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Dehydroepiandrosterone (DHEA) Overview

[Edit] [Revisions] [Writers] Overview

Dehydroepiandrosterone (DHEA), a hormone produced by the adrenal glands, is the most abundant hormone in the steroidfamily found in the bloodstream. Your body uses DHEA as the starting material for making the sex hormones testosterone and estrogen.

A meaningful body of evidence indicates that DHEA might be helpful for the autoimmune disease lupus, at least in women. DHEA may also help prevent osteoporosis (again, in women). Additionally, DHEA appears to be beneficial when taken along with standard treatment for women with adrenal failure.

Other uses with some evidence include improving sexual function in men and women and alleviating depression. DHEA does notappear to be effective for improving general well-being in seniors. Keep in mind that DHEA is not a natural supplement. The DHEA you can buy at the store is made by a synthetic chemical process, and it is a hormone, not a nutrient. Although DHEA appears to be safe to use in the short term, its safety when taken for prolonged periods is unknown.

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The body makes its own DHEA; we get very little in our diets. DHEA production peaks early in life and begins to decline as we reach adulthood. By age 60, our bodies produce just 5% to 15% as much as when we were 20. It's not clear whether this decline in DHEA is a bad thing, but some believe that it may contribute to the aging process.

For use as a dietary supplement, DHEA is manufactured synthetically from substances found in soybeans. Contrary to popular belief, there is no DHEA in wild yam .

[Edit] [Revisions] [Writers] Therapeutic Dosages

A typical therapeutic dosage of DHEA is 50 mg to 200 mg daily, although some studies used dosages above and below this range. A cream containing 10% DHEA may also be used; it is typically applied to the skin at a dosage of 3 g to 5 g daily.

Physicians sometimes check DHEA levels and adjust the daily dose to achieve blood levels of 20-30 nmol/L.

[Edit] [Revisions] [Writers] What Is the Scientific Evidence for Dehydroepiandrosterone?

Lupus

A 12-month, double-blind, placebo-controlled trial of 381 women with mild or moderate lupus (systemic lupus erythematosus, or SLE) evaluated the effects of DHEA at a dose of 200 mg daily. 1 While participants in both treatment and placebo groups improved (the power of placebo is amazing!), DHEA was more effective, reducing many symptoms of the disease. However, DHEA was found to adversely affect cholesterol levels (specifically, the ratio of total cholesterol to HDL cholesterol) and raise levels of testosterone. For this reason, study authors recommend the monitoring of serum cholesterol and keeping watch for adverse effects caused by increased testosterone.

Similarly, in a double-blind, placebo-controlled study of 120 women with SLE, use of DHEA at a dose of 200 mg daily significantly decreased symptoms and reduced the frequency of disease flare-ups. 2 A smaller study found equivocal evidence that a lower dose of DHEA (30 mg daily for women over 45, and 20 mg daily for women under 45) might also work. 3 Positive results were also seen in earlier small studies. 4 Even if DHEA is not strong enough to completely control symptoms of SLE on its own, it might allow a reduction in dosage of the more dangerous standard medications. In addition, it might directly help offset some of the side effects of corticosteroid treatment, such as accelerated osteoporosis, although the evidence for this benefit remains weak and inconsistent. 5 A 2007 review of all published studies found that use of DHEA may meaningfully improve quality of life in the short term for people with lupus, but that it probably does not alter the long-term course of the disease. 6

Osteoporosis

DHEA appears to be helpful for osteoporosis in older women. A double-blind, placebo-controlled trial of 280 men and women ranging in age from 60 to 79 years evaluated the effects of 50 mg of DHEA daily for 1 year. 7 The results suggest that DHEA can fight osteoporosis in women over 70. However, younger women did not respond to treatment with DHEA.

Other clinical trials have also found evidence that DHEA has a positive effect on bone density in older women. 8 However, so far DHEA has failed to demonstrate a significant bone-sparing effect in older men. 9 DHEA might be helpful for preventing osteoporosis in women with anorexia . Women with this condition often experience bone loss, at least in part due to a decrease in estrogen levels. In a 1-year, double-blind study, women with anorexia were randomly assigned to receive either DHEA at a dose of 50 mg per day or standard hormone replacement therapy. 10 The results showed equivalent bone preservation in both groups. However, because there is considerable doubt whether hormone replacement therapy is helpful for preventing bone loss caused by anorexia, 11 these results mean relatively little.

Adrenal Insufficiency

Two double-blind trials support adding DHEA to the usual hormone regimen for adrenal failure. One double-blind, placebo-controlled crossover trial evaluated the effects of DHEA in 24 women with this condition. The results showed that DHEA at a dose of 50 mg daily improved sexual function, feelings of overall well-being, and cholesterol levels during a 4-month treatment period. 12 Another double-blind crossover trial enrolled 39 men and women and found improvements in general feelings of well-being, mood, and energy level over a 3-month treatment period. 13 However, another double-blind study failed to find benefit with a dose of 25 mg daily. 14

Improving Libido and Sexual Function in Women

Some evidence suggests that DHEA may be helpful for improving sexual function in older women, but not for younger women.

The 1-year, double-blind, placebo-controlled trial of 280 men and women previously described in the Osteoporosis section also looked for effects on sexual function. 15 The results indicate that for women over 70, daily use of DHEA at 50 mg improves libido. Neither men nor younger women responded. Two other studies did not find benefit, but they enrolled much fewer people and also ran for a shorter time. 16 Two small, double-blind, placebo-controlled studies tested whether a one-time dose of DHEA at 300 mg could increase sexual arousability in pre- or postmenopausal women respectively. 17 The results again indicate that DHEA is effective for older women but not for younger women.

Improving Sexual Function in Men

A double-blind, placebo-controlled study enrolled 40 men with erectile dysfunction who also had low measured levels of DHEA. 18 The results showed that DHEA at a dose of 50 mg daily significantly improved sexual performance; however, the authors failed to provide a statistical analysis of the results, making the meaningfulness of this study impossible to determine.

Sports Performance Enhancement

A small double-blind study found no performance enhancement with DHEA at a dose of 150 mg per day for men undergoing weight training. 19 In addition, a 12-week, double-blind study of 40 trained male athletes given either DHEA or androstenedione at 100 mg daily found no improvement in lean body mass or strength, or change in testosterone levels. 20 A a 12-month, double-blind, placebo-controlled crossover trial of 16 people aged 50 to 65 found some evidence of fat loss and strength improvement in the male participants during the period in which they received 100 mg of DHEA daily. 21 No improvement was seen in female participants.

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References

  1. Mease PJ, Merrill JT, Lahita R, et al. GL701 (prasterone, dehydroepiandrosterone) improves or stabilizes disease activity in systemic lupus erythematosus. Presented at: The Endocrine Society's 82nd Annual Meeting; June 21-24, 2000; Toronto, Canada.
  2. Chang DM, Lan JL, Lin HY, Luo SF. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 46(11):2924-7.
  3. Nordmark G, Bengtsson C, Larsson A, Karlsson FA, Sturfelt G, Rönnblom L. Effects of dehydroepiandrosterone supplement on health-related quality of life in glucocorticoid treated female patients with systemic lupus erythematosus. Autoimmunity. 38(7):531-40.
  4. van Vollenhoven RF, Morabito LM, Engleman EG, McGuire JL. Treatment of systemic lupus erythematosus with dehydroepiandrosterone: 50 patients treated up to 12 months. J Rheumatol. 25(2):285-9.
  5. Robinzon B, Cutulo M. Should dehydroepiandrosterone replacement therapy be provided with glucocorticoids? Rheumatology (Oxford). 1999;38:488-495.
  6. Crosbie D, Black C, McIntyre L, Royle PL, Thomas S. Dehydroepiandrosterone for systemic lupus erythematosus. Cochrane Database Syst Rev. (4):CD005114.
  7. Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA. 2000;97:4279-4284.
  8. Greendale GA, Edelstein S, Barrett-Connor E. Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study. J Bone Miner Res. 1997;12:1833-1843.
  9. Kahn AJ, Haloran B. Dehydroepiandrosterone supplementation and bone turnover in middle-aged to elderly men. J Clin Endocrinol Metab. 2002;87:1544-1549.
  10. Gordon CM, Grace E, Emans SJ, Feldman HA, Goodman E, Becker KA, Rosen CJ, Gundberg CM, LeBoff MS. Effects of oral dehydroepiandrosterone on bone density in young women with anorexia nervosa: a randomized trial. J Clin Endocrinol Metab. 87(11):4935-41.
  11. Klibanski A, Biller BM, Schoenfeld DA, Herzog DB, Saxe VC. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab. 80(3):898-904.
  12. Arlt W, Callies F, van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte HM, Allolio B. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. 341(14):1013-20.
  13. Hunt PJ, Gurnell EM, Huppert FA, Richards C, Prevost AT, Wass JA, Herbert J, Chatterjee VK. Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double blind trial. J Clin Endocrinol Metab. 85(12):4650-6.
  14. Løvås K, Gebre-Medhin G, Trovik TS, Fougner KJ, Uhlving S, Nedrebø BG, Myking OL, Kämpe O, Husebye ES. Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial. J Clin Endocrinol Metab. 88(3):1112-8.
  15. Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA. 2000;97:4279-4284.
  16. Morales AJ, Nolan JJ, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab. 78(6):1360-7.
  17. Hackbert L, Heiman JR. Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. J Womens Health Gend Based Med. 11(2):155-62.
  18. Reiter WJ, Pycha A, Schatzl G, Pokorny A, Gruber DM, Huber JC, Marberger M. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study. Urology. 53(3):590-4; discussion 594-5.
  19. Brown GA, Vukovich MD, Sharp RL, Reifenrath TA, Parsons KA, King DS. Effect of oral DHEA on serum testosterone and adaptations to resistance training in young men. J Appl Physiol. 87(6):2274-83.
  20. Wallace MB, Lim J, Cutler A, Bucci L. Effects of dehydroepiandrosterone vs androstenedione supplementation in men. Med Sci Sports Exerc. 31(12):1788-92.
  21. Morales AJ, Haubrich RH, Hwang JY, Asakura H, Yen SS. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxf). 49(4):421-32.