DHEA: super supplement or snake oil?

DHEA supplements are widely claimed in the lay press to help with a huge number of diverse conditions: anti-aging, cardiovascular disease, chronic fatigue & fibromyalgia, body building, obesity, osteoporosis, sexual dysfunction, and lupus – just to name a few. Most of this excitement was based on positive results seen in early scientific studies done in mice, and from some anecdotal reports from enthusiastic users…and things took off from there.

These days, many people now take the widely available DHEA tablets, hoping to get a health benefit – are they wasting their money and effort? Or is DHEA a “fountain of youth” hormone in a bottle?

What is DHEA?
DHEA (dehydroepiandrosterone) is a hormone that is made by the adrenal glands, out of cholesterol. It is an intermediate product in the chain of biochemical events that convert cholesterol into active hormones like testosterone and estrogen. Production of DHEA seems to peak in the mid-20’s, and starts to decline after the mid-30’s. (Unlike testosterone and estrogen, we don’t have any evidence that DHEA is particularly active by itself.)

So, the theory goes, that if we can boost the falling levels of this hormone back to the levels seen in healthy young adults, then various “good things” will happen, and we should feel young again. Sounds promising, but does it work in this case?

The evidence:

We can divide DHEA uses into 2 main groups: 1) deficiency states due to a specific disease, and 2) supplementation for otherwise normal, healthy people.

Scientific evidence supporting the use of DHEA is mostly positive when it is used as part of the treatment of specific problems, such as:
– adrenal insufficiency (“Addison’s disease”)
– systemic lupus erythematosus (“lupus”)
– depression

So far, most of the other proposed indications for DHEA use in disease states (like cancer or heart disease prevention) have notbeen proven yet, based on the studies that have been completed to date.

In terms of using DHEA as an “anti-aging” supplement for normal, healthy people who just want to feel younger, the recent scientific trials that have been carefully conducted in people, rather than mice, are pretty disheartening:

– A double-blinded, placebo controlled study from France in 2003, looked at the effect of DHEA on muscle mass over a 12 month period in healthy 60-80 year olds. Although the DHEA supplements caused the blood levels of DHEA to go up to the range found in young adults, there was no significant difference in muscle strength, or muscle volume compared to the placebo group.

– A 2005 study from University of Pennsylvania looked at muscle mass, strength, endurance and quality of life measurements (feelings of well-being, sleep & sexual function) in postmenopausal women. Once again, while the levels of DHEA in the blood went up, there was no significant difference in the treated group on any of the parameters, compared to the people that had no hormone therapy at all.

– A 2001 study from Germany looked at DHEA supplementation in healthy men, aged 50-69, using a double-blinded cross-over study design with placebo controls. While the blood levels of the hormones again went up to youthful levels, there was no effect seen on serum lipids, bone markers, body composition & muscle mass or exercise capacity.

– In a study done in healthy men aged 35-65, the effect of 12 weeks of DHEA supplementation was examined in conjunction with a high-intensity fitness program. They found no enhancement above the results obtained by physical training alone, and worse, a 6.5% increase in cardiac risk, due to unfavorable changes in the cholesterol profile.

DHEA also has a number of common side effects: acne, unwanted hair growth, unfavorable changes in lipid (cholesterol) profiles.

The bottom line: DHEA supplementation remains controversial as a supplement for normal, healthy people.

Based on my own interpretation of these and other studies, I don’t currently recommend DHEA to my patients as a general anti-aging supplement. It does not seem to have conclusively-proven effects on either the physical or mental aspects of aging. While there might be some sub-groups of people where DHEA therapy may have some benefit, these groups are still being defined, and more research is needed.

People that have known hormonally-sensitive cancers (breast, prostate, etc.) should especially avoid DHEA.

 

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