Low Testosterone

Should You Take DHEA Supplements?

Metabolic reactions make an essential part of who we are and how we feel. They contribute to the aging process, mental health, sexual development, and much more.

As it is, our metabolism dictates almost everything that visibly happens in the body. But is there a way to boost or contribute to its functions? DHEA supplements are meant to contribute to steroid metabolism, as you will see in this article.

There are different ways to contribute to metabolic reactions in the body. One of them is by providing the end product, as in injecting steroids in testosterone replacement therapy. But that’s only useful when the metabolic pathways are profoundly altered. In most cases, we don’t need to go that far, and providing tools is easier and better than facilitating the end product. So, we can consume nutrients used in the metabolic process to speed it up or provide an enzyme when it’s lacking. Another option would be to cut through some steps in the process of creating a hormone. To do that, we can provide an almost finished product to jump many steps in the process.

When you’re taking DHEA, you’re not providing an end product. It’s more like a product halfway in the process of creating male sex hormones. It is not the same as testosterone therapy, and it doesn’t have the same side effects. After reading this article, you will have a helpful insight into this supplement and what current literature says about its performance and use.

What is DHEA?

Many authors consider DHEA a steroid hormone since its discovery in 1934. However, it is a very weak hormone as compared to testosterone. Instead of being created in the testis, DHEA is naturally made in the adrenal glands. Similar to other steroid hormones, DHEA is produced using cholesterol as the building block. According to more recent findings, the brain and intestinal tract also produce some DHEA.

After putting DHEA in circulation in the blood, your body can convert this substance to sex steroids. It can be converted into testosterone or estrogen. As such, data points out that DHEA supplements can boost your testosterone or estrogen levels, depending on your gender. Doing so protects older adults and individuals with hormone imbalances from various health problems associated with their condition.

There are different sources of DHEA, and one of them comes from natural foods. We can find a similar substance in wild yam and soy. However, this is diosgenin and not DHEA. The body should convert the substance before using it, which apparently doesn’t happen as effectively. According to the National Institutes of Health, the body does not convert wild yam to DHEA. That’s why dietary supplements are preferred. They have a synthetic form of DHEA instead of diosgenin (1).

How does it work?

Since the discovery of this substance, a lot of studies and speculation have surrounded DHEA. It has been a subject of debate among health professionals, and many supplements have come to the market. Even now, there are more questions than answers, and not every detail is known about this supplement.

We know that it is produced in the adrenal glands using cholesterol. It is also made in the brain and the intestines to a lesser degree. Then, it is released into the blood. However, it is a fatty substance similar to cholesterol. As such, it requires a transporter to move in the water-soluble environment of the blood. Alternatively, it transforms into dehydroepiandrosterone sulfate or DHEAS. This substance can be transported easily in the blood.

When you take a DHEA supplement, it is absorbed in the intestines. Before putting the hormone in circulation, it is converted into DHEAS by the intestine cells. The conversion is easily reversible, and when it reaches the tissues, it goes back to the DHEA form.

Once in the tissues, DHEA behaves like a weak androgen. It activates similar pathways to testosterone, but it is not very active by itself. However, in some parts of the body, DHEA is converted into androstenedione. Similar to DHEA, androstenedione is a weak androgen. It is also in the way of becoming testosterone, so we can say that it is a halfway end-product instead of the final and completed version of testosterone. It is a precursor instead of the actual hormone. The difference is that it has more androgen activity and less affinity to estrogen receptors than DHEA.

The chemistry of DHEA is very complex and difficult to trace. It can convert into androstenedione, but also estrogens. Even androstenedione can be converted to a weak estrogen called estrone. The exact triggers into one reaction or the other is currently a field of study. However, in practice, we have seen that DHEA protects men with various benefits (2). 

Benefits

Despite having more questions than answers, DHEA is currently in use because it has a wide array of benefits. People with osteoporosis, heart disease, diabetes, breast cancer, kidney disease, and other conditions have low DHEA levels. It is also declined as we get older as a result of aging. That’s why supplements are typically used to prevent the consequences of hormone problems found in seniors (2).

The FDA does not endorse the use of DHEA for a particular condition. Still, many users have had excellent experiences in these cases:

DHEA for osteoporosis

There’s a close relationship between androgens and bone density. Osteoporosis, bone pain, and fractures are common symptoms of low testosterone levels. Thus, there’s a clear rationale for using DHEA as an androgen for osteoporosis. However, the scientific literature provides mixed results. Some studies do not report any difference after using DHEA, while others show promising findings.

The relationship between DHEA levels and osteoporosis was made apparent in a recent study. The researchers took people with and without osteoporosis and took blood samples. They measured DHEAs levels in each one and found that bone mineral density was strongly related to DHEA levels. Men with better bone mineralization had the highest level of DHEA. Men with low bone mineralization and osteoporosis had lower levels of DHEA (3).

However, this is a very early finding and does not point to any direct relationship. The real cause could be lowering DHEA levels and bone density levels at the same time. That’s why more studies are required to assess the benefits by actually testing the substance. Accordingly, a group of researchers evaluated what happened after using DHEA supplements in people with osteoporosis. The study participants took DHEA every day for one year, and their bone density levels were recorded. Using the supplement increased their bone mineral density, especially in postmenopausal women (4).

DHEA for depression

Depression is often difficult to handle because there are many variants and confounders along the way. However, major depression does not always depend on what is happening. It is a chemistry problem in the brain, and it is affected by chemistry. That’s why DHEA studies focus on major depression and have had excellent results. One research on major depression used 90mg of DHEA for 6 weeks. After this time, almost half of the patients in the treatment group improved their symptoms. In the placebo group, nobody experienced improvements.

Other studies have had similar findings with higher doses of DHEA. The problem is that most studies are made in very small groups. The next step in the research would be comparing these results with a larger group to replicate these findings. It would also be useful to compare the performance of DHEA to talk therapy and other treatments.

So far, there’s a systematic review and meta-analysis about DHEA therapy for depression. These studies are useful because they gather all of the evidence from many studies to see if it’s reliable and significant or not. The study used the same Risk of Bias tool used in Cochrane systematic reviews and found a significant DHEA effect in depression. In other words, DHEA is passing the test and becoming an exciting candidate for treating depression (5).

DHEA and anti-aging

One of the most attractive benefits of DHEA has to do with its anti-aging properties. The relationship is apparent even before we are born. During fetal life, our circulating levels of DHEA are pretty high. The adrenal glands synthesize 200 mg or more DHEA every day in a fetus. This is around 10 times the amount produced in adults. Serum DHEA levels reduce after being born and increase once again during puberty. Healthy adults have peak levels of DHEA when reaching their 20’s or 30’s. After that time, DHEA levels start to decline slowly at a rate of 5% every year. By age 70, our circulating DHEA levels are shallow and sometimes difficult to trace (6).

It is not yet clear if there’s something else lowering DHEA and contributing to aging at the same time. However, recent literature shows that DHEA drops are associated with geriatric syndromes. The proposed anti-aging properties of DHEA could be related to a reduction of reactive oxygen species and a better defense against oxidative stress. However, the exact mechanism is unknown (7).

A recent systematic review on Alzheimer’s disease showed that preclinical studies support DHEA use to prevent and treat cognitive function decay. However, they are usually small clinical trials, and their results need to be reproduced in larger groups (8).

DHEA for weight loss

There are many fad diets and misleading supplements, but DHEA effects on fat reduction are promising. First off, it is important to highlight the difference between weight loss and changes in body composition. Weight loss is simply losing pounds. Changing your body composition requires measuring your fat levels and lean mass (muscle mass) levels. You can have a significant fat loss but gain some muscle and remain in the same weight. Therefore, you can have changes in your body composition without weight loss. The difference is that fat takes much more space and does not look as good as muscle. Fat is also more dangerous for your health, and muscle speeds up your metabolism.

For many years, DHEA was considered a weight-loss tool, and some studies supported this use. However, a recent systematic review changed the way we see this supplement. After evaluating the evidence in many studies, the researchers showed that weight loss is not always apparent, but body composition does change. Fat mass decreases while lean body mass increases after using DHEA supplements. Translating these findings depend on each patient, though (9).

DHEA for cardiovascular disease

Another interesting benefit of DHEA has to do with cardiovascular disease. Once again, sex hormones are known to be related to cardiovascular risk. That’s why our risk increases as we age and lower our sex hormone levels, similarly, as cardiovascular disease risk increases, DHEA levels in the body decline.

According to research, DHEA apparently slows down the formation of cholesterol plaques. By reducing the rate of cholesterol plaque formation, DHEA could be helpful against atherosclerosis. However, other studies show that it accelerates the formation of foam cells. These cells gather in the plaque and make it harder. Additional studies suggest that DHEA administration improves insulin sensitivity and other parameters indirectly associated with cardiovascular disease.

Some studies show improvements after using DHEA. Others suggest no change at all. Apparently, low DHEA levels and other factors we don’t know play a role in increasing cardiovascular risk. In other words, DHEA could reduce cardiovascular risk, but only in some cases. So far, systematic reviews show DHEA deficiency in patients with cardiovascular disease, but there are heterogeneous results when applying this to clinical practice (10).

DHEA and men’s hormone health

DHEA works in the body as a hormone. Many other supplements work as a hormone, including vitamin D. So, there’s nothing intrinsically wrong with consuming hormone supplements. In the case of DHEA, this supplement has some advantages for hormone health.

One of the medical indications for DHEA is adrenal insufficiency or Addison’s disease. If your adrenal cortex is not working as it should, it won’t produce enough hormones. Steroid hormone levels drop dramatically. Doctors try to replace these hormones by replacing them with hydrocortisone and fludrocortisone. However, studies also show that you can benefit significantly from DHEA in these cases. Patients who use DHEA replacement therapy along with their medical treatment experienced improvements in different aspects. They mostly feel better and healthier, and some patients experience sexual function improvements (11).

After 65 years old, testosterone synthesis in the testis starts to decline. DHEA is still a source of testosterone in men during this time. But around 40% of testosterone is synthesized this way. Using this supplement to improve their testosterone levels can be an option in men with very low DHEA levels. However, studies are not always conclusive. It is primarily used in menopausal women and men with adrenal gland problems (12).

Still, there’s an exciting application of DHEA to increase testosterone levels in a particular group of patients. Males who want to lose weight through vigorous exercise sometimes experience a drop in testosterone. A recent study evaluated how men perform in high-intensity interval training (HIIT) after using DHEA supplements. In this study, middle-aged men showed a significant reduction of testosterone levels during and after vigorous exercise. But when they took DHEA supplements, their free testosterone levels were not affected by exercise and sometimes increased over the baseline. In other words, this supplement keeps the balance of testosterone levels under certain circumstances (13).

Dosage and side effects

Even vitamins and minerals can be toxic when consumed in very high doses or incorrectly. For example, it is not a good idea to consume vitamin A if you’re a heavy smoker. Consuming too much calcium can increase the risk of high-grade prostate cancer. Similarly, DHEA supplements should be used under the appropriate dose and with care. A doctor should supervise its use to prevent side effects, and pregnant women and children should not take it. 

The most common side effects include abdominal pain and acne, which are more common in women. Females may also experience changes in their menstruation, hair growth, and a deepening of their voice. Men sometimes experience breast growth and breast tenderness. Plus, in patients with benign prostatic hyperplasia (BPH), DHEA may aggravate the urinary symptoms (2).

To avoid these side effects, we should use the doctor’s dose, which is usually 50mg daily. However, different doses can be used for various conditions:

  • Most applications: In most cases, the dose will be 50 mg daily
  • For aging skin: The most common application is DHEA, as a 1% cream directly applied to the trouble area twice a day.
  • For depression: Doctors should adjust the dose, which ranges between 30 to 500 mg. Its use is reduced to a few weeks, according to each case.
  • For vaginal thinning (vaginal atrophy): In this case, vaginal inserts are preferred, and they have up to 1% of DHEA. They are applied every day for 12 weeks.

Conclusion

Serum dehydroepiandrosterone or DHEA is a hormone naturally synthesized in the adrenal glands. It is also consumed in the form of supplements due to its ability to convert into testosterone and estrogen. 

Using this supplement has shown significant improvements in bone density levels. It also shows promising results in patients with depression. It is also useful to improve body composition and prevent a drop in male hormone in middle-aged men who exercise vigorously.

More scientific data is required to find out exactly how it works and its mechanisms. However, it is a safe supplement with minimal side effects. In most cases, it is used in a dose of 50 mg daily, but it is recommended to talk to your doctor before using it for better results.

Sources

  1. National Institutes of Health (2020). Wild yam. Reviewed October 29, 2020.
  2. National Institutes of Health (2020). DHEA. Reviewed September 18, 2020.
  3. Park, S. G., Hwang, S., Kim, J. S., Park, K. C., Kwon, Y., & Kim, K. C. (2017). The association between dehydroepiandrosterone sulfate (DHEA-S) and bone mineral density in Korean men and women. Journal of bone metabolism24(1), 31.
  4. Von Mühlen, D., Laughlin, G. A., Kritz-Silverstein, D., Bergstrom, J., & Bettencourt, R. (2008). Effect of dehydroepiandrosterone supplementation on bone mineral density, bone markers, and body composition in older adults: the DAWN trial. Osteoporosis international19(5), 699-707.
  5. Peixoto, C., Grande, A. J., Mallmann, M. B., Nardi, A. E., Cardoso, A., & Veras, A. B. (2018). Dehydroepiandrosterone (DHEA) for depression: a systematic review and meta-analysis. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders)17(9), 706-711.
  6. Quinn, T., Greaves, R., Badoer, E., & Walker, D. (2018). DHEA in prenatal and postnatal life: implications for brain and behavior. Vitamins and hormones108, 145-174.
  7. Yanase, T., Muta, K., & Nawata, H. (2020). DHEA: Effects on oxidative and glycative stress and glucose metabolism. Glycative Stress Research7(1), 42-49.
  8. Strac, D. S., Konjevod, M., Perkovic, M. N., Tudor, L., Erjavec, G. N., & Pivac, N. (2020). Dehydroepiandrosterone (DHEA) and its Sulphate (DHEAS) in Alzheimer’s Disease. Current Alzheimer Research17(2), 141-157.
  9. Wang, F., He, Y., Santos, H. O., Sathian, B., Price, J. C., & Diao, J. (2020). The effects of dehydroepiandrosterone (DHEA) supplementation on body composition and blood pressure: A meta-analysis of randomized clinical trials. Steroids163, 108710.
  10. Wu, T., Zheng, Y., & Xie, X. (2018). GW29-e1427 The Correlations Between endogenous DHEA/DHEAS and Coronary Artery Diseases: A Systematic Review and Meta-Analysis. Journal of the American College of Cardiology72(16S), C246-C246.
  11. Gurnell, E. M., Hunt, P. J., Curran, S. E., Conway, C. L., Pullenayegum, E. M., Huppert, F. A., … & Chatterjee, V. K. K. (2008). Long-term DHEA replacement in primary adrenal insufficiency: a randomized, controlled trial. The Journal of Clinical Endocrinology & Metabolism93(2), 400-409.
  12. Labrie, F. (2010). DHEA, important source of sex steroids in men and even more in women. Progress in brain research182, 97-148.
  13. Liu, T. C., Lin, C. H., Huang, C. Y., Ivy, J. L., & Kuo, C. H. (2013). Effect of acute DHEA administration on free testosterone in middle-aged and young men following high-intensity interval training. European journal of applied physiology113(7), 1783-1792.

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