DHEA is an endogenous steroid primarily secreted by the adrenal gland that causes a shift in cells from a state of protein break down or a catabolic state to a protein building or anabolic state. It is also made in the brain. DHEA is an endocrine precursor to other hormones and leads to the productions of male and female sex hormones including androgens (testosterone) and estrogens. Because of this, one of the side effects of DHEA is that it raises testosterone levels slightly in men and women, while raising estradiol levels slightly in men.
Levels of DHEA in the body begin to decrease around age thirty. Prescribing DHEA replacement is not recommended until around or after age forty due to sensitivity causing side effects. DHEA is a very important agent in age management medicine and helps to slow the aging process by affecting various parts of the body in many different ways.
Benefits of DHEA Replacement:
DHEA plays a large role in reducing cardiovascular risk. By inhibiting synthesis of thromboxane A2, reducing plasminogen activator inhibitor, and reducing tissue plasminogen activator it decreases platelet aggregation and ischemia. DHEA also reduces insulin requirement and increases lipolysis, which decreases visceral and subcutaneous body fat. This helps prevent conditions such as metabolic syndrome and diabetes. By preventing lipid peroxidation, DHEA is considered an antioxidant and decreases cholesterol while stimulating the immune system. It also activates T-cells, which helps to enhance the immune system. By doing so, DHEA improves well-being, mood, memory, sleep, and energy levels. DHEA has also been found to increase bone density and increase serum osteocalcin, a marker of bone formation, thus, preventing and treating osteoporosis. In addition, it increases sexual vitality by improving erectile dysfunction.
Prasterone, or GL701, is a pure pharmaceutical form of DHEA and a mild androgen. A study was done in patients with systemic lupus erythematosus (SLE) on a trial dose of 200 mg/day of prasterone. It was found to decrease levels of the proinflammatory cytokines interleukin 6 and tumor necrosis factor-alpha. By doing so, prasterone improved patient’s symptoms of arthritis and fatigue, improved their quality of life, and decreased disease flares. A 2% increase in bone mineral density was also discovered in the spine of patients on active treatment.
Because DHEA affects so many different parts of the body and helps patients overall health and well being it has been referred to as “the hormone that does it all,” “the mother of all hormones,” and a hormone with “super hormone promise.” It is being studied in the prevention and treatment of cancer, Alzheimer’s disease, immune system disorders including acquired immunodeficiency syndrome and chronic fatigue. It is also being investigated as an anti-aging hormone.
Measuring DHEA Levels
DHEA-S is the active molecule of DHEA and should be measured rather than DHEA. Levels should be monitored monthly until optimal levels are reached. Afterwards, levels may be checked semi-annually.
*Dose based on side effects as these are much more common in women than men
DHEA has a very short half-life. Over the counter supplementation should be taken three times a day while prescribed, sustained release DHEA can be taken once a day. Recommended dosages vary from person to person and depend on a patient’s tolerance of the medication. Side effects are much more common in women than men and include acne and hirsutism or excess, abnormal growth of unwanted hair on the face and/or body. These side effects can be treated by adjusting the dose, decreasing the frequency of the dose, or putting the patient on Spironolactone 100mg daily. Patients with occult or undiagnosed polycystic ovarian syndrome (PCOS) may be more prone to develop acne or hirsutism when placed on any androgen such as DHEA or testosterone. DHEA can be taken orally or applied transdermally. However, it is recommended to use it orally due to the high dose that is needed for transdermal DHEA to take effect. Serum levels only take approximately 2 weeks to return to those found in young adults. Results should be seen around this time.
Indications for DHEA Replacement:
DHEA is contraindicated in patients with sex hormone responsive tumors of the breast, ovaries, uterus, and prostate. This is due to the fact that it can potentially increase sex hormones in both men and women.