The dietary supplement dehydroepiandrosterone (DHEA) is attracting a great deal of attention these days because of the key role it plays in human metabolism of steroid hormone production. DHEA is a major precursor of both testosterone and estrogen.1 Consequently, people from athletes to aging men and women are eagerly experimenting with this nutraceutical to improve performance on the court, in the workplace, and in the bedroom.
Science
DHEA is produced in the adrenal glands and liver. In men, it is also released from the testes.1 Specified cells and organs convert DHEA into androstenedione, the main precursor of androgens and estrogens. DHEA levels are higher in men and peak at about age 20 years. Oral supplementation of DHEA tends to have a more significant effect on circulating hormone levels in women. The reasons for this effect are not well understood.1
DHEA supplementation is primarily sought after as a way to enhance or replace the normal functions of androgens. Claims made by the manufacturers of DHEA supplements include enhanced muscle-building, increased vitality, and improved sexual function (both libido and performance).
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Most clinical studies of DHEA have been small with weak statistical significance. One trial involved 24 healthy young men who were randomized to either placebo or DHEA supplementation. After a seven-day course of therapy, mood and memory were measured by visual analogue scales and found to be improved in the treatment group.2
Another study examining the effect of DHEA on mood randomized 23 men and 23 women aged 45-65 years with diagnoses of major or minor midlife depression. At baseline and after six weeks of monotherapy with DHEA supplementation, mood was evaluated using the Hamilton Depression Rating Scale. A 50% or greater reduction in depression rating scores was noted in 23 subjects in the treatment arm, compared with 13 subjects in the placebo group.3
A study to explore the antioxidant capacity of DHEA randomized 24 men with elevated serum cholesterol levels to placebo or DHEA treatment. After 12 weeks, flow-mediated dilation of the brachial artery and plasma levels of plasminogen activator (a prothrombotic chemical) were significantly decreased in the DHEA treatment group. These findings suggest a positive impact of DHEA on mitigating cardiovascular damage from aging and other oxygen-free-radical-producing conditions.4
A trial of 73 assisted pregnancies supplemented with DHEA found a statistically significant lower miscarriage rate than in assisted pregnancies that were not supplemented.5,6 Supplementation also improved ovulation and pregnancy rates in women previously diagnosed with diminished ovarian reserve or premature ovarian failure.5,6
A randomized, placebo-controlled, double-blinded study involved 87 elderly men and 57 elderly women with confirmed low serum levels of DHEA. The men were randomized to placebo, supplemental testosterone, or DHEA, and the women received either placebo or DHEA. End measurements included quality of life, physical performance, body fat percentage, and bone mineral density. Results showed no significant improvement in the DHEA-supplemented groups when compared with placebo.7
Australian researchers presented a literature review of 26 clinical studies examining DHEA supplementation and its effects on women’s sexual function and feelings of wellbeing. Findings indicated a lack of quality clinical trials, not only for efficacy but for safety as well.8,9
Safety, drug interactions
DHEA is safe in small doses for short periods of time. However, pregnant or lactating women should avoid it because of its androgenic effects. DHEA is not recommended for use in children.1 DHEA is a cytochrome P450 inhibitor, and may increase circulating levels of drugs metabolized via this enzyme system.1 Because of its estrogen-agonist activity, DHEA should not be used in combination with any anti-estrogen medications or when breast or endometrial cancer is suspected.1 Since DHEA is also androgenic, it should not be used if prostate cancer is a concern. The proven lack of consistency in the quality of supplements is a crucial safety concern.1
Dosage, cost, and how supplied
Dose ranges vary but settle around 50 mg/day.1 DHEA is typically supplied in capsule form. A one-month supply of 50-mg capsules costs approximately $25.
Summary
To date, DHEA has failed to show efficacy in the most sought-after areas (physical performance, sexual performance, and anti-aging). With the exception of the promising fertility data, DHEA appears to have no viable use as a supplement in the primary-care population and should not be recommended. n
References
1. Natural Standard Monograph (2010). DHEA. Natural Standard, Inc. Medicines Comprehensive Database.
2. Alhaj HA, Massey AE, McAllister-Williams RH. Effects of DHEA administration on episodic memory, cortisol and mood in healthy young men: A double-blind, placebo-controlled study. Psychopharmacology (Berl). 2006;188:541-551.
3. Schmidt PJ, Daly RC, Bloch M, et al. Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression. Arch Gen Psychiatry. 2005;62:154-162. Available at archpsyc.ama-assn.org/cgi/content/full/62/2/154.
4. Kawano H, Yasue H, Kitagawa A, et al. Dehydroepiandrosterone supplementation improves endothelial function and insulin sensitivity in men. J Clin Endocrinol Metab. 2003;88:3190-3195. Available at jcem.endojournals.org/cgi/content/full/88/7/3190.
5. Gleicher N, Ryan E, Weghofer A, et al. Miscarriage rates after dehydroepiandrosterone (DHEA) supplementation in women with diminished ovarian reserve: a case control study. Reprod Biol Endocrinol. 2009;7:108. Available at www.rbej.com/content/7/1/108.
6. Mamas L, Mamas E. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Curr Opin Obstet Gynecol. 2009;21:306-308.
7. Nair KS, Rizza RA, O’Brien P, et al. DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med. 2006;355:1647-1659.
8. Grimley Evans J, Malouf R, Huppert F, van Niekerk JK. Dehydroepiandrosterone (DHEA) supplementation for cognitive function in healthy elderly people. Cochrane Database Syst Rev. 2006;4:CD006221.
9. Panjari M, Davis SR. DHEA therapy for women: effect on sexual function and wellbeing. Hum Reprod Update. 2007;13:239-248. Available at humupd.oxfordjournals.org/cgi/content/full/13/3/239.
All electronic documents accessed June 16, 2010.
