DHEA & other hormones ... an update

Responsible supplementation with vitamins, minerals, and herbs is a step many of us take to fill in nutritional gaps in our diets and give a boost to our health. Now, in addition to these supplements, there is an array of hormones available for supplementation, too. Here, Dr. Ray Sahelian provides an honest, responsible discussion of some of these hormones, explaining what they are, pointing out their potential benefits and side effects, and advising who is most likely to benefit from them.
DHEA: The parent of estrogen and testosterone

It's now been four years since DHEA (short for dehydroepiandrosterone) has been available over the counter, and research continues regarding the benefits and shortcomings of this hormone. In addition, many doctors, including myself, have gained further knowledge about DHEA based on additional clinical experience.

DHEA is a hormone made mostly by the adrenal glands, which are located above the kidneys, but it is also made in the testicles, ovaries, and brain. After production, it is converted to the sex hormones testosterone and estrogen. There is a gradual decline in the production of DHEA with age. This decline generally begins in our 30s and progresses gradually over the decades. Supplementation with DHEA has been proposed as a way to improve quality of life.
Who is a candidate for DHEA replacement?

DHEA is generally recommended to those in their mid-40s, and older, who have been found through a complete medical evaluation to have a deficiency of androgens, such as DHEA or testosterone. This deficiency can occur in both sexes, and is often manifested by tiredness, low sex drive, or low mood.
What are some of the benefits of DHEA replacement?

DHEA has an influence on the brain, immune system, skin, reproductive organs, muscles, and other organs and tissues.

Influence on the mind. Most, but not all, studies indicate that this hormone is able to provide a sense of well-being. Many of my patients report DHEA increases their energy and vitality. Some report an improvement in clarity of thinking and enhancement in mental abilities, including memory.

Libido. DHEA is converted in the body into testosterone and estrogen, both of which are present, in differing levels, in men and women. It is known that testosterone increases sexual drive. In my clinical experience, about a third of men and women who take DHEA report an increase in sexual enjoyment.

Weight loss/muscle gain. A 12-month study done by Canadian researchers with DHEA found that supplementation led to a 10-percent decrease in body fat while leading to a 10-percent increase in muscle mass. DHEA is converted into androgens and, thus, has some anabolic properties, which means that more muscle is built up, while more fat is burned.

Influence on tumor formation? Some studies with mice and rats have shown that DHEA has anti-cancer abilities. However, animal studies may not directly apply to humans. The influence of long-term DHEA supplementation on human tumor promotion or inhibition is not known at this time. There is a risk that high dosages taken for prolonged periods could promote certain tumors in the prostate, breast, and ovaries. Certainly, more research is needed before we can make any definitive statements regarding DHEA's influence on human cancer prevention or promotion.
How is DHEA available?

DHEA is sold as capsules, cream, sublingual (under-the-tongue), and timed-release capsules. Capsules are sold in dosages of 5 mg upwards to 100 mg. Side effects are common in dosages greater than 10 mg, and I hope more manufacturers remain aware of the negative effects seen from improper, high dosages.
What's the right dosage?

DHEA is a powerful hormone. I only recommend 1-6 mg of DHEA as long-term hormone replacement in men deficient in androgens, while the dosage for women would be 1-4 mg. Taking occasional breaks from use -- which I call "hormone holidays" -- is justified until we learn more about this hormone.

The above dosage recommendations are only guidelines. Please recognize that no two humans are alike, so dosage requirements may vary significantly between individuals depending on genetics, age, and medical condition.
Do I need physical exams and tests?

If you plan to take hormones on a long-term basis, it would be wise to be monitored by a healthcare practitioner. During supplementation with DHEA, I recommend regular evaluation of your weight, blood pressure, heart rhythm, muscle mass, body fat, skin (particularly for hair growth, moisture, and acne), hair (facial and scalp), and brain function, such as mood, alertness, and sleep patterns.

Lab tests would involve routine urinalysis along with a blood panel that includes blood count, white count, kidney function, blood sugar, cholesterol, liver enzymes, and thyroid function. Men should have their prostate gland evaluated. Women need to have breast and pelvic exams.
Potential side effects

Side effects can occur with the misuse of DHEA. These side effects are clearly dose-dependent, and generally begin at about 5 mg.

Acne: Individuals prone to acne can get pimples on as low a dose as 5 mg. Stop the use of DHEA when pimples occur, and go off the hormone for a few days. Thereafter, restart at a much lower dose.

Hair growth and loss: Unwanted hair growth is common in women, and can occur on the face. High doses of DHEA can lead to accelerated scalp hair loss in both men and women due to this hormone's conversion into dihydrotestosterone (DHT), the hormone associated with hair loss. If you experience hair loss, stop the DHEA.

Overstimulation and insomnia: Anecdotal information indicates that high doses of DHEA can lead to overstimulation, irritability, nervousness, and aggressiveness.

Additional side effects: Heart palpitations or irregularities can occur on high dosages of DHEA, usually greater than 20 mg, especially in those who have a tendency for heart irregularities. Menstrual irregularities, headaches, and mood changes are also reported. There is a possibility that high doses could increase the risk for benign prostatic enlargement.
Summary...

There is little doubt that many individuals who take the appropriate dosage of DHEA notice an improvement in mood, energy, sex drive, and even an improvement in memory and thinking. However, these benefits have to be balanced with the potential side effects associated with misuse.

Until we learn more, I urge anyone who is currently taking DHEA, or plans to do so, to err on the side of taking less, not more. It's quite possible that low doses could be beneficial while high dosages could be counterproductive, if not harmful. Please keep in mind that the dosages available over the counter are sometimes too high and you may need to open the capsules or break the pills and take only a fraction. Make sure a healthcare provider closely monitors you.
Pregnenolone: The Grandmother of All Steroid Hormones

Pregnenolone (Preg) is primarily made in the adrenal glands from cholesterol, but it can also be made in other tissues, including the brain. The body uses Preg to convert into DHEA, progesterone, and at least 150 different steroid hormones. Preg has functions that overlap with progesterone and DHEA.

Indications. Human research with Preg is very limited. It may have a role to play as an additional hormone to replace as we get older. Rodent studies have shown it to have powerful memory-enhancing capabilities. Users report enhanced visual and auditory perception, a sense of well-being, and increased alertness and awareness.

Availability. Capsules and sublingual tablets are sold in dosages starting at 5 mg upwards to 50 mg.

Dosage. Maximum long-term, daily dosage should not exceed 5 mg. Both Preg and DHEA have overlapping functions; therefore, if you plan to add Preg to your DHEA regimen, you need to reduce your dosage of DHEA. Preg is best taken in the morning, or no later than noon.

Side effects. High doses can lead to similar side effects as DHEA, including acne, irritability, aggressiveness, headaches, and menstrual irregularities. Heart palpitations can also occur with dosages greater than 10 mg in individuals prone to irregular rhythms.

In order to reduce the risk for heart palpitations, make sure you have an adequate intake of omega-3 oils and magnesium. If your medical condition requires that you take high doses of pregnenolone, have your doctor prescribe a beta-blocker, such as propranolol, to carry with you in case you suddenly develop a palpitation.

Future potential. Preg is a fascinating hormone, and there's still a great deal we need to learn about its potential. It could eventually be found to play a role in arthritis, seizure control, intelligence enhancement, and a number of medical and psychiatric conditions.
Androstenedione: The Son of DHEA

Androstenedione (Andro) is derived from DHEA and is the immediate precursor to testosterone and estrogen. Ever since homerun hero Marc McGwire reported he had been using Andro, sales of this hormone have skyrocketed.

Indications. Andro has properties similar to DHEA; however, hardly any human studies have been done involving this hormone. Andro has the potential to be used as an alternative to testosterone. Some bodybuilders take it occasionally as an anabolic agent. Users report more muscle mass along with increased sexual drive and overall well-being.

Availability. Andro is available in dosages of 10, 25, and 50 mg. You will also find several of its cousins being sold over the counter, including androstenediol, norandrostenedione, and others. Research with human supplementation using these forms is extremely limited.

Dosage. No guidelines are available due to lack of research. Some weight lifters and bodybuilders take 25 mg or 50 mg on the days that they work out.

Side effects. Andro is very androgenic and side effects include acne, scalp hair loss, facial hair growth in women, aggressiveness, irritability, and other similar side effects to DHEA.

Future potential. Doctors sometimes prescribe testosterone to men and women in order to increase libido and well-being. Andro can be a good alternative. However, at this point, if a healthcare practitioner is planning to use andro as a testosterone alternative, it is not clear whether this hormone would offer benefits that DHEA can't provide.
Melatonin: Nature's Sleeping Pill

Melatonin is a hormone made in the pineal gland, a small pea-sized gland located in the middle of the brain. This hormone is released at night and helps us get a deeper sleep. As we age, the amount of melatonin made by the pineal gland declines.

Benefits. Melatonin works well as a sleep aid and for preventing jet lag. A few trials have indicated melatonin also has anti-tumor and antioxidant potential.

Availability. Melatonin is sold in regular pills, sublingual lozenges or liquid, time-release tablets or capsules, spray, and even in a tea form. Dosages sold usually range from 0.3 mg to 3 mg. The time-release form is a good option and provides consistent sleep throughout the night. I've found that the tea form works well, too.

Side effects. Dosages greater than 0.5 mg can produce vivid dreams, including nightmares. Higher amounts can cause morning grogginess and lethargy. Melatonin is very safe when used appropriately, but should not be regularly used for more than two or three nights a week due to the possible induction of tolerance.

Recommendations. Until more research is available, one should limit regular dosage to 0.3 to 1 mg. It can be taken one-half hour to two hours before bed on an empty stomach. Small doses of melatonin can be combined with valerian, hops, and other sedative herbs.
REFERENCES

Muscarella, P., Boros, L.G., Fisher, W.E., Rink, C., et al. "Oral dehydroepiandrosterone inhibits the growth of human pancreatic cancer in nude [shaved] mice," J Surg Res 79(2):154-7, October 1998.

Sahelian, R. and Borken, S. "DHEA and cardiac arrhythmia," Ann. Int. Med. 129(7):588, Oct. 1, 1998.

Wolf, O.T., Naumann, E., Hellhammer, D.H., Kirschbaum, C. "Effects of dehydroepiandrosterone replacement in elderly men on event-related potentials, memory, and well-being," J Gerontol A Biol Sci Med Sci 53(5):M385-90, September 1998.

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By Ray Sahelian, M.D.

Adapted by M.D.

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