DHEA

Dehydroepiandrosterone (DHEA)

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.

Men

  • Range 100-600
  • Optimal 500-600

Women

  • Range 50-300
  • Optimal 200-250

*Dose based on side effects as these are much more common in women than men

DHEA Replacement
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.   

Dosing:
Men

  • Capsule – SR micronized
  • 50 mg QAM
  • >200 lbs 75-100 mg QAM

Women

  • Capsule – SR micronized
  • 10 mg QAM if over 40 years old
  • 15 mg QAM if over 50 years old
  • 25 mg QAM if over 60 years old

Indications for DHEA Replacement:

  • Low levels
  • Chronic disease
  • Adrenal exhaustion
  • Prolonged corticosteroid therapy
  • Systemic Lupus Erythematosus (SLE)
  • Improving bone density
  • Improving depression and mood disorders
  • Patients with suppressed immune system
  • BHRT optimization for age management program

Contraindications
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.