DHEA – Dehydroepiandrosterone

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Dehydroepiandrosterone (DHEA) is easily one of the most popular supplements in the US. Its popularity stems from claims that supplementation with DHEA slows down aging, increases energy, increases muscular strength, boosts immunity, and decreases body weight.

Below is an overview of DHEA and what science and the medical community actually knows about its supplementation. Read on to learn exactly what it is, what it does, and why people use it as a supplement. Also, learn about DHEA and aging and the proof for and against supplementation.

 


 

What Is Dehydroepiandrosterone?

DHEA Production

Dehydroepiandrosterone is a steroid hormone and an indirect precursor (chemical cousin) to the more potent androgen, testosterone. It is primarily produced by the adrenal glands (small endocrine glands located on the top of the kidneys). The body converts it into two important sex hormones (through a multi-step conversion): testosterone and estrogen.1

In the blood, most DHEA is found as DHEA-S (the sulfate ester) with levels that are about 300 times higher than those of free DHEA. Upon oral administration as a supplement, DHEA is mostly converted to the sulfate ester form. Once taken up by tissues, the sulfate ester form is converted back to the free form.

What Does Dehydroepiandrosterone Do?

What dehydroepiandrosterone does in the body is not fully known, as no mechanism of action has been identified. Understanding has been limited because there is no DHEA-specific receptor, which is a prerequisite for producing and studying hormonal effects.

By itself, DHEA exerts very little androgenic potency (androgens stimulate or control the development and maintenance of male characteristics by binding to androgen receptors). Rather most DHEA is converted via a multi-step conversion into testosterone and estrogen. As mentioned above, the body converts it into testosterone and estrogen, which can then exert their hormonal effects.

Dehydroepiandrosterone and Aging

DHEA levels increase until the age of 20 to 25 to a maximum level roughly comparable to that observed at birth. After the mid-20s, levels then decline constantly and rapidly over the next 40 to 60 years to around 20% of peak levels.2 The significance of this age-related drop is unknown and trials of DHEA supplementation in older men have not produced convincing benefits.

Typical normal ranges for males are as follows3:

Age Range

Normal Range (ug/dL)

Ages 18 – 19 108-441 ug/dL
Ages 20 – 29 280 – 640 ug/dL
Ages 30 – 39 120 – 520 ug/dL
Ages 40 – 49 95 – 530 ug/dL
Ages 50 – 59 70 – 310 ug/dL
Ages 60 – 69 42 – 290 ug/dL
Ages 69 and older 28 – 175 ug/dL

 


 

DHEA Supplementation

Why Do Men Supplement with It?

DHEA Supplements

Men typically supplement with DHEA in hopes of increasing muscle mass and strength and decreasing fat mass. Men also typically use it as supplement for helping with erectile dysfunction, slowing cognitive decline, and enhancing their skin (although this latter use is far more common in women).

DHEA levels correlate with age.4 That is, levels decrease constantly with aging. Since aging and declining levels are both associated with decreased muscle mass, bone mass, overall strength, cognitive function and erectile function along with increased total and abdominal fat, some hypothesize that these undesirable effects may, at least in part, be due to the decline in DHEA. Naturally, this assertion has spurred considerable interest in taking supplemental forms as a “treatment” for aging in humans.

Men also experiment with DHEA for helping with erectile dysfunction, as certain studies show lower levels in men with cardiovascular disease and erectile dysfunction.5,6 Additionally, low levels have been associated with diseases such as lupus and diabetes.7 As will be discussed, association is not causation and supplementation with DHEA has not been shown to reverse of prevent any of these diseases.

Proof for and Against Supplementation

Muscle mass, strength and fat mass: Very little evidence exists to support DHEA supplementation in men for increasing muscle mass, increasing strength, or decreasing fat.8,9 Consistent with this point is the well-established finding that administration to healthy men does not influence testosterone levels.10-13 While it is an indirect precursor to testosterone, it does not necessarily convert into just testosterone. Therefore, it is not suitable for treating low testosterone.

Men with low testosterone should not attempt to use DHEA to increase testosterone levels. Rather, they should discuss potential testosterone replacement therapy options with their physician.

Erectile Dysfunction: DHEA supplementation may potentially benefit people with decreased libido and erectile dysfunction (ED). The Massachusetts Male Aging Study presented an inverse correlation of DHEA levels and the incidence of ED. That is, lower levels correlated to higher rates of ED. In one study, supplementation helped men achieve or maintain an erection.14

However, high-quality studies have not demonstrated consistent results regarding supplementation for improving sexual function. Although research in this area is promising, additional well-designed studies are required.

Cognitive Function: Higher DHEA levels have been linked to better cognitive function (thinking). However, supplementation has not been shown to increase your ability to think. As mentioned above, correlation is not causation, and evidence to support the use for this purpose is lacking.15

Depression: Interestingly, many studies on depression and DHEA supplementation show that supplementation may have significant antidepressant effects in some patients with major depression.16-18

Nevertheless, depression is a serious problem. In fact, it is the most common psychiatric disorder in older men. If you are depressed, you are not alone. It is important to be aware that no supplement alone will cure your depression. If you think you may suffer from depression, talk to your physician or other medical professional.

Side Effects of Supplementation

Most studies lasting between six months and a year at doses ranging from 25 to 200 mg daily have shown DHEA to be safe with minimal side effects detailed below. However, long-term effects on supplementation are unknown.

In men, DHEA can cause changes related to an increase in estrogen and/or a drop in testosterone. Side effects of supplementation include swelling or tenderness of the breasts, decrease in the size of the testicles, acne, hair loss, urinary urgency, and aggression. Other side effects that may occur include sleep problems, headache, nausea, skin itching, and mood changes. It may also affect levels of other hormones, insulin, and cholesterol. Considering the lack of convincing positive benefits, doctors generally do not recommend supplementing with it.

 

Is Dehydroepiandrosterone Legal?

Dehydroepiandrosterone is legal to buy in the United States as a dietary supplement.19 It is exempted from the Anabolic Steroid Control Act of 1990 and 2004. Various nutrition stores market and sell it over-the-counter.

Is Dehydroepiandrosterone Banned from Sports?

Despite it being legal, the World Anti-Doping Agency lists it as a prohibited substance for use in any Olympic athletic competition.20 Additionally, all major professional US sports leagues and the NCAA consider it to be a banned drug.21

Interestingly, it is not an anabolic steroid, and its use is not associated with known positive and negative effects resulting from anabolic steroid use.

Updated: April 17th, 2015

1. Nicholas A. Tritos, MD, DSc. http://www.hormone.org/hormones-and-health/myth-vs-fact/fountain-of-youth. Hormone Heath Network. January 2014.

2. Lunenfeld B, Gooren L JG, Morales A, Morley JE. Textbook of Men’s Health and Aging. 2nd Edition. Informa UK. 2007.

3. Brent Wisse, MD. http://www.nlm.nih.gov/medlineplus/ency/article/003717.htm. National Institutes of Health. May 2014.

4. Watson RR, Huls A, Araghinikuam M, Chung S. Dehydroepiandrosterone and diseases of aging. Drugs Aging 1996; 9: 274-91.

5. Weiss EP, Villareal DT, Ehsani AA, Fontana L, and Holloszy JO. Dehydroepiandrosterone replacement therapy in older adults improves indices of arterial stiffness. Aging Cell 2012;11(5):876-884.

6. Thijs L, Fagard R, Forette F, Nawrot T, Staessen JA. Are low dehydroepiandrosterone sulphate levels predictive for cardiovascular diseases? A review of prospective and retrospective studies. Acta Cardiol 2003; 58: 403-10.

7. Salek FS, Bigos KL, Kroboth PD. The influence of hormones and pharmaceutical agents on DHEA concentrations: a review of clinical studies. J Clin Pharmacol. 2002 Mar;42(3):247-66.

8. Morales A.J, Nolan J.J, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 1994; 78: 1360-7.

9. Baulieu EE, Thomas G, Legrain S et al. DHEA and aging. Proc Natl Acad Sci USA 2000; 97: 4279-84.

10. Acacio BD, Stanczyk FZ, Mullin P, Saadat P, Jafarian N, Sokol RZ. Pharmacokinetics of dehydroepiandrosterone and its metabolites after long-term daily oral administration to healthy young men. Fertil Steril 2004; 81: 595-604.

11. Wallace MB, Lim J, Cutler A, Bucci L. Effects of dehydroepiandrosterone vs androstenedione supplementation in men. Med Sci Sports Exerc 1999; 31: 1788-92.

12. Brown GA, Vukovich MD, Sharp RL, Reifenrath TA, Parsons KA, King DS. Effect of oral DHEA on serum testosterone and adaptations to resistance training in young men. J Appl Physiol 1999; 87: 2274-83.

13. Brown GA, Vukovich MD, Reifenrath TA, et al. Effects of anabolic precursors on serum testosterone concentrations and adaptations to resistance training in young men. Int J Sport Nutr Exerc Metab 2000; 10: 340-59.

14. Reiter WJ, Pycha A, Schatzl G et al. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study. Urology. 1999; 53: 590-4.

15. Grimley Evans, J; Malouf, R, Huppert, F, van Niekerk, JK (Oct 18, 2006). Malouf, Reem, ed. “Dehydroepiandrosterone supplementation for cognitive function in healthy elderly people”. Cochrane database of systematic reviews (Online) (4).

16. Wolkowitz OM, Reus VI, Keebler A, et al. Double-blind treatment of major depression with dehydroepiandrosterone. Am J Psychiatry 1999; 156: 64 6-9.

17. Schmidt PJ, Daly RC, Bloch M, et al. Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression. Arch Gen Psychiatry 2005;62:154-62.

18. Bloch M, Schmidt PJ, Danaceau MA, Adams LF, Rubinow DR. Dehydroepiandrosterone treatment of midlife dysthymia. Biol Psychiatry 1999;45:1533-41.

19. Drug Scheduling Actions – 2005. Drug Enforcement Administration.

20. https://wada-main-prod.s3.amazonaws.com/resources/files/WADA-Revised-2014-Prohibited-List-EN.PDF. World Anti-Doping Association (WADA).

21. http://www.ncaa.com/content/ncaa-banned-drug-list. National Collegiate Athletic Association (NCAA).