Allergic Disorders
Eight patients with severe attacks of hereditary angioedema were treated with 37 or 74 mg per day of DHEA-S (equivalent to 25 or 50 mg, respectively, of DHEA) every 1 to 3 days, for 3 to 29 months. DHEA-S treatment resulted in a dramatic clinical improvement in all eight patients.27
Practitioners who use DHEA have observed that treatment sometimes reduces the severity of food or chemical allergies. I have seen several patients with multiple chemical
sensitivities who responded to physiologic doses of DHEA (5-15 mg per day for women, 10-30 mg per day for men). However, it is difficult to predict which patients will improve.
Subnormal serum levels of DHEA-S are common in asthmatics. DHEA deficiency might result in part from corticosteroid-induced adrenal suppression. However, low levels of DHEA-S were also found in 21% of asthmatics who were not taking steroids.28 DHEA deficiency may also result from long-term administration of inhaled corticosteroids. In a study of 36 post-menopausal asthmatic women, those who were receiving at least 1 mg per day of beclomethasone dipropionate had nearly a 50% reduction in serum DHEA levels, compared with women who were not receiving the drug. Apparently, inhaled corticosteroids are absorbed in amounts sufficient to cause some degree of adrenal suppression.29
I have seen two female patients with long-standing asthma who had clinical
improvement after receiving 10 mg per day of DHEA. In one of these patients, chronic nasal
polyps also disappeared, much to the surprise of her otolaryngologist.
Obesity
Administration of DHEA prevented the development of obesity in genetically obese mice.30 However, studies in humans have so far failed to demonstrate a role forDHEA in the treatment of obesity.
Cardiovascular Disease
Administration of DHEA reduced the severity of atherosclerosis in cholesterol-fed rabbits.31 DHEA-S also has been shown to have digitalis-like activity, accounting for 62-100% of the total plasma digitalis-like factors in 11 healthy adults.32
Mean plasma DHEA-S levels were significantly lower in men with a history of heart disease than in men without such a history. In men with no history of heart disease at baseline, a low plasma DHEA-S level (less than 140 mcg/dl) was associated with a more than three-fold increase in the age-adjusted risk of death from cardiovascular disease.33 Similar findings have been reported by others,34 although another epidemiologic investigation found only a modest protective effect of DHEA.35
In women, no inverse association was found between DHEA-S levels and cardiovascular disease. In fact, cardiovascular death rates were highest in women in the upper tertile of DHEA-S levels and lowest in women in the middle tertile (a U-shaped distribution).36
Osteoporosis
At the time of menopause, the amount of DHEA manufactured by the ovaries declines. And, even though the ovaries are not the major source of DHEA, serum DHEA levels decline by more than 60% after menopause.37
The possible relationship between DHEA deficiency and osteoporosis was suggested by a study of women with Addison’s disease (adrenal failure). In these patients, the onset of menopause was followed by an unusually rapid rate of bone loss. This accelerated bone loss was associated with marked reductions in plasma concentrations of DHEA and testosterone (94% and 63% lower, respectively, than those of healthy post-menopausal women).38 These findings suggest that DHEA and/or testosterone is essential for the maintenance of bone mass in post-menopausal women.
In another study, bone mineral density was measured at the lumbar spine, hip, and radius in 105 women, aged 45-69. Fifty women had normal measurements, whereas 55 had low bone density. The average serum DHEA-S level was 60% lower in the women with low bone density than in those with normal bones. Women with low DHEA values were 40 times more likely to have osteoporosis than were women with normal DHEA levels. In contrast, there was no relationship between estrogen levels and bone density.39 In a group of post-menopausal women, there was a significant positive correlation between bone mineral content of the distal radius and ulna and age-adjusted serum DHEA levels.40
There are several mechanisms by which DHEA might prevent osteoporosis. First,
one of the breakdown products of DHEA, a compound called 5-androstene-3ß, 17ß-diol, is known to bind strongly to estrogen receptors. Therefore, DHEA, like estrogen, might exert an inhibitory effect on bone resorption. Second, there is evidence that androgens (a class of hormones that includes DHEA and testosterone) stimulate bone formation and calcium absorption.41 Third, the partial conversion of DHEA to estrogen and testosterone would be expected to provide additional protection against bone loss.
I often recommend low doses of DHEA (usually 5-10 mg per day) for postmenopausal women whose serum DHEA-S levels are near or below the lower limit of normal. In some cases, DHEA relieves symptoms such as hot flashes that are usually attributed to estrogen deficiency. A combination of DHEA and identical to-natural progesterone (usually given as a topical cream) may be more effective against hot flashes than either treatment alone.
Dementia
In one study, intracerebroventricular administration of DHEA or DHEA-S improved the results of certain memory tests in mice.42 Some investigators have found low levels of DHEA in patients with Alzheimer’s disease.43 However, others have failed to confirm those observations.44 In a small, uncontrolled trial, administration of DHEA appeared to produce modest improvements in cognition and behavior in a group of male patients with Alzheimer’s disease.45
Diabetes
Administration of 0.4% DHEA in the diet reversed hyperglycemia, preserved beta-cell function, and increased insulin sensitivity in genetically diabetic mice.46 Although DHEA has been reported to ameliorate insulin resistance in one patient with diabetes,47 very large doses of DHEA (1,600 mg/day for 28 days) caused mild abnormalities of glucose metabolism.48 The role of DHEA in the over all management of diabetes, therefore, remains unclear.
Toxicity of DHEA
For a steroid hormone, DHEA appears to be relatively safe. Administration of 1,600 mg per day for 28 days to healthy volunteers resulted in some degree of insulin resistance, but no other significant side effects occurred. In the SLE studies, 200 mg per day given for a number of months was well tolerated, with the exception of mild to moderate acne and occasional mild hirsutism.
Addition of 0.6% DHEA to the diet of rats reduced body weight and enhanced the development of chemically-induced pre-neoplastic pancreatic lesions.49 Although that dose of DHEA is extremely large (the equivalent human dose would be approximately 2,000 mg per day), this report indicates that DHEA is by no means innocuous and, therefore, it should be used with caution.
