DHEA – a hormone, not an acronym for a federal agent.

If there is one thing certain in this life, apart from taxes and death is the confusion surrounding our hormones. No matter what age, our body depends on hormonal communication. One hormone, in particular is of significant value and has been suggested as being the mother hormone.  The hormone in question is Dehydroepiandrosterone, commonly referred to as DHEA.  SO why is this pro-hormone important and is it as essential as we are led to believe?
 DHEA, is a precursor hormone, meaning that it has little effect on its own, but powerful effects when converted to androgens. DHEA is a precursor to all of our sex hormones, Oestrogen progesterone, testosterone and our stress hormone, cortisol. Produced from cholesterol, mainly in the outer layer of the adrenal glands, the adrenal cortex, ovaries and the testes. DHEA, however, decreases with age and is present at very different concentrations between different women, with the consequence that approximately 75% of postmenopausal women have too low circulating DHEA levels and suffer from symptoms/signs of hormone deficiency. (7).
DHEA, the precursor to estrogen provides 75% of estrogens in women prior to menopause and 100% post. The production of DHEA increases from around 10 years of age peaking in the 20s and declining gradually with age.  Normally an average adult will synthesize 25 mg of DHEA per day.  DHEA production is controlled by the brain in a negative feedback loop, meaning that when DHEA levels fall the system is activated, with increased levels the system deactivates. The switch is controlled by the corticotrophin releasing hormone, (CRH), produced by the hypothalamus, travels to the pituitary gland causing the releases of adrenocorticotropic hormone, which is then released in the blood, both hormones trigger the adrenals to produce DHEA.
 Apart from being a component of the building blocks of our sex hormones it also has mood altering qualities as production potentiates chemical or neurotransmitters such as serotonin. This is significant if we look at the cascade of hormones as they precede the conversion from DHEA to progesterone, testosterone and Estrogen.  If the body is emotionally or physically stressed DHEA is not released however Cortisol is produced instead. Over time if the adrenal glands are constantly producing this stress hormone they become over worked and Adrenal exhaustion may occur from coping with chronic stress. Since DHEA is also created by the adrenal glands these two hormones are in competition with each other and simply can't produce enough DHEA to support a healthy hormonal balance. This then can lead to further anxiety, depression and irritability and a loss of sexuality.   Since sex hormones are not synthesized naturally or rather, activated or “turned on”, neither is the woman, thus this may result in a low libido.
Exercise and calorie-restriction have been shown to increase natural dehydroepiandrosterone levels in the body and may lead to longer life. Whilst DHEA has shown great promise in menopausal women as a nutrient supplement critical to jump starting hormonal balance other drugs taken at this stage can affect its correct function. Drugs/hormones that may show decreased levels include insulin, oral contraceptives, corticosteroids, dopamine, hepatic enzyme inducers (carbamazepine, imipramine, phenytoin), fish oil, and vitamin E.
DHEA treatment through clinical trials have significantly improved overall wellbeing in menopausal women showing signs of increased sexual interest, decline in depression, anxiety, weight loss, muscle gain and a significant boost to the immune system. The dosage is dependent on every individual but as a rule of thumb it is about 30-50mg (1) taking DHEA   in the morning will mimic the natural rhythm of your body as DHEA is primarily synthesized at this time.  
 But as we know, it is never as simple as just popping a pill, although we would like to think otherwise, there are always other considerations. If you are one of the lucky ones that do not fall into the below category, then taking a DHEA supplement may be the one option for you.
 Side effects.
Like any hormonal prescription there may be additional side effects that are not particularly pretty so is advised to err on the side of caution and limit use to a minimal time. Taking  DHEA for some women has created changes in menstrual cycle, facial hair growth and a deeper voice. It may also cause, high blood pressure, hair loss and acne.
Limit TIME of hormonal replacement.
DHEA is  POSSIBLY UNSAFE when used in larger amounts and long-term. Do not use DHEA in doses higher than 50-100 mg a day or for a long period of time. Using higher doses or long-term use of DHEA can increase the chance of side effects (5)
 Hormonal sensitivity 
DHEA is not recommended for those women that may have any Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids. Why? There is some evidence to suggest that having more serum estradiol can increase endometrial thickness in women which is a risk of endometrial cancer ( uterine cancer) however there is some evidence to suggest otherwise.
Liver problems 
High doses of DHEA may prompt the body to stop making DHEA and high doses may be toxic to the liver cells. Many different metabolites are created in your liver when you swallow a DHEA supplement and any of these can produce unwanted side effects hence oral supplements may interfere with liver function. DHEA can promote free radicals in liver cells as shown in a study done on mice and rats (Metger et al.1995) However, if antioxidants like Green tea, vitamin E and N-acetyl-cysteine are given these anti-oxidants can be especially effective in suppressing those free radicals. (7)
Diabetes:
 DHEA can affect how insulin works in the body. Although it has been proposed that reduced DHEA may result in increased insulin resistance, it has been shown that insulin increases DHEA clearance — suggesting that low DHEA could simply be a consequence of insulin resistance (8)
Depression and mood disorders:
Additional DHEA may cause excitability and impulsiveness, irritability and sexual inappropriateness in some people that have a history of depression and bipolar disorders. If there is a mood disorder it is always better be sure to discuss DHEA with your healthcare provider before you start taking it. Also, pay attention to any changes in how you feel.
Polycystic ovary syndrome (PCOS):
Women with this reproductive disorder already have high circulating DHEA-S (DHEA metabolite) Supplementing with DHEA may increase male sex hormones (testosterone) which may be already high as well therefore making this condition worse therefore it is not recommended for use if you have this existing condition.
Cholesterol problems:
DHEA has potentially lowered overall cholesterol levels decreasing LDLs. DHEA through studies have shown elevated levels of HDL (good cholesterol) high density lipoproteins which remove LDS and lower the ratio. However once again there has not been enough studies to support this.
All being said and done, with today’s knowledge, DHEA offers the promise of a safe and efficient replacement therapy for multiple problems associated with hormonal deficiency after menopause without the risks associated with eostrogen based or any other treatments. Being mindful that DHEA may interfere with other medications It is unwise to purchase over the counter products such as “wild Yam” to increase your natural DHEA production. Whilst this may work it may not necessarily be the correct product for you and there are pros and cons of oral versus transdermal applications. When playing around with hormones, it is always advisable that you seek expert medical opinion before you plunge into hormonal therapy.
 References
1DHEA replacement in women with adrenal insufficiency pharmokinetics, bioconversion and clinical effects on wellbeing, sexuality and cognition Arlt w, Callies, F, Allolio B
2Dehydroepiandrosterone; a springboard hormone for female sexuality SparkRF   Fertil Steril. 2002 Apr;77 Suppl 4:S19-25.
3World J Urol. 2003 Nov;21(5):346-55. Epub 2003 Oct 10.
Androgen therapy with dehydroepiandrosterone.  Buvat J
4J endocrinol 2005 Nov;187(2):169-96 Is dehydroepiandrosterone a hormone?
Labrie F, Luu-the V, Belanger A, Lin SX, Simard J, Pelletier G, Labrie C
5 https://www.nlm.nih.gov/medlineplus/druginfo/natural/331.html
6 J Steroid Biochem Mol Biol. 2015 Jan;145:133-8. doi: 10.1016/j.jsbmb.2014.06.001. Epub 2014 Jun 9.
All sex steroids are made intracellularly in peripheral tissues by the mechanisms of intracrinology after menopause.
 7 http://www.lifeextensionvitamins.com/dhrethpa2.html#sthash.z92SRKIN.dpuf
8 Tchernol,A; EUROPEAN JOURNAL OF ENDOCRINOLOGY; 151(1):1-14 (2004)
9 http://www.whitelotusclinic.ca/blog/dr-fiona






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