Dehydroepiandrosterone (DHEA): Dosing & Benefits

Clinical research, as well as empirical evidence suggests that the use of dehydroepiandrosterone (DHEA) can be very effective in supporting the healthy aging process.* There are many areas which may be supported including; bone health¹ healthy mood², and sexual health.^3*

The question remains, “How much oral  supplemental DHEA is appropriate?” DHEA dose responsiveness  appears to depend upon the indication and the patient’s need. DHEA is a precursor to several other hormones which ultimately result in the formation of androgens such as androstenediol or testosterone and estrogens such as estrone, estradiol, and estriol. When supporting the healthy production of the aforementioned hormones, it is prudent to attend to the pleiotropic functions of these hormones as they affect a myriad of systems in the body.  For this reason, I support and encourage periodic laboratory testing to confirm that the levels of DHEA remain in the optimal range. DHEA sulfate (DHEA-S) can also be measured in serum and saliva.

Prior to recommending DHEA or a DHEA dose, it is important to understand it is a contraindication to use in individuals with hormone-sensitivities and may interact with a variety of prescription medications.  Side effects are uncommon, but women may experience changes to skin, hair, voice, menstrual periods, and other effects.  Men may also have unwanted effects, while either gender may experience changes in sleep or mood.⁴

In order to understand the best approach to DHEA dosing, specific goals should be determined.  Available research provides validation for a variety of dosing levels based on these goals.

• Bone Health: DHEA supports the healthy balance of osteoblast and osteoclast activity.* Dosing with 50 mg daily for up to two years combined with vitamin D and calcium has demonstrated support of healthy bone maintenance in women.^1*
• Mood Health: Several clinical trials have shown that using between 25 mg and 50 mg daily to maintain DHEA levels in the brain is effective in supporting brain health and mood in the elderly.* Women have been shown to have positive results after 25 mg daily for six months.^5* Additional studies showed response to 50 mg a day after six months for both men and women.^6,7*
• Sexual Health: Numerous studies have shown beneficial impacts on sexual health with one study demonstrating effectiveness with a 10 mg daily dose for one year in postmenopausal women.^8* Men also had a favorable response to 50 mg once daily for six months.^9*

In at least one instance, researchers chose a dose of 200 mg daily for up to 24 weeks.^10*

As a quick recap, the steps when utilizing dehydroepiandrosterone (DHEA) are as follows:

1. Determine contraindications to use
2. Choose appropriate starting dose, typically between 10 and 50 mg, based on goals
3. Dosing is best in the morning to mirror normal circadian rhythm¹¹
4. Test DHEA levels periodically to ensure levels remain with normal limits  
5. Monitor for side effects

REFERENCES

1. Weiss EP, Shah K, Fontana L, et al. Dehydroepiandrosterone replacement therapy in older adults: 1- and 2-y effects on bone. Am J Clin Nutr. 2009 May; 89(5): 1459–67.
2. Dong Y, Zheng P. Dehydroepiandrosterone sulphate: action and mechanism in the brain. J Neuroendocrinol. 2012 Jan;24(1):215-24.
3. Khorram O, Vu L, Yen SS. Activation of immune function by dehydroepiandrosterone (DHEA) in age-advanced men. J Gerontol A Biol Sci Med Sci. 1997 Jan;52(1):M1-7.
4. Mayo Clinic. DHEA. Available at: http://www.mayoclinic.org/drugs-supplements/dhea/evidence/hrb-20059173.
5. Yamada S, Akishita M, Fukai S, et al. Effects of dehydroepiandrosterone supplementation on cognitive function and activities of daily living in older women with mild to moderate cognitive impairment. Geriatr Gerontol Int. 2010 Oct;10(4):280-7.
6. Morales AJ, Nolan JJ, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab. 1994 Jun;78(6):1360-7.
7. Brooke AM, Kalingag LA, Miraki-Moud F, et al. Dehydroepiandrosterone improves psychological well-being in male and female hypopituitary patients on maintenance growth hormone replacement. J Clin Endocrinol Metab. 2006 Oct; 91(10):3773-9.
8. Genazzani AR, Stomati M, Valentino V, et al. Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality. Climacteric. 2011 Dec;14(6):661-8
9. 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 Mar;53(3):590-4; discussion 594-5.
10. Chang D, Chu S, Chen H, Kuo S, Lai J. Dehydroepiandrosterone suppresses interleukin 10 synthesis in women with systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2004;63(12):1623-6.
11. Ceresini G, Morganti S, Rebecchi I, et al. Evaluation of the circadian profiles of serum dehydroepiandrosterone (DHEA), cortisol, and cortisol/DHEA molar ratio after a single oral administration of DHEA in elderly subjects. Metabolism. 2000 Apr;49(4):548-51.