Taking DHEA: Q&As

 

DHEA is the most abundant steroid hormone in the human body. It plays a role in many organ systems and can have huge impacts on mood, mental cognition and sleep quality. Interest in DHEA spiked in the early 90s, when researchers found that serum levels would reliably drop in line with age; there was widespread speculation that it may be the ‘fountain of youth’ and many researchers scrambled to dose themselves up with the hormone, many at up to 200mg per day. None got any younger.

The hyped died down, but DHEA has remained a popular supplement in the last two decades and has proven to be reliable in boosting the levels at the adrenal glands when testing finds them to be low. Despite its widespread use by end users during this time, the issue of DHEA can remain confusing for many. Here are some of the most popular questions I am asked:

Why would someone take DHEA?

DHEA has been the subject of many research papers. In the literature, it has been shown to positively influence depression, immune response, libido and erectile dysfunction, osteoporosis and menopausal symptoms. Other studies have suggested that it may benefit sufferers of autoimmune diseases such as lupus. As a result of these findings, many individuals who experience such problems have taken DHEA without testing their hormonal status beforehand.

Other individuals take DHEA on the advice of their practitioners after tests have shown their serum/saliva levels to be low. These individuals are likely to suffer from low energy, low mood and reduced mental sharpness and are looking to restore the balance they previously enjoyed.

I have low DHEA. Will I need to take DHEA forever?

Unlikely. DHEA is crucial for deep sleep and for immune system function. When these are thrown into disarray, the chances of recovery become particularly slim. The idea of supplementing with DHEA is to restore the systemic levels to optimal; this then allows the body to start healing effectively, which then sees the body producing a suitable level of endogenous DHEA. This means that, after some time, the individual no longer requires supplementation. This typically means discontinuing the supplement after 2-3 months, but it can be earlier or later depending on the individual. Repeat testing is the easiest way to determine when to discontinue DHEA supplements.

Is DHEA safe?

Like herbs, minerals or even water, the key thing here is dosage. Too much and you can cause a problem. This is especially true of steroid hormones, which can have powerful affects on a multitude of body systems. The interesting thing here is that DHEA itself does not appear to have any negative effects on the body, but can convert into testosterone, DHT and estrogen. This can cause both short-term problems, such as mood disturbances and inflammation, and long-term problems, such as prostate irritation or an increased risk of estrogen-sensitive cancer. However, a number of studies have shown DHEA to be protective against such cancers, so the jury is still out here. I imagine the different results are obtained because no scientists have run long-term studies on groups with low DHEA to begin with and compared them to those with ‘normal’ DHEA levels.

In any case, both common sense and scientific studies both conclude that these risks are only present if serum DHEA levels become excessive and are maintained over a period of time. Reviews on the safety of DHEA have found no evidence of elevated risk from short-term use.

Do doctors prescribe DHEA?

US doctors make frequent use of DHEA. Some British doctors use DHEA but most are not trained in the use of DHEA and are quite unfamiliar with the interactions in the hormonal cascade. This often sees them rebuffing the idea of DHEA as a knee-jerk reaction, even when test results show a shortage. I find it ironic that many will dismiss the concept and mumble about ‘safety concerns’ of this natural substance and then try to prescribe anti-depressants in the same breath.

What are the side effects of DHEA?

I have never observed any side effects from individuals when DHEA has been elevated in isolation, but side effects can occur if there is an excess of the hormone and the body then converts this into testosterone, DHT or estrogen.  I rarely see any issues or discomfort of this kind in men, but there will sometimes be issues in women aged 20-50 who, prior to DHEA supplementation, have low levels of both progesterone and progesterone. These women may find that the supplementation of DHEA ‘kick-starts’ their production of estrogen but has no effect on their progesterone levels. These creates a situation of estrogen dominance due to the ‘partial fix’. That is why women aged 20-50 who are not menstruating – a key sign of suppressed estrogen – should always measure their progesterone and estrogen before taking DHEA.

Sometimes individuals start taking DHEA and feel a noticeable lift but then, the following day, find themselves with symptoms such as minor headaches, disturbed digestion and heavy limbs. This is a classic Herxheimer response, caused by a bolstered immune system attacking undesirable microbes, and is actually a positive sign that the DHEA is having beneficial effects (even if such effects are unpleasant for several days).

 

Are there other ways to raise my DHEA aside from direct supplementation?

Some practitioners have suggested Pregnenolone as an effective way to boost DHEA. The theory goes that this allows the body to naturally rebalance its own hormones. The first  problem is that the conversion from Pregnenalone to DHEA depends on the function of two enzymes, the rate of which will vary from one person to the next. The second problem is that Pregnenolone activates the NMDA receptor in the brain (great for learning but terrible for sleep, which is so often lacking in individuals I see).

A patented herbal supplement called Relora claims to lower cortisol while raising DHEA, but I have never seen anyone notice any measurable benefits from taking this.

Can I take DHEA as a preventative measure?

I have heard of individuals taking DHEA in small doses in anticipation of a drop that comes with age. I do not support this strategy as taking any hormones (even in small amounts) comes with the risk of pushing the body’s levels into the excessive levels. An Adrenal Stress Index test (salivary test offered by Genova) costs £75 and is a simple, easy way to test your hormones so that you are never guessing.

Summary

All hormones should be treated with respect due to the wide range of effects they can trigger across the various organ systems. For the same reason, they represent a fantastic tool to enhance well-being and allow the body to heal itself. Decades of research and usage by end users – combined with easy access to testing – means that DHEA is no longer a mystery and can be used as a powerful tool in the treatment arsenal of practitioners.

 

 

 

References:

Acacio BD, Stanczyk FZ, Mullin P, et al. Pharmacokinetics of dehydroepiandrosterone and its metabolites after long-term daily oral administration to healthy young men. Fertil Steril. 2004;81:595-604.

Adamusova E et al. Pregnenolone sulphate activates NMDA receptor channels. Physiol Res. 2013 Dec 20;62(6):731-6.

Barrett-Connor E, Friedlander NJ, Khaw K-T. Dehydroepiandrosterone sulfate and breast cancer risk. Cancer Res. 1990;50:6571-6574.

Jankowski CM, Gozansky WS, Schwartz RS, et al. Effects of DHEA Replacement Therapy on Bone Mineral Density in Older Adults: A Randomized, Controlled Trial. J Clin Endocrinol Metab. 2006 May 30. [Epub ahead of print]

Meston CM, Heiman JR. Acute dehydroepiandrosterone effects on sexual arousal in premenopausal women. J Sex Marital Ther. 2002;28:53-60.

Orner GA, Mathews C, Hendricks JD, et al. Dehydroepiandrosterone is a complete hepatocarcinogen and potent tumor promoter in the absence of peroxisome proliferation in rainbow trout. Carcinogenesis. 1995;16:2893-2898.

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.

Shibata MA, Hasegawa R, Imaida K, et al. Chemoprevention by dehydroepiandrosterone and indomethacin in a rat multiorgan carcinogenesis model. Cancer Res. 1995;55:4870-4874.

Simile M, Pascale RM, De Miglio MR, et al. Inhibition by dehydroepiandrosterone of growth and progression of persistent liver nodules in experimental rat liver carcinogenesis. Int J Cancer. 1995;62:210-215.

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.