DHEA used as an oral supplement

Dehydroepiandrosterone, better known as DHEA, is a hormone that is produced by the adrenal glands, gonads, gastrointestinal tract, and even in the brain. DHEA is also converted to dehydroepiandrosterone-sulfate (DHEA-S), a slightly more active metabolite of DHEA, in the body.

DHEA and DHEA-S themselves have some biological activity; however, more importantly, these molecules are enzymatically converted into more potent hormones such as testosterone, 5-dihydrotestosterone (5-DHT), estradiol, and estrone.

Diseases associated with DHEA deficiency

The human adrenal glands produce DHEA throughout life, though DHEA levels are at their highest in one’s mid-20s. By the time a person is in their 80s, DHEA levels are perhaps only 20% of what they were when he/she was in their 20s. Because of this wide variability due to age and the fact that DHEA/DHEA-S is converted into so many other powerful hormones, it is difficult for scientists to determine if low DHEA levels are a cause of disease. Nonetheless, several medical conditions are associated with abnormally low levels of DHEA including:

• Adrenal insufficiency
• Alzheimer’s disease
• Anorexia nervosa
• Cardiovascular disease
• Chronic fatigue
• Crohn’s disease
• Depression
• Diabetes, insulin resistance
• Heart failure
• Obesity
• Osteoporosis
• Menopause
• Sexual dysfunction
• Sleep disorders
• Systemic lupus erythematosus

While people with these conditions have lower than normal levels of DHEA, it is not necessarily the case that low DHEA levels are the cause of any of these conditions.

Purported benefits of DHEA

Manufacturers and marketers of DHEA supplements and even reports in the lay press have suggested that DHEA supplementation may act as an energy booster, an aphrodisiac, an athletic performance enhancer, or may even retard the aging process, reduce fatigue, and alleviate sexual dysfunction. In actuality, there is little evidence to support these claims.

Conditions in which DHEA supplements do help

Unfortunately, little is known about the effects of DHEA supplementation on health and disease. Clinical trials, when they have been performed, have yielded conflicting results. One condition for which DHEA supplementation has been shown to help patients is adrenal insufficiency. In adrenal insufficiency, the adrenal glands do not produce enough of certain hormones including cortisol, aldosterone, and DHEA. Several small studies have shown that 25 to 50 mg of DHEA taken daily can bring blood levels of androgens into the normal range and improve symptoms of central adrenal insufficiency.

Conditions in which DHEA supplements may help

Systemic lupus erythematosus

Limited evidence suggests that DHEA supplementation may help reduce the effects of lupus. A daily 200 mg supplement of DHEA decreased the corticosteroid dosage patients needed to treat their lupus, resulted in fewer flares and higher bone mineral density, and promoted a feeling of improvement in patients with lupus. 

Bone mineral density

Most clinical trials have shown that DHEA supplements can improve bone density in the hips and spine as compared to a placebo. This effect of DHEA is similar in men and women. It is important to note that the effect of DHEA on bone mineral density is far less than the benefit one would anticipate from osteoporosis-treating drugs. Moreover, it is unclear whether DHEA reduces the risk of bone fracture.

Vaginal atrophy

In postmenopausal women, intra-vaginal DHEA improves vaginal atrophy and vaginal dryness and improves some measures of sexual function compared to a placebo.

Depression

DHEA is better than a placebo at reducing depressive symptoms in people with major depressive disorder. The supplement may be particularly helpful in people who develop depression between the ages of 45 and 65.

Sjögren's syndrome 

DHEA improved dry mouth symptoms in patients with Sjögren's syndrome.

Athletic performance

It is unclear whether DHEA can help improve athletic performance. Two groups—one of nine men and the other of ten women--were given 100 mg/day of either DHEA or a placebo for six months. After six months, each group’s treatment was reversed for an additional six months. In the men, but not in the women, knee and lower back strength increased while on DHEA. In a separate study, 100 mg/day of DHEA did not change fat-free mass or muscle mass compared to a placebo in bodybuilders.

Conditions in which DHEA supplements do not help

While future research may shed new light in these areas, current work suggests that DHEA supplementation is not helpful for several medical conditions.

• In elderly people who have documented dementia, treatment with DHEA does not improve their ability to think or remember (i.e. cognitive performance). Likewise, DHEA does not seem to prevent cognitive decline or improve memory as people age. Despite the fact that DHEA levels drop precipitously as people age, replacement therapy does not seem to slow or reverse the effects of aging.
• Three out of four trials showed that DHEA did not improve psychological well-being or quality of life.
• DHEA does not improve muscular strength in elderly individuals, nor does it stop age-related accumulations of fat or improve insulin sensitivity.
• DHEA does not reduce the effects of menopause such as flushing, mood disturbances, cognitive problems, or memory problems, nor does it improve well-being.
• DHEA supplementation also may not be helpful in the treatment of fibromyalgia although studies are pending.

Adverse effects of DHEA supplements

Since DHEA is converted into testosterone and other androgens, the supplement is associated with a number of unpleasant side effects.

DHEA increases the likelihood that the user will develop acne, oily skin, hirsutism (abnormally thick body hair and thick hair growth in unusual places), lower HDL cholesterol (good cholesterol), heart palpitations, and mania.

The quality of DHEA supplements varies substantially

In some countries, DHEA is available only by prescription. In the United States, however, DHEA is considered a nutritional supplement rather than a drug and is available over-the-counter. When various commercially available DHEA supplements were tested in the laboratory, the amount of DHEA contained in the supplement varied widely and was not consistent with the amount stated on the label. Some commercial supplements contain no DHEA at all. Thus, while patients may report that they routinely take over-the-counter DHEA supplements, it is impossible to know if the supplements they are taking actually contain the published amount of DHEA. This lack of uniformity makes clinical studies difficult for researchers to conduct as well, since reliable sources of DHEA are scarce.

In Australian, DHEA is available to be compounded (made from raw ingredients) into a capsule. Access to this product requires a doctor's prescription, and since much of the data is inconclusive, many doctor's are hesitant to prescribe DHEA.

References

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