DHEA deficiency

What is DHEA?

DHEA (dehydroepiandrosterone ) is the most abundant steroid hormone in the human body.  DHEA starts to increase when children are about 9 or 10.  Levels peak between the ages of 20 and 35 and then start to decline.1 It is often referred to as the ‘anti-ageing hormone’, the ‘super-hormone’ or ‘the fountain of youth hormone’ due to the decline in certain functions associated with the ageing process.  DHEA plays a part in many of our bodily functions including regulating testosterone and oestrogen , memory and cognitive functions, the immune system , stress management and even vitality and wellbeing. The synthesis of DHEA is very complicated because there are several enzymes involved in the process. 

Metabolic Pathway for DHEA

DHEA is a precursor hormone that is controlled by the brain via a negative feedback loop (similar to that of the thyroid gland).  The system starts with the hypothalamus, which produces a corticotrophin-releasing hormone (CRH), which then informs the anterior pituitary gland to produce adrenocorticotropic hormone (ACTH).  Both CRH and ACTH enable the adrenal glands to produce DHEA. DHEA is also produced by the testes and ovaries as well as by the brain but in very small amounts.2  DHEA is synthesized mostly from cholesterol in the adrenal glands, which is then converted to pregnenolone.3 Once formed, pregnenolone can be converted to progesterone , which will then be converted to cortisol , or DHEA, which can be converted into other hormones including testosterone and estradiol .3,4

What are the symptoms of a DHEA imbalance?

Depending on whether your DHEA levels are high or low for your age, symptoms could vary. Whilst DHEA production decreases with age in both men and women, a low level of DHEA can also indicate conditions like a damaged adrenal gland , Addison’s disease or hypopituitarism.

Low DHEA levels often present symptoms such as memory loss, fatigue, low libido, osteoporosis and erectile dysfunction in men.  It has also been linked with a shorter lifespan in men but not in women.  Low levels are associated with an increased risk of cardiovascular disease in men with type 2 diabetes mellitus.1 Low levels of DHEA in women are associated with low libido, reduced bone mineral density and osteoporosis.

High levels of DHEA have been seen in females with PCOS (polycystic ovarian syndrome) and hirsutism , children with congenital adrenal hyperplasia and people with cancer of the adrenals. Some studies have linked high levels with cardiovascular disease and death as well as a reduction in depression.5  All of these conditions would require testing and diagnosis by a specialist medical professional. High levels can cause acne, additional facial and body hair as well as hair loss, missed periods in women, fertility issues and other symptoms.6

Testing

Your GP may be able to test your DHEA levels if you are concerned you might have an imbalance although it is more likely to be tested by an endocrinologist . If you are taking any DHEA supplements or supplements that could contain DHEA, you must advise your doctor of this ahead of your test.  The DHEA test is a straightforward blood test.7

Treatment

Your clinician will use the results of your DHEA test to ascertain the cause of any DHEA imbalances.  There are many possible causes and solutions. Your treatment would be dependent on the root cause of the change in your DHEA levels. DHEA has been used along with gonadotropins to treat infertility.1

What is the link between DHEA and thyroid disease?

It is common for people with Addison’s disease to have hypothyroidism and because DHEA is produced by the adrenals, problems with the adrenals can, but not always, affect its production and the levels present in the blood.Thyroid conditions can impact other hormone levels in the body, which can in turn also affect DHEA levels.  One study showed that DHEA, DHEA-S and PREG-S were all significantly lower in patients with hypothyroidism.  Interestingly, although DHEA levels were normal in patients with hyperthyroidism, their DHEA-S and PREG-S levels were significantly higher.9

What about the research?

Research into DHEA is still relatively recent and producing some mixed results. It’s effectiveness is controversial with little supporting evidence.10  Most studies indicate no effect of DHEA on cognitive function or on muscle size or strength.  It’s use as a supplement carries certain side effects that should be considered.  The consistency of the quality across the supplements available is also not at a very high standard.  There are currently dosage guidance concerns too.11 Early research indicates that DHEA could be used to help people with certain conditions, such as adrenal insufficiency and lupus .  Further research into this solution is still required.

What about 7-keto DHEA?

7-keto DHEA is produced from DHEA but is not converted to steroid hormones when taken orally.12 However, when used on the skin, it has been shown to affect hormone levels in men.13 7-keto-DHEA is often taken to speed up metabolism and weight loss as well as increase the activity of the thyroid gland, boost the immune system, enhance memory, and slow aging14 as well as to treat depression, anxiety, and post-traumatic stress disorder (PTSD).15,16 One randomized, placebo-controlled research study on dieting and exercising healthy overweight individuals found 7-keto DHEA significantly increased body-weight loss and fat-loss.17 Studies show that it was well tolerated in normal healthy men at doses up to 200 mg/d for up to 8 weeks although it might cause mild side effects such as nausea, dizziness, or low blood pressure in some people.18 Not enough is known about the use of 7-keto DHEA during pregnancy and breast-feeding so it’s best to avoid it.19 Be aware that the World Anti-Doping Association has classed 7-keto DHEA as a prohibited anabolic agent 20,21 and the UK class DHEA as a CLASS C controlled drug.22 When ordering online you may have your DHEA or 7-keto DHEA seized by customs.  

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Date updated: 23/03/21 (V1.6) Review date: 09/10/21

References

  1. You and your hormones Educational Resource from the Society of Endocrinology http://www.yourhormones.info/
  2. You and your hormones – Dehydroepiandrosterone Educational Resource from the Society of Endocrinology http://www.yourhormones.info/hormones/dehydroepiandrosterone/
  3. Early steps in androgen biosynthesis: from cholesterol to DHEA NCBI – Miller W L –https://www.ncbi.nlm.nih.gov/pubmed/9890062
  4. DHEA and Health: More Questions that Answers Harvard Medical School https://www.health.harvard.edu/newsletter_article/dhea-and-health-more-questions-than-answers
  5. What is a DHEA Test? WebMD  https://www.webmd.com/healthy-aging/aging-dhea-test#
  6. Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate University of Rochester –https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=dhea
  7. Lab Tests Online UK DHEAS  https://labtestsonline.org.uk/tests/dheas
  8. Addison’s Disease – Diagnosis NHS – Southend University Hospital https://www.nhs.uk/conditions/addisons-disease/diagnosis/
  9. Serum Dehydroepiandrosterone, Dehydroepiandrosterone Sulfate, and Pregnenolone Sulfate Concentrations in Patients with Hyperthyroidism and Hypothyroidism Noriko Tagawa et al American Association for Clinical Chemistry http://clinchem.aaccjnls.org/content/46/4/523
  10. How can DHEA benefit your Health? Medical News Today  https://www.medicalnewstoday.com/articles/308684.php
  11. Dehydroepiandrosterone (DHEA): hypes and hopes  Rutkowski K  NCBI (Drugs. 2014 Jul;74(11):1195-207. doi: 10.1007/s40265-014-0259-8.) https://www.ncbi.nlm.nih.gov/pubmed/25022952
  12. Effect of Oral DHEA on serum testosterone and adaptations to resistance training in your men Gregory A. Brown, Matthew D. Vukovich, Rick L. Sharp, Tracy A. Reifenrath, Kerry A. Parsons and Douglas S. King https://journals.physiology.org/doi/full/10.1152/jappl.1999.87.6.2274
  13. Effects of transdermal application of 7-oxo-DHEA on the levels of steroid hormones, gonadotropins and lipids in healthy men. Sulcová J1, Hill M, Masek Z, Ceska R, Novácek A, Hampl R, Stárka L. https://www.ncbi.nlm.nih.gov/pubmed/11300231
  14. Medical Definition of 7-keto-DHEA MedicineNet – 7-keto-DHEA:  https://www.medicinenet.com/script/main/art.asp?articlekey=155195
  15. Fighting the Winter Blues with DHEA James Lake MD Psychology Today https://www.psychologytoday.com/gb/blog/integrative-mental-health-care/201812/fighting-the-winter-blues-dhea
  16. DHEA Enhances Emotion Regulation Neurocircuits and Modulates Memory for Emotional Stimuli Rebecca K Sripada, Christine E Marx, Anthony P King, Nirmala Rajaram, Sarah N Garfinkel, James L Abelson and Israel LiberzonNeuropsychopharmacology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717538/
  17. A randomized, double-blind, placebo-controlled study of 3-acetyl-7-oxo-dehydroepiandrosterone in healthy overweight adults. Kalman DS, Colker CM, Swain MA, Torina GC, Shi QCurr Therap Res. 2000;61(7):435-42. https://www.researchgate.net/publication/239995714_A_randomized_double-blind_placebo-controlled_study_of_3-acetyl-7-oxo-dehydroepiandrosterone_in_healthy_overweight_adults
  18. Safety and pharmacokinetic study with escalating doses of 3-acetyl-7-oxo-dehydroepiandrosterone in healthy male volunteers. Davidson M1, Marwah A, Sawchuk RJ, Maki K, Marwah P, Weeks C, Lardy H.Clin Invest Med. 2000 Oct;23(5):300-10. https://www.ncbi.nlm.nih.gov/pubmed/11055323
  19. Dehydroepiandrosterone (DHEA) Beth Israel Lahey Health Winchester Hospital Health Library https://www.winchesterhospital.org/health-library/article?id=21678
  20. 7-keto-DHEAmetabolism in humans. Pitfalls in interpreting the analytical results in the antidoping field. Martinez-Brito D, de la Torre X, Colamonici C, Curcio D, Botrè F, Drug Test Anal. 2019 Nov;11(11-12):1629-1643. https://www.ncbi.nlm.nih.gov/pubmed/31701664
  21. World Anti-Doping Agency ANABOLIC ANDROGENIC STEROIDS (AAS) https://www.wada-ama.org/en/content/what-is-prohibited/prohibited-at-all-times/anabolic-agents
  22. List of Most Commonly Encountered Drugs Currently Controlled under the Misuse of Drugs Legislation https://www.gov.uk/government/publications/controlled-drugs-list–2/list-of-most-commonly-encountered-drugs-currently-controlled-under-the-misuse-of-drugs-legislation

Other Sources

https://www.sciencedirect.com/topics/neuroscience/dehydroepiandrosterone

https://academic.oup.com/endo/article/145/3/1039/2877953

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