HOW USEFUL IS DHEA AS A SUPPLEMENT?

neil.burman@gmail.com  Cape Town

DHEA PRASTERONE- THE PARENT SEX HORMONE :

Steroid physiology course 101 teaches that our bodies convert vitamin C to cholesterol and then PREGNENOLONE – the progenitor  of the human adrenal and gonadal steroid hormones. that are formed also in our liver, skin and brain. In turn this grandparent steroid produces PROGESTERONE (- one of the three prime sex hormones- and thence also some the anti-inflammatory (cortisones) sex hormones and the salt-controlling steroid mineralocorticoids: and 

 DHEA – dehydroepiandrosterone, prasterone – an important sex steroid in its own right, and one of the parents of the main androgen-TESTOSTERONE – and the ESTROGENS.

The above steroid hormones are distinct from the other human steroid hormones, the calciferols (vitamin D) which we make in the skin; and the heart-formed glycosides, which regulate and strengthen the failing heart and may suppress some cancers.

DHEA is by far the most abundant blood steroid hormone, peaking at around 30 years of age, then like most dropping by up to 95% into old age,. DHEA seems to be as a resevoir for our needed androgen and estrogens.

USE AS  HRT sex steroid hormone replacement/therapy:  There was high hope that DHEA would prove major benefit for many diseases including the major degenerative diseases of aging, systemic lupus, etc; but this has not been confirmed by trials and experience except for osteoporosis in androgen-deficient women. .

The Mayo, Creighton and Cleveland Clinic websites give   it a cautious but doubtful nod.

RECENT TRIAL EXPERIENCE: Judith Rabkin ea  2006 showed significant improvement in non-major mood depression in AIDS cases.

Labrie 2007 showed that DHEA in women preferentially boosts androgen rather than estrogen levels- which explains its energizing and bone-strengthening benefits in women with low androgens ie estrogen dominance.

 The last trials of DHEA in osteoporosis (Jankowski 2008 ; von Muhlen 2008) in the elderly showed improvement in women. So this is a potential use in the old.

The two trials published this year of DHEA in systemic lupus (Marder USA and Hartkamp Netherlands) also failed to show significant benefits.

 Review by Panjari and Sue Davis 2010 from Monash University found no significant role for oral DHEA in women.

PERSONAL PRACTICAL EXPERIENCE AND CONCLUSION: The only time DHEA is often worth trying, helpful is in the frail elderly – biologically old  or past the mid-sixties- with low bloodpressure, low energy, wasting or inflammatory disease, osteoporosis. In such patients one is for obvious reasons very cautious about starting even non-oral testosterone in men, and appropriate ie non-oral testosterone/estradiol/estriol in women. One soon sees whether any dose has any benefit, as compared to balanced titrated testosterone-estradiol-progesterone.

Dr Lee Vliet (endocrinologist in Tucson, Arizona) starts DHEA as low as about 1mg a day ie a quarter or 1/8th of a 25mg tablet to start, repeating the dose every few days and then gradually up to 1/4 to /2 to 1 – 2tabs a day.

The difficulty is the unpredictability of whether metabolism to androgens and estrogens will be balanced, or cause adverse effects through imbalance. Such adversity can be better minimized by using separate non-oral daily testosterone and estrogens, but obviously these are both more emotive and more potent, with sexual overtones that the aged often dont want.

For the frail and old, or those concerned about androgenic/estrogenic adverse effects, an even safer alternative is the human metabolite 7 keto DHEA , which is also like DHEA generally available over the counter. It reputedly cannot be metabolized back to androgen and thus estrogen. Ihler 2003 suggested it useful as a thermogenic agent for Raynaud’s phenomenon ie periodic white cold digits; Some consider it no different from DHEA, some stronger; and worth trying for weight loss.

Overall, DHEA supplement may be useful, but only in the elderly.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s