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 DHEA
  • DHEA

  • DHEA

    Background

    DHEA () is an endogenous hormone (made in the human body) secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). DHEA levels in the body begin to decrease after age 30, and are reported to be low in some people with anorexia, end-stage kidney disease, type 2 diabetes (non-insulin dependent diabetes), AIDS, adrenal insufficiency, and in the critically ill. DHEA levels may also be depleted by a number of drugs, including insulin, corticosteroids, opiates, and danazol.
    There is sufficient evidence supporting the use of DHEA in the treatment of adrenal insufficiency, depression, induction of labor, and systemic lupus erythematosus.
    There is a lack of available studies on the long-term effects of DHEA. However, DHEA may cause higher than normal levels of androgens and estrogens in the body, and theoretically may increase the risk of prostate, breast, ovarian, and other hormone-sensitive cancers. Therefore, it is not recommended for regular use without supervision by a licensed healthcare professional.

    Synonyms

    5-androsten-3 β-ol-17-one, 19-norandrostenediol, 19-norandrostenedione, androstenediol, androstenedione, C19 steroid, clenbuterol, clostebol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, DHA, DHAS, DHEA-enanthate, DHEA-FA, DHEA-S, DHEAS, DS, 7-KETO DHE, 7-oxo-DHEA, fenoterol, fluoxymesterone, mesterolone, metandienone, metenolone (metheneolone), methandriol, methyltestosterone, nandrolone, norethandrolone, oxandrolone, oxymesterone, oxymetholone, stanozolol, testosterone, the mother steroid, trenbolone, prasterone.
    Note: DHEA can be synthesized in a laboratory using wild yam extract. However, it is believed that wild yam cannot be converted into DHEA by the body. Therefore, information that markets wild yam as a "natural DHEA" may be inaccurate.

    Evidence

    These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

    Uses based on scientific evidence Grade*
    Adrenal insufficiency Several studies suggest that DHEA may improve well-being, quality of life, exercise capacity, sex drive, and hormone levels in people with insufficient adrenal function (Addison''s disease). Though promising, additional study is needed to make a strong recommendation. Adrenal insufficiency is a serious medical condition and should be treated under the supervision of a qualified healthcare professional, including a pharmacist. B
    Depression The majority of clinical trials investigating the effect of DHEA on depression support its use for this purpose under the guidance of a specialist. Further research is needed to confirm these results. B
    Obesity The majority of clinical trials investigating the effect of DHEA on weight or fat loss support its use for this purpose. Further research is needed to confirm these results. B
    Systemic lupus erythematosus The majority of clinical trials investigating the effect of DHEA for systemic lupus erythematosus support its use as an adjunct treatment. Additional study is needed to confirm these results. B
    Aging DHEA may offer some benefit to individuals in terms of aging. Small increases in bone mineral density have been seen, but more study is needed to confirm these findings. C
    Alzheimer''s disease Initial research reports that DHEA does not significantly improve cognitive performance or change symptom severity in patients with Alzheimer''s disease, but some experts disagree. Additional study is warranted in this area. C
    Bone density The ability of DHEA to increase bone density is under investigation. Effects are not clear at this time. C
    Cardiovascular disease Initial studies report possible benefits of DHEA supplementation in patients with cholesterol plaques ("hardening") in their arteries. There is conflicting scientific evidence regarding the use of DHEA supplements in patients with heart failure or diminished ejection fraction. Other therapies are more proven in this area, and patients with heart failure or other types of heart disease should discuss treatment options with a cardiologist. C
    Cervical cancer Initial research reports that the use of intravaginal DHEA may be safe and may promote regression of low-grade cervical lesions. However, further study is necessary in this area before a firm conclusion can be drawn. Patients should not substitute the use of DHEA for more established therapies, and they should discuss management options and follow-up with a primary healthcare professional or gynecologist. C
    Chronic fatigue syndrome The scientific evidence remains unclear regarding the effects of DHEA supplementation in patients with chronic fatigue syndrome. Better research is necessary before a clear conclusion can be drawn. C
    withdrawal Preliminary study shows that DHEA is not beneficial in treating cocaine dependence, but further study is needed before a firm conclusion can be drawn. C
    Critical illness Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in critically ill patients. At this time, it is recommended that severe illness in the intensive care unit be treated with more proven therapies. C
    Crohn''s disease Initial research reports that DHEA supplements are safe for short-term use in patients with Crohn''s disease. Preliminary research suggests possible beneficial effects, although further research is necessary before a clear conclusion can be drawn. C
    Dementia Early evidence gives conflicting results as to whether DHEA offers benefit to individuals with dementia. C
    Heart failure There is conflicting scientific evidence regarding the use of DHEA supplements in patients with heart failure. Other therapies are proven in this area, and patients with heart failure or other types of heart disease should discuss treatment options with a cardiologist. C
    HIV/AIDS Although some studies suggest that DHEA supplementation may be beneficial in patents with HIV, results from different studies do not agree with each other. There is currently not enough scientific evidence to recommend DHEA for this condition, and other therapies are more proven in this area. C
    Induction of labor Preliminary evidence suggests that DHEA may help to induce labor. Further research is needed and people who are pregnant should not self-treat. C
    Infertility DHEA supplementation may be beneficial in women with ovulation disorders. There is currently not enough scientific evidence to form a clear conclusion about the use of DHEA for this condition. C
    Menopausal disorders Many different aspects of menopause have been studied using DHEA as a treatment, such as vaginal pain, osteoporosis, hot flashes, emotional disturbances such as fatigue, irritability, anxiety, depression, insomnia, difficulties with concentration and memory, or decreased sex drive (which may occur near the time of menopause). Study results disagree and additional study is needed in this area. C
    Myotonic dystrophy There is conflicting scientific evidence regarding the use of DHEA supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn. C
    Ovulation disorders Low-quality studies suggest that DHEA supplements may benefit women with ovulation disorders. However, results of research in this area are conflicting, and safety is not established. C
    Partial androgen deficiency Restoring DHEA levels to young adult values seems to benefit the age-related decline in physiological functions. However, additional study is required to confirm these preliminary results. C
    Psoriasis Study results suggest that DHEA offers no benefit to individuals with psoriasis, but some disagree. Additional study is needed before a firm recommendation can be made. C
    Rheumatoid arthritis Preliminary evidence from a case series suggests that DHEA likely offers no benefit to individuals with rheumatoid arthritis. Well-designed clinical trials with appropriate endpoints are required before a strong recommendation can be made. C
    Schizophrenia Initial research reports benefits of DHEA supplementation in the management of negative, depressive, and anxiety symptoms of schizophrenia. Some of the side effects from prescription drugs used for schizophrenia may also be relieved. Further study is needed to confirm these results before a firm conclusion can be drawn. C
    Septicemia (serious bacterial infections in the blood) Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in septic patients. At this time, more proven therapies are recommended. C
    Sexual function / libido / erectile dysfunction The results of studies vary on the use of DHEA in erectile dysfunction and sexual function, in both men and women. Better research is necessary before a clear conclusion can be drawn. C
    Sjogren''s syndrome DHEA showed no evidence of efficacy in Sjogren''s syndrome in preliminary study. Without evidence for efficacy, patients with Sjogren''s syndrome should avoid using unregulated DHEA supplements, since long-term adverse consequences of exposure to this hormone are unknown. Further research is needed in this area. C
    Skin aging Preliminary study suggests the possibility of using DHEA topically as an anti-skin aging agent. Further research is needed to confirm these results. C
    Fibromyalgia (postmenopause) DHEA does not seem to improve quality of life, pain, fatigue, cognitive function, mood, or functional impairment in fibromyalgia. D
    Immune system stimulant It is suggested by some textbooks and review articles that DHEA can stimulate the immune system. However, current scientific evidence does not support this claim. D
    Memory Studies of the effects of dehydroepiandrosterone (DHEA) on cognition have produced complex and inconsistent results. Additional study is warranted in this area. D
    Muscle strength Many study results in this area conflict but overall the current available evidence in this area is negative. Further research is needed before firm conclusions can be drawn D
    *Key to grades
    A: Strong scientific evidence for this use;
    B: Good scientific evidence for this use;
    C: Unclear scientific evidence for this use;
    D: Fair scientific evidence against this use;
    F: Strong scientific evidence against this use.

    Grading rationale

    Uses based on tradition or theory

    The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

    Adrenoleukodystrophy, allergic disorders, amenorrhea associated with anorexia, andropause/andrenopause, angioedema, antioxidant, antiviral, anxiety, arthritis, asthma, bladder cancer, breast cancer, burns, colon cancer, diabetes, fatigue, hair loss, heart attack, high cholesterol, Huntington''s disease, hypopituitarism, influenza, joint diseases, lipodystrophy in HIV, liver protection, malaria, malnutrition, movement disorders, multiple sclerosis, osteoporosis, pancreatic cancer, Parkinson''s disease, performance enhancement, platelet aggregation, pneumonia, polycystic ovarian syndrome, post-traumatic stress disorder (PTSD), premenstrual syndrome, prostate cancer, quality of life, Raynaud''s disease, skin disorders, skin graft healing, sleep disorders, stress, tetanus, thymic regeneration, trauma, ulcerative colitis, viral encephalitis.

    Dosing

    The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

    Adults (18 years and older)
    DHEA is available as capsules, tablets, and injections. Commonly used doses range from 25-200 milligrams daily. Higher doses of 200-500 milligrams per day have been studied for depression in HIV/AIDS. Daily use of DHEA has been studied up to one year in the available scientific studies.
    Topical (on the skin) and intravenous injections (into the veins) have also been studied, but safety and effectiveness has not been proven. A 5-10% cream containing DHEA has been used up to four weeks.
    Children (younger than 18 years)
    The dosing and safety of DHEA are not well studied in children. In theory, DHEA could interfere with normal hormone balance and growth in children.

    Safety

    The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

    Allergies
    Patients should avoid if allergic to DHEA products.
    Side Effects and Warnings
    Few side effects are reported when DHEA supplements are taken by mouth in recommended doses. Side effects may include nausea, abdominal discomfort, fatigue, nasal congestion, headache, acne, or rapid/irregular heartbeats. In women, the most common side effects are abnormal menses, emotional changes, headache, and insomnia. Individuals with a history of abnormal heart rhythms, blood clots or hypercoagulability, and those with a history of liver disease should avoid DHEA supplements.
    Because DHEA is a hormone related to other male and female hormones, there may be side effects related to its hormonal activities. For example, masculinization may occur in women, including acne, greasy skin, facial hair, hair loss, increased sweating, weight gain around the waist, or a deeper voice. Likewise, men may develop more prominent breasts (gynecomastia), breast tenderness, increased blood pressure, testicular wasting, or increased aggressiveness. Other hormonal-related side effects may include increased blood sugar levels, insulin resistance, altered cholesterol levels, altered thyroid hormone levels, and altered adrenal function. Caution is advised in patients with diabetes or hyperglycemia, high cholesterol, thyroid disorders, or other endocrine (hormonal) abnormalities. Serum glucose, cholesterol and thyroid levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.
    In theory, DHEA may increase the risk of developing prostate, breast, or ovarian cancer. DHEA may contribute to tamoxifen resistance in breast cancer. Other side effects may include insomnia, agitation, delusions, mania, nervousness, irritability, or psychosis.
    High DHEA levels have been correlated with Cushing''s syndrome, which may be caused by excessive supplementation.
    Pregnancy and Breastfeeding
    DHEA is not recommended during pregnancy or breastfeeding. Because DHEA is a hormone, it may be unsafe to the fetus or nursing infants.

    Interactions

    Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

    Interactions with Drugs
    DHEA may interfere with the way the body processes certain drugs using the liver''s "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. Central nervous system agents, including carbamazepine and phenytoin, induce the P450 enzymes that metabolize DHEA and DHEA-S and therefore can decrease circulating concentrations of these hormones. Patients using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
    DHEA may increase blood sugar levels. Caution is advised when using medications that may also lower blood sugar such as metformin (Glucophage®). A qualified healthcare professional should closely monitor patients taking drugs for diabetes by mouth or insulin. Medication adjustments may be necessary.
    DHEA may increase the risk of blood clotting. Patients who take anticoagulants (blood thinners) or antiplatelet drugs (such as aspirin) to prevent blood clots should discuss the use of DHEA with a healthcare professional. Examples of blood thinning drugs include warfarin (Coumadin®), heparin, and clopidogrel (Plavix®). The risk of blood clots is also increased by smoking or by taking other hormones (such as birth control pills or hormone replacement therapy), and these should not be combined with DHEA unless under medical supervision.
    DHEA may alter heart rates or rhythm, and should be used cautiously with heart medications or drugs that may also affect heart rhythm. Alcohol may increase the effects of DHEA.
    Although it is not widely studied, there are some reports that drugs such as canrenoate, anastrozole (Arimidex®), growth hormones, methylphenidale, amlodipine, nicardipine, and other calcium channel blockers like diltiazem (Cardizem®) and alprazolam (Xanax®) may increase DHEA levels in the body, which could lead to increased side effects when taken with DHEA supplements. In theory, increased hormone levels may occur if DHEA is used with estrogen or androgen hormonal therapies. DHEA may interact with psychiatric drugs such as clozapine (Clozaril®).
    DHEA may interact with GABA-receptor drugs used for seizures or pain. DHEA may decrease the effectiveness of methadone. DHEA may add to the effects of clofibrate or contribute to tamoxifen resistance in breast cancer.
    DHEA use has been suggested to result in a decreased rate of developing protective antibody titer after influenza vaccination.
    Drugs that reduce the normal levels of DHEA produced by the body include dopamine, corticosteroids such as dexamethasone, drugs used to treat endometriosis such as danazol, opiate painkillers, and antipsychotics. Metopirone, alprazolam, and benfluorex may increase blood DHEA levels. Many other interactions are possible; check with a qualified healthcare professional, including a pharmacist, for a thorough list.
    Interactions with Herbs and Dietary Supplements
    Based on laboratory and animal studies, DHEA may interfere with the way the body processes certain herbs or supplements using the liver''s "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
    DHEA may raise blood sugar levels or cause insulin resistance, and may add to the effects of herbs/supplements that may also increase blood sugar levels, such as arginine, cocoa, ephedra (when combined with caffeine), or melatonin. DHEA may work against the effects of herbs/supplements that may decrease blood sugar levels, such as   vera , American ginseng, and bilberry. Serum glucose levels should be monitored closely by a qualified healthcare professional while using DHEA. Dosing adjustments may be necessary.
    In theory, DHEA may increase the risk of blood clotting, and may add to the effects of herbs/supplements that may also increase the risk of clotting, such as coenzyme Q10 or  Panax ginseng . DHEA may work against the effects of herbs/supplements that may "thin" the blood and reduce the risk of clotting, such as   , garlic, and saw palmetto.
    It is not known what effects occur when DHEA is used with herbs that are believed to have hormonal effects in the body. Examples of agents with possible estrogen-like (phytoestrogenic) effects in the body include alfalfa, black cohosh, and bloodroot.
    DHEA may alter heart rates or rhythms. Caution is advised in patients taking herbs/supplements that may alter heart function or that include cardiac glycosides. Examples include adonis, balloon cotton, and foxglove/digitalis.
    picolinate may increase blood DHEA levels. Carnitine and DHEA may have additive effects. Based on animal research, DHEA may increase melatonin secretion and prevent breakdown of vitamin E in the body.
    Although it is not widely studied, there are some reports that DHEA may also interact with fiber, flavanoids, polyunsaturated fatty acids, probiotics, soy protein, and yam. Caution is advised.

    Methodology

    This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); William Benda, MD, FACEP, FAAEM (University of Arizona); Stephen Bent, MD (University of California, San Francisco); her Boon, B.Sc.Phm, PhD (University of Toronto); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Michael Smith, MRPharmS, ND (Canadian College of Naturopathic Medicine); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).

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