Dehydroepiandrosterone (DHEA) is an endo-genous, steroid hormone that many people consider to be the modern-day Fountain of Youth. It’s widely marketed as an alternative means of perking up a lagging libido, building muscle, and even reversing the effects of aging. DHEA is produced by human adrenal glands and is secreted in the testes in men. It can be converted into the primary sex hormones—testosterone and estrogen.1

Scientists don’t yet know everything about how DHEA works in the body, but it’s clear that DHEA levels peak when we’re in our 20s and then go into a steady decline.


Background


DHEA quickly became a controversial research topic when it was discovered in the 1930s.1 Scientists felt certain they had stumbled upon the perfect anti-aging compound. Unfortunately, regulatory agencies saw the potential for abuse, and the FDA banned the sale of DHEA supplements in 1985. Although this ban was subsequently lifted in 1994, many sports organizations — including the National Football League, National Basketball Association and National Collegiate Athletic Association — still forbid the use of DHEA supplements.2

Science


In spite of DHEA’s potential, there are very few human trials documented before the 1990s, and none large enough to yield statistical significance.2 In addition, there are no studies to date on the long-term effects of DHEA.2 But as a precursor to the dominant sex hormones, DHEA can cause higher-than-normal levels of androgens and estrogens in the body, thus potentially increasing the risk of hormone-sensitive cancers, such as prostate, ovarian and breast cancers. 


Initial research on DHEA supplementation (DHEA-S) in schizophrenia patients shows some benefits in the management of anxiety and depressive symptoms. In a randomized, double-blind study investigating the effects of DHEA administration on medication-induced extrapyramidal symptoms (EPS) in schizophrenics, DHEA-S appeared to have a significant effect on EPS with marked improvement in Parkinsonian symptoms.3

Collective research has suggested that DHEA-S may have adverse cognitive effects in postmenopausal women. In an analysis of 24-hour measurements of endogenous DHEA and DHEA-S, investigators from the Department of Neurology at the University of North Carolina at Chapel Hill, found an increase in negative associations between DHEA-S levels and cognition, suggesting a correlation between exogenous DHEA and impaired cognition.4

A recent review assessing the benefit of DHEA-S on muscle strength and physical functioning in adults older than age 50 years, was inconclusive.5 Several studies examined varying measures of muscle strength — handgrip, chest press, leg press, knee extension and flexion — and showed no substantive differences between the DHEA-S cohort and controls for any endpoint.5

DHEA and circulating sex hormones (endogenous and exogenous) have also been linked to a decreased risk of heart disease. In one study, more than 2,000 middle-aged white men with no known cardiovascular disease (CVD) at baseline were enrolled in a 10-year study. Participants were tested for a multitude of indices, which were later correlated with any development of CVD during the trial. In this large, community-based sample, the findings indicated that higher endogenous serum estradiol levels — as would be seen with DHEA-S — were consistent with a lower risk of CVD.6

One trial tested the effect of DHEA-S in patients with systemic lupus erythematosus (SLE).7 Prior studies evaluating the impact of DHEA-S in SLE patients were inconsistent in their findings. This review also failed to find evidence to substantiate or refute the benefits of DHEA-S in this patient population.

The trial demonstrated improved quality-of-life scores and a reduction in flares in the DHEA cohort, but up to 30% of participants dropped out of the study prior to conclusion. The potential negative effects in the DHEA group included a lowering of serum HDL, a known antioxidant.7

Safety, interactions


In recommended doses, few side effects were reported when DHEA-S were administered orally. Common side effects include fatigue, headache, tachycardia, nasal congestion and acne.2 For women, the most common side effects are abnormal menses, emotional changes, headache and insomnia. Patients with a history of heart disease, abnormal heart rhythms, hypercoagulability and liver disease should avoid DHEA-S. DHEA-S is not recommended for pregnant or lactating women.2

How supplied, dosage


DHEA is supplied in capsules, tablets and injections. Dose-range recommendations are from 25 mg to 250 mg daily. A 5% to 10% topical cream containing DHEA is also available for daily use.


Summary


While there is the potential for substantive health benefits with DHEA-S, the lack of consistent, positive clinical trial data at present makes this a weak therapeutic choice. DHEA-S may be a star of the future, but it is not shining brightly enough for selection at this time.

Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.

References


  1. About herbs, botanicals and other products:
dihydroepiandrosterone page. Memorial Sloan Kettering Cancer Center website.
  2. DHEA page. Mayo Clinic website. 
  3. Nachshoni T, Ebert T, Abramovitch Y et al. Improvement of extrapyramidal symptoms following 
dehydroepiandrosterone (DHEA) administration 
in antipsychotic treated schizophrenia patients: A 
randomized, double-blind placebo controlled trial. Schizophr Res. 2005;79:251-256.

  4. Parsons TD, Kratz KM, Thompson E et al. DHEA 
supplementation and cognition in postmenopausal women. Int J Neurosci. 2006;116:141-155.

  5. Baker W, Karan S, Kenny AM. Effect of dehydro-
epiandrosterone on muscle strength and 
physical function in older adults: A systematic review. 
J Am Geriatr Soc. 2011;59:997-1002.

  6. Arnlöv, J,Pencina MJ, Amin S et al. Endogenous sex 
hormones and cardiovascular disease incidence in men. Ann Intern Med. 2006;145:176-184.

  7. Sawalha AH, Kovats S. Dehydroepiandrosterone in systemic lupus erythematosus. Curr Rheumatol Rep. 2008;10:286-291.

  8. All electronic documents accessed on October 1, 2012.