DHEA – Dehydroepiandrosterone: What is it? History, Dosage, Adverse Reactions and Interactions

It is a hormone produced naturally by the adrenal glands. DHEA levels fall naturally after 30 years.

Some people take DHEA supplements in the hope that it will have health benefits and prevent some diseases. However, the evidence is mixed.

  • Scientific name: Dehydroepiandrosterone / dehydroepiandrosterone sulfate.
  • Common name : DHEA, DHEAS, prasterone.

Why do people take DHEA?

Several studies have found that DHEA supplements can help people with depression , obesity, lupus and adrenal insufficiency.

DHEA can also improve the skin in older people and help treat osteoporosis , vaginal atrophy, erectile dysfunction and some psychological conditions. But the results of the study are mixed and often contradictory.

Low levels of DHEA are associated with aging and a number of diseases, such as anorexia, type 2 diabetes and HIV.

In older men, having low levels of DHEA is also associated with a higher chance of death. However, it is not clear that the use of DHEA supplements helps to reduce the risk of contracting a disease.

DHEA is used by some people who want to “reverse” aging and increase immunity, cognitive function and muscle strength. For now, studies do not support these uses.

DHEA has been studied as a treatment for other conditions, ranging from cardiovascular disease to menopause and Alzheimer’s. The results have not been totally accurate, so they are not reliable in the pharmacological field.

Risks

Using high doses of DHEA may not be safe. People who have heart problems, liver disease, diabetes, high cholesterol, thyroid problems, polycystic ovarian syndrome and a history of bleeding problems should not use DHEA.

This can increase the risk of some cancers that are affected by hormones, such as breast cancer, ovaries and prostate.

History

DHEA was isolated for the first time by the German biochemist Adolf Butenandt in the 1930s.

The claims about DHEA supplementation as the “fountain of youth” hormone have arisen in large part from the observation that endogenous hormone levels decrease with age and from anecdotal descriptions of increased energy and well-being in treated patients with DHEA due to adrenal insufficiency.

Although its use is prohibited by the World Anti-Doping Code and the National Collegiate Athletics Association, several high-profile athletes have tested positive for DHEA.

The FDA banned over-the-counter sales of DHEA in 1985; however, since the approval of the ACT Health and Education Dietary Supplement of 1994, DHEA has been marketed as a dietary supplement.

Chemistry

DHEA is a weak androgen and acts as a precursor in the production of sex hormones. It is produced endogenously in the adrenal gland from cholesterol, but it can also be synthesized in neurons and glial cells.

Both DHEA and its main metabolite, dehydroepiandrosterone sulfate (DHEAS), are the main circulating hormones in the body.

The levels vary according to age, reaching a maximum in early adulthood and decreasing from 10% to 20% between 70 and 80 years of age.

Other factors that influence the circulating levels of DHEA or DHEAS include alcohol consumption, body mass index, ethnic origin, nutritional status, sex, smoking, thyroid function and concomitant medications such as corticosteroids.

Dosage

DHEA administered orally has a bioavailability of less than 10% and is converted to inactive DHEAS, which can then act as a reservoir for the body to use.

And intravenous DHEA is subject to rapid hepatic elimination. The transdermal and subcutaneous routes offer greater bioavailability.

The daily administration of 25 mg of DHEA in postmenopausal women has been suggested because this dose minimizes adverse androgenic effects; however, only studies that used at least 50 mg per day showed positive results.

The doses used in the clinical studies of assisted reproduction were in the range of 50 to 75 mg per day (in divided doses).

In adrenal insufficiency, DHEA of 50 mg daily for 3 months is considered a replacement dose, while 200 mg daily achieves circulating supra-physiological levels and, therefore, would be considered a pharmacological dose.

DHEA is available as oral preparations, intraoral sprays, and transdermal creams and gels.

DHEA 200 mg daily administered to healthy men for 1 week resulted in a DHEA level of 1 mcg / dL and a DHEAS level of 400 mcg / dL.

Contraindications

The contraindications have not been identified. But it can be said that:

  • The use of DHEA or DHEAS in breast or prostate cancer is not recommended.

Pregnancy and breastfeeding

Information regarding safety and efficacy in pregnancy and lactation is poor. Supplementation with DHEA has been evaluated to improve the production of oocytes in infertility.

Adverse reactions

Studies in adrenal insufficiency suggest that DHEA is generally well tolerated. However, long-term study data are lacking. The adverse effects observed include acne, hirsutism and unfavorable effects on lipid metabolism (decrease in HDL levels).

Supplementation with DHEA should not be used in hormone-dependent prostate and breast cancers. There is only one report of a seizure in a woman taking DHEA to increase the production of voids.

Toxicology:

The information that is known in humans is very limited and limited. Although it has been demonstrated that DHEA is carcinogenic in rodents, causing liver tumors, the relevance in humans has been debated due to hepatic and biliary mechanisms that eliminate the causal accumulation of peroxisomes suggested.

The protective effects of DHEA in other cancers have also been demonstrated in rodents.

Asthma:

It has been shown that circulating levels of DHEA / DHEAS are lower among patients with asthma .

Nebulized DHEAS (70 mg daily) was evaluated in a moderate to severe asthma study. No effect on forced expiratory volume at one second or maximum expiratory flow rate was demonstrated; however, a difference was shown with respect to placebo using the Asthma Control Questionnaire.

Postmenopausal effects:

Reviews of clinical trials and a meta-analysis of DHEA supplements found no convincing evidence to support a place in the treatment of postmenopausal symptoms in women with intact adrenal function.

Sexual function, well-being, quality of life measures, metabolic parameters (lipid profile, carbohydrate metabolism) and cognition are among the measured results.

It has been shown that DHEAS stimulates osteoblasts; however, the results of improvements in bone density are equivocal, with only a small effect demonstrated in some studies.

A benefit of DHEAS supplements can be seen in elderly women with low DHEA in circulation, but not in elderly men. Fracture rates were not reported in the studies.

Limited studies suggest that transvaginal DHEA may have a potential benefit in vaginal atrophy; however, more studies on this drug are required to verify its effectiveness.

Assisted reproduction:

Limited clinical studies have been conducted in women with decreased ovarian stores. Reviews of the studies have concluded that DHEA supplementation increases the amount of oocytes produced and, therefore, increases the chances of pregnancy.

It was also found that the rate of spontaneous abortion decreased, possibly by reducing aneuploidy. The adverse events reported are of an androgenic nature, but also include a case of seizure and the potential for male bias due to the increase in intrafollicular testosterone.

Cancer:

The relevance of rodent cancer models is not clear. The epidemiological data are inconclusive regarding the role of DHEA and DHEAS in cancer.

Some studies suggest that the age-related decrease in DHEA or DHEAS, testosterone and estrogen is protective for hormone-sensitive cancers.

DHEA is a weak androgen, and adrenal androgens are associated with an increased risk of cancer, especially of the breast and prostate. Until rigorous clinical and laboratory studies have been carried out, the use of DHEA / DHEAS in the prevention of cancer is not allowed.

Cognition:

Circulating levels of DHEA in elderly patients are only 10% to 20% of those in young adults, and some, though not all, observational studies suggest that patients diagnosed with dementia have lower circulating levels of DHEA / DHEAS.

This observation has led to the concept that DHEA supplementation could prevent or slow down the decline of cognitive function with age; however, there is currently no positive evidence to support this notion.

Metabolic effects (lipids / insulin):

Studies that evaluated the effect of DHEA supplementation on lipid profiles have produced equivocal results. The doses used in the trials vary from 25 to 1,600 mg daily and include heterogeneous populations, which makes meta-analysis difficult.

Some studies report decreases in total cholesterol and decreased HDL cholesterol; other studies do not report any effects. It is possible that the subpopulations benefit; however, these have not yet been identified.

Similarly, the results of body composition and the results of body fat distribution are inconsistent. The role of exogenous DHEA in insulin sensitivity is not clear. Some studies report a modest effect, while a larger number shows no effect.

Schizophrenia:

Uncontrolled studies conducted in the 1950s found a better sense of well-being with DHEA supplements; however, recent clinical trial data are limited and misleading.

There is some evidence of circulating DHEA / DHEAS levels altered in patients with schizophrenia, and differences in baseline levels may account for equivocal results demonstrated in clinical studies.

At doses of 150 mg daily for 12 weeks, improved negative symptoms (loss of interest, energy and mood) were demonstrated without effect on hallucinations or delirium.

Another study used DHEA 200 mg daily for 6 weeks and found no superiority over placebo.

Systemic lupus erythematosus:

The use of DHEA in systemic lupus erythematosus is controversial and is based on the observed effects of DHEA and DHEAS on the immune system and the improved production of autoantibodies by estrogen and suppression by androgens .

A review of 7 studies evaluating the use of DHEA in mild to moderate systemic lupus erythematosus found little clinical effect, with only 1 study improving with respect to placebo (8%).

The review found modest and clinically relevant increases in health-related quality of life measures, but the long-term effect (more than 1 year) of supplementation is unknown.

The use of DHEA in the most serious lupus is not admitted because it exerts antiglucocorticoid effects.

Immune effects:

Correlations between circulating levels of DHEA / DHEAS and urticaria and other disorders related to the immune system have led to proposals for DHEA supplementation. However, clinical trials are largely lacking.

In one study, no effect of DHEA supplementation on well established rheumatoid arthritis was observed. But a decrease in the activity of the disease was observed in a study with patients with inflammatory bowel disease. However, the study was not placebo controlled.

Animal studies of experimental sepsis and trauma have shown that DHEA decreases Splenocyte proliferation and increases circulating NK cells and lymphocytes; A role in the management of critical illness has been suggested as a result.

Physical strength:

The data are inconclusive on the effect of supplemental DHEA on muscle strength or physical function in elderly patients.

Interactions with other medications

Currently there is no well-documented interaction.

But, if you take medications regularly, talk to your doctor before you start using DHEA supplements. It is possible for DHEA to interact with anticoagulants, anticonvulsants, hormone therapy and medications for diabetes and heart or liver problems.

Pharmacology

Studies in non-primate animals have a limited applicability in humans because circulating DHEA or DHEAS levels are different; Rodents have very little circulating DHEA.

Toxicology

Information in humans is little enough to define complex toxicological values. It has been shown that DHEA is carcinogenic and protects against certain cancers in rodents.

Considerations

How much DHEA should I take?

There is no standard dose of DHEA. Some studies have used capsules dosed between 25 and 200 milligrams per day, or sometimes even more, but this depends on the medical conditions being treated. Ask your doctor for advice.

Can you get DHEA naturally from food ?:

There are no dietary sources of DHEA. Wild yam contains a substance similar to DHEA that is used to make DHEA in the laboratory. The body manufactures DHEA naturally in the adrenal glands.