Dehydroepiandrosterone (DHEA) is the most abundant androgen (15 to 30 mg/day) secreted by the adrenal glands and to some extent by the ovaries and testes. It is a precursor for other steroid hormones, such as testosterone and estrogen. Peak levels of DHEA occur at age 25. By age 80, DHEA levels have decreased to 10% to 20% of the peak level. DHEA has been called an antiaging hormone because deficiencies of DHEA in old age may make individuals more susceptible to cancer of the breast, prostate, bladder; atherosclerosis; hypertension; autoimmune diseases (e.g., diabetes, lupus erythematosus, rheumatoid arthritis); osteoporosis; high cholesterol; obesity; memory disturbances; chronic fatigue; and manifestations of aging (older persons with these conditions have been found to have low levels). When given to older patients, DHEA increased feelings of physical and psychological well-being; increased immune cell production; and enhanced mood, energy, and sleep. Older individuals with higher DHEA levels are often in better health than individuals with lower levels. The two most important factors concerning DHEA are its decline in old age and its deficiency in several major disease states.

Most of the DHEA on the market is made in laboratories from sterols (especially diosgenin) extracted from wild yams found in Mexico. Some extracts from wild yams are marketed as "natural DHEA." These extracts of diosgenin are supposedly converted into DHEA by the body. However, because it takes several chemical reactions to convert diosgenin into DHEA, it is unlikely that the body can make this conversion. Thus, only pharmaceutical grade DHEA should be used.

DHEA is a weak androgen synthesized in large quantities by the adrenal cortex. However, it can be converted into more potent androgens (testosterone and estrogen) throughout the body as needed. Only a small percentage of the body's DHEA (5%) is in the active form; the rest (95%) is attached to sulfur molecules (DHEA-S)—that is, it is sulfated by the liver—and serves as a reserve to be converted to the active form when needed. When blood levels of DHEA are measured, DHEA-S is usually the measurement taken.

DHEA is available in capsules, chewing gum, or drops that are placed under the tongue. DHEA is either natural or synthetic. However, it is debatable whether the body can process diosgenin into steroid hormones. Thus, it is recommended that only "pharmaceutical grade" DHEA be taken.

• Heart disease. Men with heart disease have low levels of DHEA-S. In one study, healthy men with low levels of DHEA-S were three times more likely to eventually die of heart disease than those with high levels of DHEA-S.
• Obesity. Experimental animals given DHEA did not become obese, but a control group given no supplements did become obese when given the same amount of food. In human studies, DHEA has not demonstrated a beneficial effect on body composition, even at high doses.
• Aging. Significant positive changes (e.g., less muscle wasting, less memory loss, improved mood and energy) have been seen in elderly men given DHEA.
• Osteoporosis. DHEA given to postmenopausal women increases bone mass. However, supplementation is not recommended until more extensive human trials have been conducted.
• Cancer. Experimental animals bred for breast cancer did not develop cancer when given DHEA supplements. Also, women with breast cancer have low levels of DHEA.
• Autoimmune disease. Low levels of DHEA have been found in patients with autoimmune disorders (e.g., lupus erythematosus, rheumatoid arthritis, multiple sclerosis, ulcerative colitis, AIDS). DHEA supplements improved stamina and overall sense of well-being in patients with autoimmune disorders. Patients with lupus treated with DHEA have shown symptomatic improvement, especially of kidney function, often permitting a reduction of their corticosteroids.
• Depression. DHEA has been used experimentally, to treat depressed patients. Improvements in both depression and memory were observed.
• AIDS. DHEA treatment in AIDS patients may have promise since low DHEA levels have been correlated with decreased immune function. However, controlled trials have not been conducted to investigate this supposition.
• Performance enhancement. Because DHEA is thought to build muscle mass, reduce fat, and reduce recovery time following injury, it is popular with athletes. However, human studies are needed to verify these claims. DHEA is also used to enhance sexual performance.

DHEA is available without a prescription. Dosages for men and women differ; men seem to tolerate higher doses. Men can safely take up to 50 mg/day; women should not take more than 25 mg/day. Positive effects have been noted at dosages as low as 5 mg/day. Because the long-term effects of DHEA supplementation have not been studied and data from clinical trials is virtually nonexistent, the safety and efficacy of DHEA has not been determined.

High doses of DHEA are associated with negative side effects for both men and women. However, the administration of high doses may be appropriate when treating serious illness (e.g., autoimmune diseases). High doses may inhibit the body's natural ability to synthesize DHEA and may be hepatotoxic. In addition, women should be alert for any signs of masculinization because the end products of DHEA in women are androgens (male hormones). Possible signs include loss of hair on the head, hair growth on the face, weight gain around the waist, and acne. Men should also be alert for signs of excess testosterone (e.g., sexual aggressiveness, testicular atrophy, aggressive tendencies, male pattern baldness, and high blood pressure). Blood levels of DHEA should be checked every six months.

Because DHEA is a precursor of estrogen and testosterone, patients with hormone-sensitive cancers (e.g., breast, prostate, ovarian, testicular) should avoid taking DHEA.

DHEA is not recommended for people under the age of 40, unless DHEA levels are known to be low (<130 mg/dL in women and <180 mg/dL in men).

The International Olympic Committee and the National Football League recently banned the use of DHEA by athletes because its effects are very similar to anabolic steroids.

When AZT-resistant and AZT-sensitive human HIV-1 cell isolates were inoculated with DHEA (50 µM), viral replication was suppressed by over 50% (Yang et al. 1994). The addition of DHEA enhanced the cytopathic effect of AZT and inhibited reverse transcriptase activity. DHEA may play a role in the treatment of HIV infection as an adjunct to conventional therapies by inhibiting replication of HIV-1 cells and preventing resistance to AZT.

DHEA (20 mg/kg) caused a dose-dependent increase in sleep time and enhanced the hypnotic and hypothermic effects of pentobarbital in male mice (Melchior and Ritzmann 1992).

Pretreatment with DHEA-supplemented diets (6% w/w) amplified therapeutic effects derived from a chemotherapeutic regimen of cisplatin (6 mg/kg) and AZT (400 mg/kg) for the treatment of colorectal carcinoma in mice (Klann et al. 1992). These results warrant further study to determine whether DHEA supplementation enhances the effectiveness of chemotherapeutic regimens in humans. 

Although DHEA alone was 1000 times less potent than prednisolone alone, synergy existed when DHEA was combined with prednisolone to inhibit rat lymphocyte proliferation (Meno-Tetang et al. 1996). Combination therapy could lower the doses of corticosteroids necessary to treat inflammatory disorders.

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