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Dr. Aaron Hartman

January 11, 2022


Although DHEA is one of the most commonly overlooked hormones, it is a master hormone responsible for the creation of cortisol, testosterone, and estrogen.
While cortisol, testosterone, and estrogen often dominate conversations about hormones, DHEA (dehydroepiandrosterone) may be an underrated maestro of hormone health. Low DHEA can be responsible for many symptoms as varied as decreased cognitive function, weight gain, and an inability to deal with stress.

Why is DHEA critical for general hormonal health?

Many of the functions of DHEA will sound familiar to those who look to estrogen or progesterone for hormone therapy, as these deficiencies may be caused by an upstream deficiency of DHEA.
DHEA is produced by your adrenal glands and in the brain and skin. Receptors for DHEA are found throughout the body, and many systems within our bodies rely on DHEA for proper function. This important hormone is required for various healthy functions including:

* optimal brain function
* youthful skin appearance
* reduced risk for cardiovascular disease
* optimal cholesterol levels
* bone growth
* improved ability to deal with stress
* normal healing
* prevention of blood clots
* reduced blood sugar levels
Even beyond this long list of jobs in the body, DHEA also works as an antioxidant, anti-inflammatory, and it improves blood flow and circulation by increasing nitric oxide.
As you can see, the functions of DHEA are many and varied. This is why DHEA is necessary for optimal health and why it’s important to consider in testing.

What are the some of the signs and symptoms of DHEA deficiency?

These familiar symptoms may be signs of a DHEA deficiency:

* low energy
* decreased muscle mass and/or strength
* decreased ability to deal with stress
* depressed immune system and increased infections
* joint soreness
* weight gain
* flushing or hot flashes
* irritability

What causes DHEA deficiency?

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

* Optimal sleep quality and duration
* Stress reduction
* Proper nutrition consisting of a diet of clean, whole foods
* Adequate levels of vitamin C and other key nutrients
In addition, sometimes a small supplementation can have a massive impact on health.

DHEA testing and supplementation

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, not just one in isolation.
Hormone balance in the body is a dance; you can’t push on one hormone without affecting the others.
So let’s say you had your DHEA levels checked, and they were low. As you were thinking about supplementation, what would be the potential benefits? Well, some of the benefits include helping the person deal more effectively with stress, better stress tolerance, 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

Most importantly, dosing for DHEA supplementation needs to be gentle and cautious. Again, although it is available without a prescription, DHEA is a hormone. Many people take too much because it’s so available over-the-counter, and because they assume it’s “safe”.
Typical dosing for woman will range from 2.5 milligrams to about 25 milligrams. Usually I won’t recommend more than 2.5 milligrams 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 lab tests. Sometimes people will try to find the right dose with trial-and-error dosing, but again, for hormones, I tend to discourage this less precise dosing method as it may cause more harm than good.
For example, if your cortisol is high, DHEA supplementation can make 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

Taking a deep dive into the medical literature, we’ll find many other uses and utilities for DHEA. However, my purpose in this post is to draw awareness to the importance of DHEA and to encourage testing when appropriate.
It is important to look at your hormone hierarchy (cortisol, insulin, and thyroid) first, as well as gut function before jumping on the hormonal bandwagon with 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.
As we continue this series on hormone health, I’d recommend reading through all of these posts to get an overview of estrogen progesterone, testosterone, and DHEA, and how they interact. I hope they will help you to see the interplay of your hormones and give better insight into how your hormones are working.
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. This is the realm of functional medicine where we focus on these areas all day, every day.
Please look out for new posts in this series on hormone health. As we continue to put out more articles about hormones, please share them with others. The only way to get this information out there is for people like you to share it and comment on it. Unfortunately, in the current media climate, even good quality information is not being dispersed unless there is feedback from the readership. Your interaction with this information can help make this more readily available to others.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.


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