On The Shelf
Mickie Cathers
DHEA supplements are advertised as an antidote to aging. Products on store shelves also purport that DHEA supports immune balance, metabolism, sexual health, mood, and bone and cardiovascular health. What is DHEA and what does it really do?
Background
DHEA (dehydroepiandrosterone) is an abundant steroid hormone in the human body, mainly synthesized in the adrenal glands and the liver. Several tissues, including the brain, liver, kidney, and gonads metabolize DHEA to biologically active steroids, such as testosterone and estrogen. More than 30% of total androgen in men and over 90% of estrogen in postmenopausal woman is derived from the conversion of DHEA in the body.
If DHEA is produced naturally in the body, why should anyone take it as a supplement? Though one of the most plentiful circulating hormones in the human body, DHEA does begin to decrease around age 30 years; diminishing by up to 80% throughout adulthood. Decreased levels of DHEA are associated with various pathophysiological conditions related to aging, such as lower bone density, as well as adrenal insufficiency, acute stress, and other severe systemic diseases. Low DHEA levels have also been associated with heart disease, depression, and mortality.
Is there a benefit?
Research shows that DHEA has a wide range of effects on numerous organs and organ systems and supports the use of DHEA in individuals with adrenal insufficiency as well as patients with depression and associated cognitive disorders. For those with adrenal insufficiency, in which the adrenal glands can’t produce normal amounts of hormones, some research indicates DHEA may improve quality of life. DHEA may improve aspects of sexual function, including libido and fertility in women with benefits primarily seen in those with sexual disorders. Prescription DHEA is available to address vaginal tissue thinning.
Many preclinical studies have reported that DHEA has preventive and therapeutic efficacy against cancer, atherosclerosis, diabetes, obesity, and excess glucocorticoid exposure. However, few clinical trials clearly substantiate the beneficial effect of DHEA as a dietary supplement. Due to inadequate sample sizes and treatment durations, the safety and efficacy of DHEA warrants further investigation to draw reliable conclusions for the physiological role, optimal dosage, and effects of these steroid hormones.
Several studies have examined whether DHEA can improve bone density and body composition. A November 2020 meta-analysis by Wang and colleagues in Steroids reviewed 21 randomized clinical trials evaluating DHEA supplementation on body composition, including bone mineral density, lean body mass, and BP. Results revealed DHEA did not affect body weight or BP. While the researchers found DHEA supplementation may increase lean body mass and decrease fat mass, they wrote “there is not sufficient magnitude to recommend DHEA supplementation as a tool to improve body composition.”
Dosage and availability
DHEA was previously marketed for weight loss and banned by FDA in 1985, only to again be widely available in health food stores and online as tablets and capsules ranging from 10 mg to 500 mg since the passage of the Dietary Supplement Health and Education Act of 1994. DHEA remains banned by the International Olympic Committee and the National Collegiate Athletic Association. The standard dosage in many clinical studies is 50 mg/day to 100 mg/day.
What to tell your patients
In general, young and healthy individuals produce DHEA naturally and supplementation is unnecessary. Older adults and those with certain adrenal, sexual, or fertility issues should talk with their health care providers before using DHEA. DHEA supplements have been safely used for up to two years in research studies in doses of 50 mg daily without severe adverse effects. Mild adverse effects have included upset stomach, acne, and increased hair growth in the armpits and pubic area. DHEA should not be taken by individuals with cancers affected by sex hormones, or those using medications changed by the liver, medications for depression, or anticoagulants. ■