DHEA is hot. It is being touted as an anti-aging hormone, effective in preventing and reversing many of the debilitating changes in emotional and physical well-being we associate with aging and chronic disease. We are all aware that traditional western medicine has made impressive contributions in managing acute medical emergencies, but has less to offer the vast majority of people whose lives are limited by chronic disability. What is interesting about the data collected thus far is that low levels of DHEA appear to correlate with many aspects of the decline from vigorous good health in to what we think of as old age. What is even more interesting is that low-dose, physiologic supplementation with DHEA, in appropriate cases, appears to enhance one’s health and sense of well-being. Used like a medicine in higher doses, it appears to ameliorate many serious disease processes.
Over the last few years, this hormone has caught the attention of physicians who follow the literature carefully, looking for new ways to help patients with medical problems unresponsive to traditional therapies. The following conditions have been associated with levels of DHEA lower than those of healthy people: cardiovascular disease, high cholesterol, diabetes, obesity, cancer Alzheimer’s disease, memory disturbances, autoimmune disease including AIDS, chronic fatigue, poor immune response to infection, osteoporosis and manifestations of aging.
Backed by numerous animal a few human studies, physicians prescribing DHEA have compiled impressive anecdotal evidence of a wide range of benefits, without significant side effects, for patients with these conditions. Of course, we are all hoping for more clinical trials to document the efficacy and safety of DHEA, but until then, physicians and their patients, familiar with the data, may want to consider a trial of supplementation for recalcitrant health problems.
DHEA is but one of the hormones, made in various glands and organs, which facilitate communication in the body, keeping biological processes in balance and running smoothly. DHEA, which stands for dehydroepiandrosterone, is the most abundant steroid hormone in the body. It is synthesized by the adrenal glands, ovaries, and testes. Secretion of DHEA peaks by the age of 25, after which levels gradually decrease by about 80 to 90 percent by the age of 70. Scientists have long been interested in the therapeutic uses of other hormones such as estrogen, progesterone, testosterone, and corticosterone, but DHEA has been relatively ignored, largely because its functions could not be ascertained. Until recently, scientists believed that DHEA merely formed the pool from which other active hormones could be synthesized. However, we now know that there are specific receptors on cells for the DHEA molecule, indicating the likelihood that it has specific functions of its own.
Here are a few examples of the
research that has been done.
Heart disease. Men with
heart disease have lower levels of DHEA-S than healthy men.
Healthy men with low levels of DHEA-S were 3.3 times more
likely to die of heart disease than those with high levels.
DHEA lowers serum LDL cholesterol.
Obesity. Mice bred for
obesity do not become obese when their diets are supplemented with DHEA.
Cancer. Mice bred for breast cancer do not develop cancer when their diets are supplemented.
Autoimmune disease. Patients with lupus, rheumatoid arthritis, multiple sclerosis, and ulcerative colitis usually have very low levels of DHEA, especially if they are taking steroids. When supplemented, they had improved stamina and sense of well-being. Lupus patients had significant improvement of their kidney disease.
Aging. Mice treated with DHEA looked younger and had glossier coats. Elderly patients had significant improvement in generalized weakness, muscle wasting, tremulousness, and memory loss.
Osteroporosis. DHEA can theoretically work like estrogen, androgen, and progesterone in preventing bone loss and stimulating bone formation. An increase in bone mass has been documented in postmenopausal women.
Who should consider being tested? Certainly, people with any of the above conditions or those at risk of developing them are likely candidates. Perimenopausal and postmenopausal womenwho are at risk for osteoporosis, as well as the elderly complaining of fatigue, inability to gain weight, malaise, and a lack of zest for life often have low DHEA levels. People with multiple chemical sensitivities might want to be tested. In fact, it may be worth testing anyone over 40, who feels his or her physical or emotional health declining despite efforts to live a healthy lifestyle.
Although most doctors will be familiar with DHEA with respect to endocrine disorders, many will not be aware of the latest research. As a scientist, your doctor is trained to make therapeutic decisions based on research, in order to avoid useless or dangerous therapies. Many physicians will respond with interest to references in scientific journals or better yet to the articles, themselves. Information for this article was derived mainly from Preventing and Reversing Osteoporosis by Dr. Alan Gaby. He has written an excellent chapter on DHEA, within the context of overall good health. I’ve listed some articles from his extensive bibliography of the current literature at the end of this article. You can read the ones pertinent to your own medical situation and share them with your doctor. Another resource is Women’s International Pharmacy, which will send your doctor articles and discuss dosing regimens, as well as filling prescriptions for DHEA. The address is below.
DHEA deficiency can be assessed by measuring either serum DHEA or DHEA-S, which is cheaper (about $40) and may be more sensitive. A normal range is given for each decade. (These ranges will vary according to the type of machine used by a particular lab.) As no lab test is perfect and so called normal levels may vary considerably, a patient’s clinical condition should also be taken into account in deciding whether to treat. A 60-year-old with general malaise, fatigue, decreased appetite, weight loss and depression associated with a low normal DHEA level may well benefit from supplementation.
At present, no studies have determined the optimal dose of DHEA. Experienced physicians, however, have found doses of 5-15 mg. twice a day to be beneficial for women. Doses at these levels rarely produce side effects, which include acne and an increase in hair growth on the arms and legs. Start with the lowest dose and increase each week until symptoms improve. Dosages for men are often greater than 100 mg. per day. Maintenance doses may have to be gradually increased over time as the endogenous output of DHEA decreases with age. The widely used guideline for determining the maintenance dose is to increase the DHEA level to that of a 25-35 year old. For treatment of serious illnesses like systemic lupus, cancer, and AIDS, much higher doses may be appropriate.
It is important to assess the need for DHEA supplementation within the context of a thorough examination, as other serious illnesses can present with similar symptoms. Your doctor may also want to check levels of other hormones like cortisone and thyroid hormone, to assure that the proper balance of hormones is achieved. For women with breast cancer and men with prostate cancer, there is clearly not enough data to make general recommendations, and caution should be used.
After reviewing the literature, one can’t help but be excited about the potential therapeutic uses for this hormone. The broad spectrum of desirable effects and the lack of serious side effects thus far are very encouraging. Unfortunately, since natural substances are not patentable, drug companies have been unwilling to invest in the long-term research required to learn more about this promising new therapeutic agent. This is one more example in health care, where educated consumers can make a difference in bringing new therapies into mainstream medicine.
Women’s International Pharmacy
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Barrett-Connor, D., K.T. Khaw, and S.S.C. Yen (1986). A prospective study of dehydroepiandrosterone sulfate, mortality, and cardiovascular disease. New England Journal of Medicine 315:1519-1524.
Gaby, Alan, M.D. ( ). Preventing and Reversing osteoporosis. Prima Publishing, 916-786-0426. pp. 157-173.
Schwartz, A.G. (1979). Inhibition of spontaneous breast cancer formation in female C3H(Avy/a) mice by long-term treatment with dehydropiandrosterone. Cancer Research 39:1129:1132.
Von Vollenhoven, R.F., Engleman, E.G., McGuire, J.L. (1994). An open study of dehydroepiandrosterone in systemic lupus erylhernatosis. Arthritisand Rheumatism. Vol. 37, no. 9, pp. 1305-1310.
Sambrook, P.N., et. al. (1988). Sex hormone status and osteoporosis in postmenopausal women with rhematoid arthritis. Arthritis and Rheumatism 31:973-978.