Dehydroepiandrosterone (DHEA) and its metabolite DHEAS are the most plentiful hormones in the human body and can aid in sexual and cognitive functioning. Unfortunately for some, DHEA production will decline by about 95% over a person's lifetime. This article will discuss what DHEA is, its role in the body, evidence-based health benefits, and side effects. We'll also discuss how to test for DHEA so you know if supplementation is appropriate for you or your patient.
What is DHEA?
DHEA is a hormone made in the brain, nerves, reproductive organs, and, primarily, the adrenal glands. DHEA can be converted into its metabolite, DHEAS, which is more abundant. DHEAS can also convert into other hormones when needed. The amount of DHEA produced declines with age; starting at age 25, there is a 10% reduction in DHEA synthesis every decade. DHEA levels tend to be 10-30% lower in women.
What is DHEA's Role in The Body?
DHEA and Hormones
DHEA can convert into different reproductive hormones, and this conversion is dependent upon where it is in the body. Production of these hormones begins with the conversion of DHEA to androstenedione. Androstenedione is a weak hormone and primarily serves as an intermediate. Androstenedione can convert into either testosterone or estrone, a type of estrogen. Both testosterone and estrone can convert into estradiol, the primary estrogen in women. Because of its capability to turn into testosterone, estrone, and eventually estradiol, DHEA has been referred to as a "prohormone."
For men, DHEA conversion to testosterone is of little impact; it's estimated to account for less than 5% of total testosterone produced. However, the amount of testosterone produced from DHEA for women is drastically different. During the first half of the menstrual cycle, known as the follicular phase, 66% of testosterone production comes from adrenal DHEA production. In the second half of the cycle, known as the luteal phase, 40% of testosterone production originates from DHEA. Most of the testosterone produced here will turn into estradiol. DHEA can also convert into the other estrogen, estrone, in women's bones, brains, breasts, and ovaries.
DHEA and Cognition
DHEA also has effects on the central nervous system. It has been labeled a neurosteroid, a molecule that can rapidly affect brain function and behavior. DHEA and DHEAS have been shown to modulate various neurotransmitter pathways, including dopamine, serotonin, GABA, NDMA, and others. These neurotransmitters affect emotions, moods, reward processing, executive functioning, and attention regulation. DHEA and DHEAS have also been shown to have roles in producing inflammatory mediators and in nerve cell generation and survival. These effects can impact cognitive functioning.
DHEA works closely with cortisol, another adrenal hormone. Cortisol is the body's primary stress hormone and controls our circadian or sleep-wake cycles. In a similar fashion to cortisol, DHEA is also released under stress as well as in a circadian rhythm. While cortisol is essential for many processes, chronic cortisol release in the brain due to stress can be detrimental, causing memory problems and increasing the risk of depression. However, DHEA seems to have a protective effect, opposing cortisol's negative impacts.
What are Some Evidence-Based Health Benefits of DHEA?
Sexual Function and Wellbeing
DHEA has been extensively studied for its benefits on genitourinary symptoms in women, including painful intercourse, vaginal dryness, and atrophy or breakdown of the tissues in the vaginal tract. These symptoms are common among postmenopausal women. Prasterone, brand name Intrarosa, is a prescription vaginal DHEA suppository available in the United States. In a phase three clinical trial of over 400 women, daily Intrarosa use for 12 weeks resulted in lessening pain during intercourse, increased vaginal lubrication, and improvements in the integrity of the vaginal lining. In addition, serum levels of hormones were not affected, indicating that Intrarosa's DHEA stays local to the tissues, lessening the potential for side effects.
Vaginal DHEA is one of the recommended therapies by the North American Menopause Society for the treatment of genitourinary symptoms not relieved by over-the-counter therapies.
A meta-analysis of five studies investigated the effect of DHEA supplementation on over 900 women diagnosed with poor ovarian response going through fertility treatments, either in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). They concluded that supplementation with DHEA increased the pregnancy rate and lowered the miscarriage rate but did not affect egg retrieval. Based on these results, the authors suggested that DHEA may improve the quality of the egg.
DHEA supplementation may be beneficial for weight. A meta-analysis of over 900 elderly women showed a significant decrease in body mass index (BMI), a reliable measurement of height and weight that can indicate a healthy weight. It is thought the reduction in BMI results from DHEA's ability to convert into testosterone, as testosterone has been shown to positively impact weight.
What Are The Side Effects Of DHEA To Be Aware Of?
High levels of DHEA in females can lead to hirsutism (unwanted body/facial hair), acne, infertility, and virilization (development of male physical characteristics). High DHEA is seen in adrenal carcinoma, congenital adrenal hyperplasia, and Cushing syndrome. High levels in men can lead to abnormal pituitary hormone production of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), hormones that control the production of testosterone and sperm.
How to Test DHEA Levels
DHEA can be checked in blood, saliva, and urine.
Both DHEA and DHEAS can be measured in the blood, but it is best to check DHEAS levels, as 98% of DHEA in the blood is in the DHEAS form. In addition, DHEA is released according to a diurnal pattern, meaning levels will fluctuate throughout the day. DHEAS, on the other hand, is stable throughout the day.
DHEAS blood levels depend upon age and sex.
- Ages 18 to 19: 145 to 395 micrograms per deciliter (µg/dL) or 3.92 to 10.66 micromoles per liter (µmol/L)
- Ages 20 to 29: 65 to 380 µg/dL or 1.75 to 10.26 µmol/L
- Ages 30 to 39: 45 to 270 µg/dL or 1.22 to 7.29 µmol/L
- Ages 40 to 49: 32 to 240 µg/dL or 0.86 to 6.48 µmol/L
- Ages 50 to 59: 26 to 200 µg/dL or 0.70 to 5.40 µmol/L
- Ages 60 to 69: 13 to 130 µg/dL or 0.35 to 3.51 µmol/L
- Ages 69 and older: 17 to 90 µg/dL or 0.46 to 2.43 µmol/L
- Ages 18 to 19: 108 to 441 µg/dL or 2.92 to 11.91 µmol/L
- Ages 20 to 29: 280 to 640 µg/dL or 7.56 to 17.28 µmol/L
- Ages 30 to 39: 120 to 520 µg/dL or 3.24 to 14.04 µmol/L
- Ages 40 to 49: 95 to 530 µg/dL or 2.56 to 14.31 µmol/L
- Ages 50 to 59: 70 to 310 µg/dL or 1.89 to 8.37 µmol/L
- Ages 60 to 69: 42 to 290 µg/dL or 1.13 to 7.83 µmol/L
- Ages 69 and older: 28 to 175 µg/dL or 0.76 to 4.72 µmol/L
Saliva testing shows the amount of unbound, free DHEAS, which is important as this is the amount available for use.
DHEAS range in the saliva is 2– 23 ng/mL
Urine testing shows hormone metabolites, thus showing how the body processes hormones. This can be important as hormone metabolism can play a role in both excess or deficiency of hormones. DHEA metabolites can be found on the DUTCH tests, as well as cortisol, testosterone, estradiol, and estrone metabolites. Thus, this test gives a comprehensive view of DHEA from production to degradation. Additionally, this test shows levels of both DHEA and DHEAS. As discussed above, DHEAS is the most abundant form of DHEA. Seeing levels of both can help to assess adrenal patterns and the state of stress.
Urine Ranges of DHEA:
Ages 20-39: 1300-3000ng/mg
Ages 40-60: 750-2000ng/mg
Age 60 and older: 500-1200ng/mg
Ages 20-39: 60-750ng/mg
Ages 40-60: 30-350 ng/mg
Ages 60 and older: 20-150 ng/mg
DHEA Prescriptions and Supplements
Although a hormone, in the United States, DHEA can be purchased over the counter. DHEA is available in a capsule from 5-50mg, with recommended dosages anywhere from 25-200mg, depending on the patient and the therapeutic goal.
DHEA is also available as the prescription Intrarosa, a vaginal DHEA insert used in the treatment of painful sexual intercourse due to vaginal dryness in menopausal women. The insert contains 6.5mg of DHEA and is recommended for daily use.
DHEA is an influential hormone and neurosteroid that affects many body systems, including the reproductive and central nervous systems. DHEA supplementation may benefit sexual functioning, hormone production, and cognitive measures. Practitioners should be knowledgeable about the differences between DHEA and DHEAS and the different types of testing to properly assess and monitor levels when considering DHEA therapy.