DHEA



DHEA

Original Article:  http://www.mayoclinic.com/health/dhea/NS_patient-dhea
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DHEA

Natural Standard® Patient Monograph, Copyright © 2013 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

DHEA

DHEA (dehydroepiandrosterone) is an endogenous hormone (made in the human body), and 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.

No studies on the long-term effects of DHEA have been conducted. DHEA can 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 health professional.

Related terms

5-androsten-3 β-ol-17-one, C19 steroid, dehydroepiandrosterone, dehydroepiandrosterone sulfate, DHA, DHAS, DHEA-enanthate, DHEA-FA, DHEA-S, DHEAS, DS, 7-KETO DHE, 7-oxo-DHEA, dehydroepiandrosterone (DHEA), the mother steroid, 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.

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 health care 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 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
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 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
Cocaine 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
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 or emotional disturbances such as fatigue, irritability, anxiety, depression, insomnia, difficulties with concentration, 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
Psoriasis
Overall study results suggest that DHEA likely 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 recommendations 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 (it may not work)
F Strong scientific evidence against this use (it likely does not work)

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.

Aging, allergic disorders, amenorrhea associated with anorexia, andropause/andrenopause, angioedema, anxiety, asthma, bone diseases, bone loss associated with anorexia, bladder cancer, breast cancer, burns, colon cancer, dementia, diabetes, fatigue, heart attack, high cholesterol, Huntington's disease, influenza, joint diseases, lipodystrophy in HIV, liver protection, malaria, malnutrition, movement disorders, multiple sclerosis, osteoporosis, pancreatic cancer, Parkinson's disease, performance enhancement, polycystic ovarian syndrome, post-traumatic stress disorder (PTSD), premenstrual syndrome, prostate cancer, Raynaud's disease, skin graft healing, sleep disorders, stress, tetanus, 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 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.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

  1. Finckh A, Berner IC, Aubry-Rozier B, et al. A randomized controlled trial of dehydroepiandrosterone in postmenopausal women with fibromyalgia.J Rheumatol. 2005 Jul;32(7):1336-40.
  2. Johannsson G, Burman P, Wiren L, et al. A. Low dose dehydroepiandrosterone affects behavior in hypopituitary androgen-deficient women: a placebo-controlled trial. J Clin Endocrinol Metab 2002;87(5):2046-2052.
  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 Nov 15;79(2-3):251-6.
  4. Parsons TD, Kratz KM, Thompson E, et al. Dhea supplementation and cognition in postmenopausal women.Int J Neurosci. 2006 Feb;116(2):141-55.
  5. Pillemer SR, Brennan MT, Sankar V, et al. Pilot clinical trial of dehydroepiandrosterone (DHEA) versus placebo for Sjogren's syndrome. Arthritis Rheum. 8-15-2004;51(4):601-604.
  6. Rabkin JG, McElhiney MC, Rabkin R, et al. Placebo-controlled trial of dehydroepiandrosterone (DHEA) for treatment of nonmajor depression in patients with HIV/AIDS. Am J Psychiatry. 2006 Jan;163(1):59-66.
  7. Shoptaw S, Majewska MD, Wilkins J, et al. Participants receiving dehydroepiandrosterone during treatment for cocaine dependence show high rates of cocaine use in a placebo-controlled pilot study. Exp.Clin.Psychopharmacol. 2004;12(2):126-135.
  8. Strous RD, Maayan R, Lapidus R, et al. Dehydroepiandrosterone augmentation in the management of negative, depressive, and anxiety symptoms in schizophrenia. Arch Gen Psychiatry 2003;60(2):133-141.
  9. Sugino M, Ohsawa N, Ito T, et al. A pilot study of dehydroepiandrosterone sulfate in myotonic dystrophy. Neurology 1998;51(2):586-589.
  10. Vakina TN, Shutov AM, Shalina SV, et al. [Dehydroepiandrosterone and sexual function in men with chronic prostatitis]. Urologiia. 2003;(1):49-52.
  11. van Vollenhoven RF, Park JL, Genovese MC, et al. A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus. Lupus 1999;8(3):181-187.
  12. Villareal DT, Holloszy JO, Kohrt WM. Effects of DHEA replacement on bone mineral density and body composition in elderly women and men. Clin.Endocrinol.(Oxf) 2000;53(5):561-568.
  13. Villareal DT, Holloszy JO. Effect of DHEA on abdominal fat and insulin action in elderly women and men: a randomized controlled trial. JAMA 11-10-2004;292(18):2243-2248.
  14. Wolkowitz OM, Costa ME, Yaffe K, et al. Double-blind dehydroepiandrosterone treatment of Alzheimer's disease. 152nd Annual Meeting of the American Psychiatric Association 1999.
  15. Wolkowitz OM, Reus VI, Roberts E, et al. Dehydroepiandrosterone (DHEA) treatment of depression. Biol Psychiatry 2-1-1997;41(3):311-318.
Related terms
NS_patient-dhea Portions of this document last updated: Sept. 1, 2012

THIS EVIDENCE-BASED MONOGRAPH WAS PREPARED BY
THE NATURAL STANDARD RESEARCH COLLABORATION
(www.naturalstandard.com)

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