Using DHEA Wisely and Safely
As this review suggests, DHEA shows promise for preventing age-related decline and as a treatment for certain diseases. Innovative practitioners, therefore, have begun prescribing DHEA for their patients and the public is becoming increasingly interested in this purported “anti-aging pill.”
Although DHEA appears to be safe, its long-term effects are unknown. It is possible that adverse consequences will become evident with chronic use. It is, therefore, important that we use this hormone with care and err on the side of caution. Although some practitioners are routinely prescribing 50 mg per day for healthy women and 100 mg per day for healthy men, those doses may be supraphysiologic, raising legitimate concerns about the long-term safety of such dosages.
Unlike hydrocortisone (cortisol), for which the physiologic replacement dose is
known, it is not clear what the physiologic dose of DHEA is. However, it may be lower than many practitioners believe. I have treated one patient with severe adrenal insufficiency who had a clear response to 15 mg per day of DHEA. She experienced marked clinical improvement at that dose, and her serum level of DHEA-S increased from barely detectable to well above the lower limit of normal. Another female patient with a history of bilateral adrenalectomy reported marked symptom relief with DHEA doses as low as 5-10 mg per day.
In my practice, I usually prescribe 5-15 mg per day for women and 10-30 mg per day for
men. Many patients have obvious improvements with these doses. With some patients
who have not improved, I have prescribed larger doses, but in most cases, the larger doses
were not helpful either. The one exception has been patients with lupus or other autoimmune diseases, who sometimes needed as much as 100 mg per day or more to obtain benefit. I typically prescribe DHEA in capsule form, in a base of hydroxymethylcellulose. In most cases, I recommend twice-a-day dosing, usually morning and evening.
Although serum measurements of DHEA and DHEA-S are available through
most laboratories, it is not clear how closely one should rely on these measurements; nor
is it clear whether DHEA or DHEA-S is the more reliable test. The normal range for DHEA-S as listed by my local laboratory is 350-4,300 ng/ml for women and 800-5,600 ng/ml for men. Many older individuals have values near or below the lower limit of normal. However, I prefer not to use an age-adjusted reference range (as published by some labs), since it seems that the age-related decline in serum DHEA-S is undesirable.
When DHEA therapy appears to be clinically indicated, I will consider treating a
woman whose DHEA-S level is below 600 ng/ml and a man whose level is below 1,200 ng/ml. There are as yet no data on what constitutes an optimum serum level. Consequently, I continue to err on the side of caution by using low doses of DHEA.
There are also no data available concerning long-term administration of DHEA.
While lifetime replacement therapy seems appropriate for patients with age-related DHEA deficiency, other patients should be assessed on a case-by-case basis.
I have found that about 10% of patients who are taking thyroid hormone develop
symptoms of thyrotoxicosis after starting DHEA therapy. That observation is consistent
with a report that DHEA potentiates the action of thyroid hormones.50 Symptoms of thyroid over-treatment responded to a reduction in the thyroid-hormone dosage, and patients reported that they felt better on DHEA plus lower-dose thyroid hormone than they did on thyroid hormone alone.
In conclusion, DHEA appears to be one of the major therapeutic advances of the
past 20 years. However, this powerful hormone must be utilized with caution in order to maximize its benefits and minimize its risks.
