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DHEA

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Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • 5-androsten-3 ?-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.

Background
  • 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.

Evidence Table

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. GRADE *


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


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


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


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


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


The ability of DHEA to increase bone density is under investigation. Effects are not clear at this time.

C


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


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


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


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


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


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


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


Preliminary evidence, suggests that DHEA may help to induce labor. Further research is needed and people who are pregnant should not self-treat.

C


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


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


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


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


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


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


Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in septic patients. At this time, more proven therapies are recommended.

C


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


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


Preliminary study suggests the possibility of using DHEA topically as an anti-skin aging agent. Further research is needed to confirm these results.

C


DHEA does not seem to improve quality of life, pain, fatigue, cognitive function, mood, or functional impairment in fibromyalgia.

D


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


Studies of the effects of dehydroepiandrosterone (DHEA) on cognition have produced complex and inconsistent results. Additional study is warranted in this area.

D


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 for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. 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. There may be other proposed uses that are not listed below.

  • 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

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.

Interactions

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 oral contraceptives 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, insulin, corticosteroids such as dexamethasone, drugs used to treat endometriosis such as danazol, opiate painkillers, antipsychotics, and estrogen-containing drugs. 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 Aloe vera, American ginseng and bilberry. Serum glucose levels should be monitored closely by a qualified health care 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 Ginkgo biloba, 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.
  • Chromium 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, flavaanoids, polyunsaturated fatty acids, probiotics, soy protein and yam. Caution is advised.,

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  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.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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