DHEA: Future of HRT?

dhea

"... DHEA... appears poised to make the transition from trendy health food supplement to ...hormone worthy of study." - Dr Richard F. Spark, MD. Harvard Medical School. (1)

"These data support and confirm that DHEA must be considered a valid compound and drug for [hormone therapy] in postmenopausal women and not just a 'dietary supplement" - Dr Genazzani, MD, Ph.D. (2)

Oestrogen is not the only hormone to change at menopause. One of the most influential hormones to decline is, in fact, DHEA. According to research from the Monash University, menopausal women with the lowest level of DHEA are the most likely to experience a decline in cognitive function and well-being. (3)

DHEA is the most abundant hormone in the body. It is made by the adrenal glands, as well as by the ovaries and testes. t is the natural precursor for oestrogen and testosterone, and it also interacts directly with all hormone receptors. It slows ageing, and exerts a beneficial influence on the nervous system and the immune system.

There is scientific evidence that DHEA supplements provide benefit for the following conditions:

  • female libido and sexual function (4,5)
  • mood and hot flushes (2)
  • osteoporosis and bone density (4)
  • impaired fertility due to age (5)

Safety concerns 

The potential conversion of DHEA to oestrogen carries some breast cancer risk, but only if oestrogen elevates above normal. (6) When oestrogen remains normal, DHEA's immune-enhancing effect may actually protect against breast and other cancers.

As a first rule, DHEA should be used only after a deficiency has been demonstrated on blood, saliva or urine test. This is important for safety, but it also improves outcome, because DHEA supplements work only when the hormone is deficient. Baseline oestrogens should also be tested, so that any rise in oestrogen resulting from treatment can be prevented. Tests should be repeated after 3 months on treatment.

As a second rule, the DHEA dose should be small: 5-10mg for women. A higher dose of 25mg was used in some studies, but, clinically, I find that dose is not necessary for symptom relief, and it carries an unnecessary risk of oestrogen conversion. High doses may also result in testosterone-type side effects such as skin break-outs.

 

References:

(1)Spark, RF. Dehydroepiandrosterone: a springboard hormone for female sexuality. Fertility and Sterility. 2002. 77(4)

(2)Genazzani AD, et al. Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fertil Steril 2003;80:1495-1501.

(3) Davis SR et al. DHEA sulfate levels are associated with more favourable cognitive function in women. Jour Clin Endo & Metab. 2008 93(3): 801-808

(4) Spark, RF. Dehydroepiandrosterone: a springboard hormone for female sexuality. Fertility and Sterility. 2002. 77

(5)Barad DH et al. Increased oocyte production after treatment with dehyroepiandrosterone. Fertility and Sterility. 2005. 84(3):

(6)Raven, PW and J P Hinson. Dehydroepiandrosterone (DHEA) and the menopause: an update. Menopause Int 2007;13:75-78

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