For Patients & Caregivers
Bottom Line: DHEA has not been shown to be effective in treating cancer.
DHEA is the most abundant hormone secreted by the adrenal glands. Clinical trials have shown that DHEA is effective in treating certain forms of depression and anxiety, lupus, sexual dysfunction, and Addison’s disease. High blood levels of DHEA have been associated with increased risk of breast, ovarian cancers; DHEA supplementation resulted in flare-up of prostate cancer.
- Addison’s disease
Studies have shown that DHEA is effective in treating Addison’s disease.
- Alzheimer’s disease
DHEA was not found to be beneficial for patients with Alzheimer’s disease.
- Cancer treatment
Although studies have been done to determine DHEA’s benefits for cancer patients, results are not conclusive.
DHEA has been shown to reduce symptoms of manic depression.
- Memory loss
DHEA is not effective in treating memory loss.
Studies have shown that DHEA benefits patients with schizophrenia.
- Sexual performance
DHEA has been shown to be effective for erectile dysfunction.
- Systemic lupus erythematosus
A few studies have shown that DHEA reduces the number of flare-ups but there was no reduction in overall disease activity.
Fifty-eight volunteers with Alzheimer’s disease participated in a randomized controlled trial in which they received either DHEA or placebo for six months. Researchers did not observe a significant improvement in the treatment group when they measured cognitive performance.
The effects of DHEA on muscle function were observed during a one-year trial in which 280 healthy males between the ages of 60 and 80 were randomized to receive either daily doses of DHEA or placebo. At the end of the trial, men in the treatment group displayed DHEA levels normally seen in young adults, but researchers observed no beneficial effects on muscle state.
Forty patients recruited from an impotence clinic participated in a randomized controlled trial of the effect of DHEA on erectile dysfunction. Patients received either DHEA or placebo for six months. Patients in the treatment arm showed a statistically significant increase in erectile function, intercourse satisfaction, sexual desire and orgasmic function compared to the control group.
Systemic lupus erythematosus
In a trial examining the effect of DHEA on systemic lupus erythematosus, 120 women with a mild-to-moderate form of the disease were randomized to receive either DHEA or a placebo. Women in the treatment group did not experience a significant reduction in disease activity, but they did report having fewer flare-ups.
- In premenopausal women, high levels of DHEA have been associated with increased risk of ovarian and breast cancers.
- When taken for an extended period by postmenopausal women, DHEA may increase the risk of breast cancer, especially in obese subjects.
- Patients with hormone-sensitive cancer should avoid DHEA because the hormone is converted to sex steroids.
- Patients who are pregnant or breast-feeding should avoid DHEA because of its effect on estrogen levels.
For Healthcare Professionals
The most abundant hormone secreted by the adrenal glands, DHEA circulates in the blood as the sulfate ester, dehydroepiandrosterone-3-sulfate (DHEA-S). Both are precursors for other hormones, including estrogen and androgens (1). Animal studies indicate that DHEA may have chemopreventive effects (2)(3), block the development of tumors (4), and enhance immune response following hepatitis (5) and influenza (6) vaccinations. Although it has been postulated that DHEA may play a role in increasing immune response in acquired immune deficiency syndrome (AIDS) (7), no antiviral or immunostimulatory effects were observed in HIV-positive participants receiving DHEA (8).
In clinical trials, DHEA was shown effective in treating Addison's disease (13)(14)(15)(16)(17), major depression (9), schizophrenia-induced anxiety (10), systematic lupus erythematosus (11), osteoporosis (12), and erectile dysfunction (13). Topical application of DHEA in postmenopausal women resulted in increased sebum production and epidermal thickening in the hands and face (18). However, other studies show DHEA is ineffective in treating Alzheimer's disease (19), obesity in adolescents (20), and perimenopausal symptoms (21). Furthermore, DHEA does not increase muscle mass (22) or physical performance (23), enhance insulin secretion or action (24), or improve cognitive performance (25) in elderly individuals. In addition, DHEA supplementation, believed to enhance physical strength, did not improve physical performance or quality of life in a study done in older men and women (26). However conflicting data suggest improvements in cognitive (43) and physical function (44) in older women. DHEA has been used to treat sexual dysfunction in postmenopausal women. But results from clinical studies are mixed (28)(29). Further research is needed. Whether DHEA is effective for treating adrenal insufficiency is not clear (41)(42).
DHEA alters some of the activities of the cytochrome P-450 enzyme that metabolizes several drugs (3). In premenopausal women, high levels of DHEA have been associated with increased risk of ovarian (7) and breast (27) cancers. High DHEA-S levels have also been shown to contribute to tamoxifen resistance and disease progression in breast cancer (28). A case of cancer flare-up was reported in a patient with advanced prostate cancer undergoing DHEA treatment (29).
DHEA is an endogenous hormone secreted by the adrenal cortex in response to adrenocorticotropin. DHEA is metabolized into androstenedione in the body and may be further converted into either testosterone or estrogen. Low levels of endogenous DHEA have been associated with the following disease states: burn trauma, coronary artery disease, non-insulin-dependent diabetes mellitus, obsessive-compulsive disorder, rheumatoid arthritis, and systemic lupus erythematosus (5). Endogenous DHEA concentration peaks around 20 years of age and declines with age.
DHEA has been shown to stimulate insulin growth factor-1 (1). G6PD is necessary for nicotinamide adenine dinucleotide phosphate (NADPH) production. DHEA has also been shown to increase levels of interleukin-2 in animal models (7). DHEA reduces the effects of inflammatory cytokines such as interleukin-6, which are thought to reduce flares in systemic lupus erythematosus (11). Numerous studies have reported an inverse relationship between DHEA concentration and cardiovascular disease (5). DHEA administration improved mental function scores in patients with advanced HIV infection (32), enhanced influenza vaccination in elderly patients (6), and decreased oxidative stress markers in patients with type II diabetes in part by negatively influencing TNF-alpha signaling (33). Although DHEA-S concentration does not appear to be correlated with cognitive decline in aging men (34), the anti-depressive effects of DHEA may be mediated by GABAA receptor modulation (35). DHEA has also been shown to affect cytochrome P-450 enzymes in the liver (3). The exact effect that this will have on other drugs remains unclear.
Analogs of DHEA that cannot be converted to androgens and estrogens have been developed and have demonstrated anti-proliferative effects (7)(31). DHEA inhibits glucose-6-phosphate dehydrogenase (G6PD) in vitro and blocks the development of tumors in mice (4). But an increase in concentration of sex hormones including DHEA has been shown to increase the risk of breast cancer (30). And prolonged intake of DHEA in postmenopausal women may increase the risk of breast cancer particularly in obese subjects (36). The sulfate ester DHEA-S also stimulates estrogen receptor-positive cell growth (28).
DHEA concentrations peak between 60 and 480 minutes following administration. DHEA-S concentration peaks between 120 and 300 minutes (37).
Blood DHEA has a half-life of over 20 hours (38). Concentrations of DHEA and DHEA-S are considerably higher in the brain than in other organs (5).
DHEA-S has a longer half-life than DHEA (5). Concentration of serum DHEA and DHEA-S returned to baseline 12 hours following administration of 50 mg DHEA and 18 hours following administration of 100 mg DHEA (37).
- Serum concentrations of DHEA and DHEA-S can be increased by alprazolam, amlodipine, diltiazem, and metformin
- Serum concentrations of DHEA and DHEA-S can be decreased by dexamethasone, insulin, and morphine (5)
Basu R, Dalla Man C, Campioni M, Basu A, Nair KS, Jensen MD, et al. Two years of treatment with dehydroepiandrosterone does not improve insulin secretion, insulin action, or postprandial glucose turnover in elderly men or women. Diabetes. Mar 2007;56(3):753-766.
One hundred twelve elderly participants exhibiting normal age-related DHEA deficiency were given DHEA (75 mg daily for males and 50 mg daily for females) replacement or placebo for 2 years during which glucose and insulin levels were determined. No improvements in glucose levels or turnover as well as insulin secretion or action were detected. These data argue against the use of DHEA for age-related decline in glucose tolerance. Of note, few of the subjects in this study were obese, so possible positive influences of DHEA in obese individuals could not be determined.
Abrams DI, Shade SB, Couey P, McCune JM, Lo J, Bacchetti P, et al. Dehydroepiandrosterone (DHEA) effects on HIV replication and host immunity: a randomized placebo-controlled study. AIDS Res Hum Retroviruses. Jan 2007;23(1):77-85.
The effects of DHEA on HIV replication and overall immune function in 40 HIV-positive participants receiving antiviral therapy were analyzed in this study. Participants either received DHEA (100 and 50 mg twice daily for males and females, respectively) or placebo for 12 weeks followed by a 12-week open label period in which all participants were given DHEA. Although no antiviral or immunostimulatory effects derived from DHEA were detected, DHEA improved the overall quality of life in these subjects. Due to the small sample size and short duration of treatment, a larger, long term analysis is necessary. Furthermore, because only two women were recruited into this study, gender-specific effects of DHEA treatment were not determined.
Wolkowitz OM, Kramer JH, Reus VI, Costa MM, Yaffe K, Walton P et al. DHEA treatment of Alzheimer’s disease: a randomized, double-blind, placebo-controlled study. Neurology 2003;60:1071-6.
58 volunteers with Alzheimer’s disease were randomized to receive DHEA (50 mg twice a day) or placebo for six months. Volunteers were evaluated at three and six months for improvement in cognitive functioning as measured by the AD Assessment Scale-Cognitive as well as observer-based ratings. Researchers did not observe a significant improvement on cognitive performance in the treatment group. Nearly a third of the participants dropped out of the DHEA treatment arm and over half dropped out of the placebo arm.
Chang DM, Lan JL, Lin HY, Luo SF. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2002;46:2924-7.
120 women with active systemic lupus erythematosus were randomized to receive either DHEA (200 mg / day) or placebo for 24 weeks. The main endpoint of the study was change from baseline in the systemic lupus activity measure (SLAM) score at the conclusion of the trial. While women in the treatment group did not experience a significant reduction in SLAM score, the treatment arm did have significantly fewer SLE flares and improved the patient’s subjective assessment of disease activity. DHEA was well tolerated in this study, although an increase in acne was observed.