Decreased levels of DHEA (dehydroepiandrosterone) are thought to be associated with a number of age-related phenomena or deterioration of various physiological functions, including: ischemic heart disease, endothelial dysfunction, atherosclerosis, osteoporosis, inflammatory diseases, and sexual dysfunction.
In empirical medicine, what are the benefits of DHEA? Are there any side effects of DHEA supplements? See the latest analysis in the text for details
What is DHEA?
DHEA (dehydroepiandrosterone) and its sulfate form (DHEAS), the most abundant steroid hormone precursor in the human body, are synthesized by the adrenal cortex reticular band, gonads (testes, ovaries), adipose tissue, brain, and skin.
In target tissues, DHEA can be converted to androgens or estrogens through intracellular mechanisms, acting on specific receptors.
In addition to being a hormone precursor, DHEA can also bind directly to steroid hormones and nuclear receptors, activate various cell membrane receptors, and are related to regulating endothelial function, reducing inflammation, improving insulin sensitivity, blood flow, cellular immunity, body components, bone metabolism, sexual function, neuroprotection, cognitive function, and memory.
The highest concentration of DHEA occurs around the age of 20, every decade and gradually decreases by about 10%, and by the age of 70 to 80, the level may be only 10%-20% of what was when it was younger.
Does DHEA supplementation have a negative effect on blood lipids?
A systematic literature review and meta-analysis (27 randomized controlled trials) noted that DHEA supplementation (duration ranging from 4 weeks to 104 weeks, daily dose between 25 and 1600 mg) did not change total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglyceride levels, but significantly reduced high-density lipoprotein cholesterol (HDL-C) levels compared with controls, especially in women. Note 1
*Conclusion: DHEA supplementation does not alter the circulating values of cholesterol, LDL cholesterol, and triglycerides, but it may lower HDL cholesterol levels. Considering that testosterone and estrogen hormone replacement therapy are associated with an increased risk of venous thromboembolism, and that DHEA (dehydroepiandrosterone) supplementation can be used as a precursor to androgens and estrogens, long-term trials are needed to confirm the effects of DHEA supplementation on venous thromboembolism and major adverse cardiac events such as cardiovascular death, acute myocardial infarction, stroke etc.
What are the empirical benefits of DHEA?
1. DHEA is beneficial for blood sugar regulation
Plasma glucose measurement is important for screening, diagnosing and monitoring diabetes and predicting the risk of comorbidities such as cardiovascular disease, eye and kidney disease.
It is estimated that more than 2000 million people in the United States have diabetes, 90 to 95 percent of whom have type 2 diabetes. Therefore, adequate blood glucose monitoring for high-risk or pre-diabetic patients can help guide them through lifestyle interventions that effectively reduce the risk of becoming diabetic.
A systematic literature review and meta-analysis (including 12 randomized controlled trials) showed that taking DHEA (duration of treatment ranged from 8 weeks to 12 months, daily doses ranging from 50 to 400 mg) significantly reduced fasting plasma glucose, but did not have any significant changes in insulin levels and insulin resistance index (HOMA – IR index). Note 1
In addition, subgroup analyses found that fasting blood glucose reduction was most significant when daily supplementation was ≤50 mg, treatment time <12 weeks, and age ≥60 years.
*Conclusion: Taking DHEA may have a positive effect on blood glucose regulation, but due to the heterogeneity of the included studies, more studies are needed to further validate
2. DHEA improves depression
Depression is a common mood problem these days, often associated with mood disorders, major depressive disorder, seasonal affective disorder, situational depression or related emotions, bipolar disorder, or psychosis.
Key symptoms include loss of interest in activities, sadness, irritability, feelings of worthlessness, hopelessness, guilt, worry about death, or suicidal thoughts.
Associated symptoms may include changes in appetite, weight loss or gain, sleep disturbances, psychomotor activity, decreased physical strength, indecision, or distraction.
A systematic literature review and meta-analysis (2 randomized controlled trials, 68 people with depression) suggested that oral DHEA (dehydroepiandrosterone at a daily dose of 30 to 450 mg for 6 weeks) was associated with improving depressive symptoms (as measured by the Hamilton Depression Rating Scale) compared with placebo. Note 1
*Conclusion: DHEA may have a positive effect on the improvement of depression symptoms, but limited by small sample sizes, more studies are needed to support this
3. DHEA maintains bone health
Currently, the definition of osteoporosis is based on a measure of bone mineral density, which is the most reliable predictor of fracture risk
Low bone density is an important public health problem for both older women and men because of its associated fractures, illness, disability, and social costs.
Similar to women, osteoporosis is also prevalent in men, with 50% of men over the age of 25 developing osteoporotic fractures.
A pooled analysis (Pooled analyses, including 4 double-blind randomized controlled trials involving 585 participants over the age of 55) showed that oral DHEA in women increased DHEAS, testosterone, estradiol, and insulin-like growth factor 1 (IGF-1), compared with placebo. and maintain total hip bone density (but the bone density maintenance effect has not been seen in men). Note 2
*Conclusion: For older women, DHEA may be a positive effect on bone mineral density maintenance, but more research is needed to confirm its efficacy and safety in long-term use
4. DHEA increases the success rate of in vitro IVF
In vitro fertilization is a popular method of assisted reproductive technology, and today IVF numbers millions of births worldwide, accounting for 1% to 3% of the total number of births each year in the United States and Europe.
Studies have shown that certain lifestyle and patient characteristics (e.g., underweight, obesity, psychological stress, caffeine intake, alcohol consumption) and environmental exposures, including pesticides, PCBs and other endocrine disruptors, can negatively affect pregnancy success.
A systematic literature review and meta-analysis (6 randomized controlled trials of 745 women undergoing IVF) suggested that DHEA supplementation significantly improved clinical pregnancy, live birth rate, endometrial thickness, and retrieved number oocytes), but did not significantly help embryo transfer, miscarriage rate, or estradiol values after hCG administration. Note 3
*Conclusion: For women undergoing in vitro IVF, the use of DHEA is helpful in improving clinical pregnancy rate and live birth rate, but limited by small sample sizes, more large studies are still needed to support it
5. DHEA improves sexual function
Sexual relations are a complex phenomenon, influenced by cardiovascular, neurological and hormonal factors, as well as by the established traditions of an individual’s biology, relationships, family and society, culture and religion.
Sexual dysfunction in men, especially erectile dysfunction, has been extensively studied and has effective treatments, however, female sexual dysfunction is more complex and significantly less understood.
Female sexual dysfunction is generally defined as one or more of the following four disorders, including: sexual desire, arousal, painful intercourse, and inability to experience orgasm.
A systematic review of 38 studies found that DHEA was helpful in improving sexual interest, lubrication, pain, arousal, orgasm, and frequency, and its effects were more pronounced in people with sexual dysfunction, particularly perimenopausal and postmenopausal women. Note 4
*Conclusion: For women around menopause, the use of DHEA may have a positive effect on improving sexual function, but more research is needed to support it due to possible bias
6. DHEA improves muscle strength and physical function
The optimal state of physical fitness of the human body is about 20 to 30 years old, as the age increases, muscle and bone mass decrease, and physical fitness declines, the body composition is also changing, after the age of 30, adults lose 10% to 3% of muscle every 8 years, in addition, muscle strength can be reduced by 10 to 12% every 15 years.
Muscle loss and decreased physical performance are key to maintaining an independent life, and below-average are often associated with impaired motor and balance function, osteoarthritis, and an increased risk of falls/fractures.
A systematic review (8 studies involving 661 adults over the age of 50) noted that some studies have shown that DHEA supplementation improves muscle strength (grip strength, chest press, leg press, knee extension and curvature), physical function, and physical performance, but the results remain inconsistent. Note 5
*Conclusion: For older adults, currently available data do not support the use of DHEA supplements to improve muscle strength or physical function.
Are there any side effects of DHEA?
Unlike most vitamins and minerals, DHEA is a powerful hormone in the body and should not be taken unless necessary or confirmed with a physician or pharmacist before use.
Generally, it is safe to take it for a short time after evaluation by medical personnel (oral dose of less than 50mg and for 6 months).
Possible side effects include pimples, hair loss, stomach upset, dizziness and high blood pressure, and some women may experience menstrual disorders, abnormal hair growth and a deeper voice, and men may experience breast pain or breast growth.
Safety precautions (16 contraindications for use)
1. Do not use if liver and kidney function is abnormal, pregnant and breastfeeding women (safety concerns)
2. DHEA has neurotransmitter receptor regulation function, so some studies have found that it can help regulate brain circuits to achieve the effect of controlling drug addictive behavior (but it still needs to be confirmed by large-scale studies). Note 6
3. Do not use in patients with hormone-related cancers or a family history of these cancers, such as breast, prostate, ovarian, adrenal and testicular cancers (because DHEA is a precursor to estrogen and testosterone)
4. Patients with endometriosis or polycystic ovary syndrome should be careful, DHEA may worsen symptoms
5. Those with depression, bipolar disorder or related emotional diseases should be careful, after use, it may cause side effects such as excitement, impulsivity, irritability, mania, etc
6. May affect the effect of insulin, so diabetic patients should monitor blood sugar regularly
7. Excessive consumption of DHEA in women may increase male hormone production, so they are prone to signs of virilization, such as hair loss, deeper voice, hair growth on the face, pimples, etc
8. Excessive consumption of DHEA in men may also increase the risk of testicular shrinkage, male baldness, high blood pressure or testosterone-related cancers
9. May lower HDL cholesterol or increase triglyceride levels
10. Use of high doses or long-term use may increase the chance of potentially serious side effects
11. Because DHEA may increase testosterone levels in the body, it is banned in some professional sports
12. Do not combine with breast cancer treatment drugs selective estrogen receptor inhibitors, such as tamoxifen, Anastrozole (Ameda lozenge), Exemestane (Norman cancer sugar-coated lozenges), fulvestrant, Letrozole (remammary membrane clinged), may reduce the effectiveness of the drug
13. Do not combine with drugs to be processed by liver CYP450 enzyme, may increase drug side effects, related drugs are: Lovastatin, ketoconazole, itraconazole (etraconazole), fexofenadine, triazolam
14. Do not combine with corticosteroids, which may affect the effectiveness of DHEA supplements: Dexamethasone, hydrocortisone, methylprednisolone, prednisone
15. Do not combine with estrogen and testosterone related supplements, which may increase the chance of adverse reactions
16. Do not use it in combination with Progesterone, it may cause false positive progesterin test concentrations
How is DHEA used? What is the dose?
DHEA can be used orally, intraoral sprays, skin creams and gels, and the oral doses used in studies are listed below (although it is recommended to check with a physician before use to avoid possible adverse effects)
Depression: Take 30 to 50 mg daily for 6 to 8 weeks
Diminished ovarian reserve: 50 to 75 mg daily (given in divided doses)
Aging skin: 50 mg daily for 1 year