DHEA: The Mentor

DHEA is commonly associated with anti-aging. It is prescribed for reproductive health. Supplements are marketed for aging skin, depression, infertility, muscle strength, heart disease, erectile dysfunction, and many other conditions. Is there any good evidence for these uses?

Is DHEA a fountain of youth … or a phony?

It depends on how you think about DHEA…

Throughout this series, I’ve moved progressively down the Hormone Hierarchy. I’ve emphasized that you need to first test and address your primary hormones — Cortisol, Insulin, Thyroid — before testing and addressing your sex hormones (estrogen, progesterone, and testosterone). In this final article, I’m turning to this puzzling hormone without a clear place in the hierarchy.

Where does DHEA fit?

The Role of DHEA

Returning to a point made in my first article, all of your sex hormones AND cortisol AND dehydroepiandrosterone (DHEA) are lipid-derived. They’re made from cholesterol in your adrenal glands.

DHEA is the most abundant adrenal steroid hormone in the body. After it’s produced by the adrenal glands (alongside cortisol) it travels throughout the body, where it is converted into androgens and estrogens (i.e. sex hormones). DHEA is known as a “precursor hormone.” It is a precursor to estrogen, progesterone, or testosterone.

For this reason, all of the MANY benefits previously cited for estrogen, progesterone, and testosterone can reasonably be attributed to DHEA, their precursor. At the risk of oversimplification, without DHEA, you don’t have estrogen, progesterone, or testosterone.

In addition, DHEA plays an important role counterbalancing cortisol. If cortisol is the “King of All Hormones,” we could envision DHEA as the queen … or the mentor (or both). I’ll return to the interplay of cortisol and DHEA later.

First, what happens when DHEA runs low?

DHEA Deficiency

Since DHEA is a precursor to androgens and estrogens, the list of symptoms should sound familiar:

Causes of DHEA Deficiency

Age: First, DHEA is a youthful hormone that decreases naturally as we age. By about age 50, nearly everyone will have lower levels of DHEA. By the age of 70, levels are about 1/4 of what they were in a person’s early 20’s.

Stress: The next common cause for DHEA deficiency is prolonged stress. Although it’s typical to see lower DHEA levels by around age 50, with unchecked stress, it’s possible to hit lower levels earlier in your 30s and 40s. I often see women who come to me for hot flashes or other hormone symptoms that happen around menopause. Commonly we’ll find abnormalities in cortisol levels , which are regulated through DHEA, and discover that the root issue is actually the stress, which is driving hormonal deficiencies.

Smoking: Smoking also lowers DHEA, but we all know we shouldn’t smoke so I won’t belabor that point.

How to Support DHEA Naturally

There are several ways to support your body’s natural ability to make this master hormone. As with all hormones, we need to give our bodies the natural building blocks and adequate rest that allow it to function optimally. Here are a few things to think about when aligning your lifestyle in a way that supports hormonal balance:

• Adequate levels of vitamin C and other key nutrients
• Proper nutrition consisting of clean, real foods
• Optimal sleep quality and duration
• Stress reduction

In addition, sometimes a small supplementation can have a massive impact on health.

DHEA Testing & Supplementation

Test…Don’t Guess!

You should always check all hormones before beginning a hormone supplementation protocol. This is a common concept in functional medicine that is often overlooked by many “hormone specialists” as well as general practitioners. Hormones work in concert with each other, so it is critical to consider the big picture of all the hormone players (in other words, “Your Hormones in Harmony”).

The Benefits of Supplementing DHEA

Assuming that you tested your hormones, and discovered that your DHEA is low, what would be the potential benefits of supplementing?

Potential benefits include stress tolerance and helping you deal more effectively with stress, weight loss, and cortisol balance. Supplementation can also help with insomnia, decrease your risk for heart disease, and improve cognition.

There is also some interesting research with DHEA related to autoimmune diseases. Johns Hopkins currently has an ongoing study using DHEA to treat lupus, and there is research showing that DHEA may help with rheumatoid arthritis as well.

Finally, some of the menopausal symptoms that many women experience can be treated with DHEA. However, I’d like to point out that DHEA supplementation is not just for menopausal or postmenopausal women. Many women who deal with chronic stress, who have flushing, flashing, and some early hormonal symptoms, have a cortisol and DHEA issue that can be addressed simply through stress reduction and mild supplementation.

DHEA Dosing

Dosing for DHEA supplementation needs to be gentle and cautious.

Although it is available without a prescription, DHEA is a hormone. Many people assume because it’s available over-the-counter, it’s “safe” … and take too much.

Typical dosing for women will range from 2.5 – 25 milligrams. I rarely recommend more than 2.5mg without lab tests to guide me. This is one of the advantages of seeking out an experienced functional medicine physician who can run and interpret these kinds of tests.

I discourage trial-and-error dosing, as it may cause more harm than good. For example, if your cortisol is high, DHEA supplementation can make your cortisol even higher. Since DHEA does turn into cortisol (and other hormones), in this situation, using a keto form of DHEA might be helpful. Keto forms of DHEA don’t convert into steroid hormones, so if you’re not testing, that’s a safer option.

Final thoughts on DHEA

Diving into the medical literature, we’ll find many other uses and utilities for DHEA. My purpose in this article is to draw awareness to the importance of DHEA and to encourage testing when appropriate. The mantra of this series has been: Test…Don’t Guess!

It is important to remember the Hormone Hierarchy (cortisol, insulin, and thyroid) first, as well as gut function before jumping on the bandwagon of supplementing sex hormones. However, due to the way your body uses DHEA, if your levels are low, this can be one leverage point to use to support your body’s hormonal health.

Hormones can be a very complicated subject and it is important to work with a practitioner who is adept at testing, has experience working with other hormones in the hierarchy, and considers gut health, nutritional status, and a person’s whole health. Once again, this is one of the ways in which functional medicine really shines.