The ABCs of DHEA

Controversy is not new to the health food and supplement industry. In 1995, melatonin, a hormone made by the pineal gland, generated much discussion, became big news, and even got its own cover on the November 6th issue of Newsweek. Now DHEA has taken a brighter spotlight, especially since it has become readily available without a prescription. We now have two over-the-counter hormones that can be easily purchased and used (or misused) by the consumer.



If you thought claims about melatonin were hyped, confusing, and controversial… If you thought everybody you asked had a different opinion about its benefits and shortcomings… Just wait and see what researchers and doctors are saying about DHEA.



What does DHEA stand for?

DHEA is short for dehydroepiandrosterone (D-hi-dro-epp-E-an-dro-stehr-own), a hormone made by the adrenal glands located just above the kidneys.



Is DHEA a new hormone that we’ve discovered?

Scientists have known about this hormone since 1934 and there have been thousands of articles published about it since then. However, only a small percentage of these studies have involved human subjects.



Why all the hype about DHEA?

Back in 1994, researchers at the University of California, San Diego, School of Medicine, wanted to find out what would happen to older individuals if they received DHEA supplements (Morales and Yen).



The researchers gave middle-aged volunteers 50 mg of DHEA nightly for 3 months. There was an increase in physical and psychological well-being. The subjects reported enhanced energy, deeper sleep, improved mood, more relaxed feelings, and an improved ability to deal with stressful situations. We’ll discuss this study more fully in Chapter 3.



When the results of this study were published, there was a flurry of publicity. Stories about DHEA appeared in newspapers and magazines. Radio picked it up. Many local and national TV shows did segments on it. However, since DHEA was not easily available to the consumer, it didn’t become popular as quickly as did melatonin.



One of the reasons that this study caused so much publicity was that it was supported by dozens of previous studies (most conducted in rodents) that found DHEA to have a benefit in heart disease, cancer, diabetes, weight loss, lupus, and a variety of other conditions. Some people started calling DHEA “the fountain of youth.”



Before the Morales and Yen study was published, DHEA was already well known in the holistic health community. Articles about this hormone had appeared in many alternative magazines and newsletters.



Is DHEA safe?

Whenever doctors talk about the safety of a medicine they separate it into short-term safety over a few days or weeks, and long-term safety over months and years of use. Dr. Nestler, a researcher at the Medical College of Virginia/Virginia Commonwealth University in Richmond, has given 1600 mg of DHEA a day for 4 weeks to healthy young men without any serious side effects (Nestler, 1988). At this dosage there was a lowering of cholesterol and a decrease in body fat, with a greater response in obese individuals. Most DHEA supplements on the market are less than 50 mg.



As to the safety of using DHEA for 5, 10, 20 years or longer, no formal human studies have been published; then again, few long-term human studies have been done for any medicines, hormones, or nutrients.



Is DHEA the only adrenal hormone?

More than 150 hormones are known to be synthesized by the adrenal glands (see diagram next page for a general overview). However, the most abundant hormone made by the adrenal glands is DHEA. We’ll discuss the adrenal glands in more detail in Appendix A.



After DHEA is made by these glands it goes into the bloodstream, and from then on it travels all over the body and goes into our cells, where it is converted into male hormones, known as androgens, or female hormones, known as estrogens (Drucker, 1972). Whether DHEA gets converted predominantly into androgens or estrogens depends on a person’s medical condition, age, and sex. Every person has a unique biochemistry.



In males the testicles also make androgens, while in females, before menopause, the ovaries also make estrogens. So the body has developed at least two organs where sex steroids are made. After menopause, the ovaries no longer make estrogens. DHEA is also thought to be made in the brain.



How much DHEA does our body make?

Humans are thought to make between 1 and 2 mg of DHEA and between 10 and 15 mg of DHEAS a day (Longcope, 1995 and personal communication), although higher estimates– up to 25 mg– have been made. These numbers are lower for women by about 10 to 30%.



How is DHEAS different from DHEA?

When DHEA is metabolized, a chemical called sulfate is added. Sulfate consists of the mineral sulfur combined with oxygen (SO4). Thus DHEAS stands for DHEA-sulfate.



DHEA is mostly made in the morning hours. Its levels decline fairly rapidly during the day because it is quickly cleared by the kidneys. However, DHEAS is cleared much more slowly and blood levels remain much more stable throughout the day (Longcope, 1995). About 90% of this hormone in the blood is in the DHEAS form; the rest circulates as DHEA. That is why, when researchers want to assess blood levels for DHEA, they often measure DHEAS levels.



When you take DHEA supplements, some will circulate in your bloodstream as DHEA, but most of it will be sulfated by your liver to circulate as DHEAS.



Will taking DHEA supplements suppress my adrenal gland’s natural DHEA production?

The production of most hormones is controlled by a “feedback loop,” which means that when hormone levels get too high, the body is told to make less, and when hormone levels are too low, the body is told to make more. Cortisol, testosterone, and estrogen are all regulated by this feedback. In other words, if you take cortisol, or a similar derivative such as prednisone, it will shut off your body’s natural production.
Fortunately, DHEA appears to be one of the exceptions. According to Dr. Peter Hornsby at the Baylor College School of Medicine in Houston, Texas, there doesn’t seem to be a feedback mechanism for DHEA or DHEAS. In other words, DHEA supplements, except perhaps in very high dosages, are not likely to stop our body’s own production, although there are no long-term human studies to confirm this.



Where does the DHEA that I buy come from?

The DHEA pills that you buy are made by vitamin and pharmaceutical companies. They extract sterols from wild yams, the most common sterol being diosgenin. After cleaving a few side chains from diosgenin in the laboratory, DHEA is produced.



Will natural yam extract pills increase my DHEA levels?

Most of the DHEA sold now in vitamin stores, drug stores or through mail order firms is produced in a laboratory from diosgenin. However, some vitamin companies do sell extracts of wild yams in pill form, without first processing it into DHEA. Some even promote these yam-extract products as “DHEA precursor complexes” or “natural DHEA.”



To get to the bottom of the yam-extract conversion issue, I spoke with a leading expert in the field, Seymour Lieberman, Ph.D., from St. Luke’s-Roosevelt Hospital Center, New York. Dr. Lieberman has been studying DHEA (which he calls ‘dehydro’) and other steroids longer than most researchers in the field (55 years so far!). He is one of the top experts in the world on the biochemical aspects of DHEA.


Sahelian: Congratulations on publishing such a detailed and thorough article on the metabolism of DHEA and other steroids in the Annals of the New York Academy of Sciences.



Lieberman: Thank you. Dehydro is my favorite topic. It’s a fascinating compound and we only know a fraction of what we need to know.



Sahelian: Some vitamin stores sell wild yam extracts. There are claims that these yams have compounds which can be converted into DHEA by the body. Is this possible?



Lieberman: DHEA is made commercially from a plant of the Dioscorea family [wild yams] found in abundance in Mexico. Extracts of this plant contain a steroidal saponin [called diosgenin] which may be converted in a laboratory by a series of 6 to 8 chemical reactions into DHEA. A comparable series of reactions is not known to exist in nature and certainly not in humans.
Consequently it is highly unlikely, perhaps impossible is a better word, that the ingestion of extracts of the Dioscorea plant will lead to the formation, by metabolic transformation of the relevant plant constituent, to either pregnenolone or DHEA.



In a word, Dr. Lieberman means “No.”

Do animals also make DHEA?

Significant amounts of DHEA are made only by humans and primates, such as apes, gorillas, and monkeys. Rodents, such as mice or rats, have only small amounts circulating in their bloodstream. DHEA administration in rodents has often shown beneficial effects, but many researchers caution about making health claims for humans based solely on rodent studies.



What can I do to keep my DHEA(S) level up?

Leading a relaxed lifestyle with high psychological well-being (easier said than done) can help you live longer and maintain optimal DHEAS levels. Chronic stress can decrease DHEAS levels (Labbate, 1995). As to the role of exercise, one study did not find an association. Ninety-six patients with coronary artery disease were started on an exercise program and had their DHEAS levels measured. After 12 weeks, there was no change in the levels of this hormone (Milani, 1995). The researchers conclude, “Although behavior therapy in combination with exercise training was previously shown to lead to increase in DHEAS, exercise training alone has no significant impact on DHEAS, thereby strengthening the suggested role of behavioral changes in modifying this hormone.”



Is it okay if I self-medicate with DHEA?

I recommend that you see a health care practitioner who is familiar with the use of this hormone before taking it for prolonged periods.



What if my doctor is not knowledgeable about DHEA?

Unfortunately, most doctors at this time are not familiar with DHEA therapy. I had a telephone conversation with a colleague from residency, Lou Mancano, M.D. He is now the co-director of the Family Practice Residency Program at Montgomery Hospital in Norristown, Pennsylvania. Because he is involved in a teaching hospital supervising residents, Dr. Mancano keeps up with the latest standard medical research. His account is probably typical of most doctors:



I practice traditional medicine, in a traditional hospital, and I am familiar with DHEA, but only in the context of checking levels in women who present to the office with hirsutism (excess hair) and uncontrolled acne. Basically, the reason for checking DHEA levels is to find out if there is an adrenal tumor, or polysystic ovary, that account for the excess. When the DHEA levels are very high, I order a CAT scan or ultrasound of the abdomen, and if an abnormality is found, I refer the patient to a specialist.



I didn’t know that this hormone was available without a prescription. I also didn’t know that DHEA levels decline with age until now that you told me. I religiously read all the medical journals that are sent to doctors, and I don’t remember seeing any articles on DHEA.



It wouldn’t surprise me if the majority of physicians in the country also are not aware that DHEA levels decline with age. I’ve never thought of this steroid in terms of a deficiency state, but always in terms of excess.



The concept that DHEA can be used as hormone replacement therapy either by itself or with estrogen and other hormones is intriguing. Keep me in touch with your latest findings.

Ray Sahelian MD Written by Ray Sahelian MD

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