DHEA
Scientific Names: Dehydroepiandrosterone Other Common Names: Prasterone, 5-androsten-3-Ξ²-ol-17-one Overall Safety: π Β
Therapeutic Efficacy and Considerations:
Memory: π Three of four trials have found no benefit of DHEA on memory or cognitive performance. The small study that did note changes in certain memory processes in postmenopausal women had very significant methodological limitations. Current evidence does not support the use of DHEA for memory or cognitive function in men or women. Normal dose for this indication is 50 mg per day.
Sexual Arousal in Women: π Only two small studies, both using a single high dose of DHEA, have examined effects on arousal in women. No benefit was found in young, premenopausal women, while in postmenopausal women, self-reported subjective arousal increased, although physical objective parameters did not. At this time, evidence is not sufficient to support a recommendation for use even in postmenopausal women. More research is needed to determine long-term effects and safety. Usual dose is 50 mg per day.
Erectile Dysfunction: π Two studies have evaluated DHEA in the treatment of ED. Evidence is preliminary but does support that DHEA may be effective for ED due to HTN or unknown etiology. Men with diabetes-associated or neurological ED do not seem to respond to DHEA treatment, so patients wishing to try DHEA should obtain an appropriate diagnosis and discuss the situation with their physician prior to use, so that proper monitoring of hormone levels can occur. Usual dose is 50 mg per day.
Muscle Strength and Performance: π DHEAβs effects on muscle strength have been examined in both aged men and women and in young healthy men during resistance training. Three of the five studies found no differences from placebo in muscle strength or performance. Two very small studies found a slight increase in men, but not in women. No increases in testosterone were found in men, and only one small study found increased testosterone levels in women. Evidence does not support use of DHEA for muscle strength and performance in any age group. Normal dose for this indication is 50-150 mg per day.
Chemistry/Pharmacology: DHEA is produced in the adrenal glands, liver, testes, and brain. Levels naturally decline with increasing age in both men and women by 20-30% after age 40. Supplementation seems to help prevent this decline in DHEA, but supplementation has gender-specific results for hormone levels. Women experience a greater increase in androgens, whereas men experience a greater increase in estradiol. These increases may only be temporary, as levels often decrease somewhat after 12 months of supplementation. DHEA increases estradiol, growth hormone, insulin-like growth factor 1, androstenedione, and testosterone. DHEA levels are decreased in patients with depression, SLE, diabetes, schizophrenia, and erectile dysfunction, which is why supplementation has been attempted. DHEA also inhibits synthesis of platelet thromboxane A2 in and in increases nitric oxide synthesis. This nitric oxide release may be involved in effects on arteriosclerosis.
Drug Interactions: Hormone replacement therapy, aromatase inhibitors, or estrogen receptor antagonists. Will increase levels of triazolam and may increase levels of other CYP450 3A4 inhibitors. Use with oral contraceptives increases the risk of blood clots.
Contraindications/Precautions: Contraindicated in patients with benign prostatic hyperplasia and hormone-responsive cancers (due to possible stimulation of growth), during pregnancy (due to teratogenic hormonal effects), during breastfeeding (due to unknown effects), in patients with psychological disorders (due to triggering of hypomania, mania, or increased psychosis), and in children. Avoid use in diabetes because of possible increased insulin resistance or sensitivity, hyperlipidemia, or liver dysfunction.
Adverse Effects: May cause potentially serious cases of mania or hypomania (even in patients without psychological disorders). May also cause irregular heartbeat, insomnia, irritability, anxiety, fatigue, aggressiveness, headache, hypertension, nasal congestion, hirsutism and acne in women, gynecomastia in men, and increased liver function tests. May cause hormone-related side effects such as hirsutism in women and gynecomastia in men. May alter glucose, cholesterol, and thyroid levels. Note: Because of the possibility of severe adverse effects, it is recommended that DHEA only be used under the supervision of a primary care provider who will monitor for side effects and hormone levels.
