to subnormal levels. Androgen effects on skin and/or pubic and/or axillary hair were observed in 84% (32 of 38) of the women after all received 6 months of DHEA treatment. No such effects were observed after the placebo treatment. These effects after 6 months were correlated with the serum levels of DHEAS (r = 0.37; P = 0.03), androstenedione (r = 0.42; P = 0.01), and T (r = 0.37; P = 0.03). The percentages of partners who reported improved alertness, stamina, and initiative by their spouses were 70%, 64%, and 55%, respectively, in the DHEA group and 11%, 6%, and 11%, respectively, in the placebo group (P < 0.05). According to the partners, sexual relations tended to improve compared with placebo (P = 0.06). After 6 months of treatment, increased sexual interest or activity was reported by 50% of the women taking 30 mg DHEA, by none taking 20 mg DHEA, and by two women taking placebo (P = NS). Compared with levels after placebo administration, high density lipoprotein cholesterol and apolipoprotein A-1 levels decreased after DHEA. Serum concentrations of IGF-I, serum markers of bone metabolism, and bone density did not change. Low dose dehydroepiandrosterone affects behavior in hypopituitary androgen-deficient women: a placebo-controlled trial. Johannsson G, Burman P, Wiren L, Engstrom BE, Nilsson AG, Ottosson M, Jonsson B, Bengtsson BA, Karlsson FA. J Clin Endocrinol Metab 2002 May;87(5):2046-52 Thomas E. Radecki, M.D., J.D. |