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DHEA: The feel-good hormone

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Tired and tapped out? Upping your levels of DHEA could be the answer, says Marcelle Pick

Twenty-eight-year-old working mom Lisa was so worn out when she came to see me, she couldn’t get out of bed. Just driving to my practice took everything she had.

I listened to her story and recommended we test her adrenals. The results revealed severe adrenal imbalance and low levels of an important hormone called DHEA.

DHEA, or dehydroepiandrosterone, is a natural steroid and precursor hormone produced by the adrenals. It’s also available at health food stores and online as an over-the-counter supplement.

Manufacturers hype it as a magic cure-all for many things: muscle loss, weight gain, osteoporosis, depression—even menopause.

A few years ago, headlines linked DHEA to athletes “doping” with steroids, leading to a lot of confusion about DHEA, its role in the body, and how it should be used. DHEA was labeled as everything from a “fountain-of-youth drug” to a fraud. But its very real benefits, particularly for women, got a little lost in all the controversy.

The truth is, for the women who need it, adrenal support with DHEA supplementation can make a big difference. I’ve seen it help patients get going again when they feel like they’ve hit rock bottom. But it’s never as simple as just popping a pill.

When used appropriately—in a therapeutic setting under medical supervision—DHEA is a critical component of a plan to jump-start hormonal balance.

Just ask Lisa. After two months of treatment that included lifestyle changes and adrenal support with low daily doses of DHEA, she finally felt like herself again.

What’s the deal with DHEA?

DHEA is a steroid hormone synthesized from cholesterol and secreted by the adrenal glands. The adrenals are walnut-sized glands located right above your kidneys.

The average adult makes about 25 mg of DHEA per day (some more, some less) with dwindling production as we get older. Men at all ages have more DHEA than women.

Natural DHEA production is at its highest in your 20s: by the time we reach age 70, we make only about 20 percent of the DHEA we did when we were young.

A decline in DHEA with the passage of time is clearly what nature intended—and, as far as we know, a healthy process. This is one of the major reasons I don’t recommend self-prescribing DHEA through over-the-counter products.

Another reason is that for women, DHEA is a very powerful precursor to all of your major sex hormones: estrogen, progesterone and testosterone. (Its molecular structure is closely related to testosterone.) It’s considered the “mother hormone”—the source that fuels the body’s metabolic pathway.

Besides DHEA, your adrenals also make the stress hormones cortisol and adrenaline. Adrenal exhaustion from coping with chronic stress—like from poor nutrition, yo-yo dieting, emotional turmoil and job-related stress—means your adrenals are bone-tired from pumping out cortisol and simply can’t make enough DHEA to support a healthy hormonal balance.

The end result? You feel tapped out, overwhelmed and often depressed.

It’s likely that, for women, DHEA and adrenal function are related to neurotransmitter-release rates, based on the mood elevation my patients report after just two weeks of adrenal support.

But more research is needed to isolate the individual effects of DHEA from the hormones it gets metabolized into before we can know for sure what part it plays in all of this.

One thing we do know is that women require adequate levels of DHEA to ensure their body can produce the hormones it needs when it needs them. In that balanced state, your mood is stable and you feel clear-headed, joyful and vigorous.

DHEA is the best “feel-good” hormone we know. And it works quickly and effectively when taken with the right combination of support.

When DHEA levels are low, your body does not have enough working material for proper endocrine function. This throws off your hormone production and makes you feel a general sense of malaise, along with other symptoms of hormonal imbalance. How severe these symptoms become depends on how many other demands are being made on your body at the same time.

A growing body of evidence suggests healthy levels of DHEA may help stave off Alzheimer’s disease,1 cancer,2 osteoporosis,3 depression,4 heart disease5 and obesity.6

There may be some increased risks associated with DHEA for women with a history of breast cancer7—all the more reason to take DHEA under medical supervision. At the Women to Women Clinic, we use DHEA for women where we’ve seen reliable proof of efficacy — in cases of adrenal imbalance.

DHEA and adrenal function

Your lifestyle, diet and stress levels all contribute to the amount of DHEA your body can produce in a given period. At my practice, we look first and foremost at adrenal function, using DHEA levels as one of several diagnostic tools.

Think of our exhausted mother, Lisa. Like hers, your adrenals work tirelessly to meet the demands placed on them until they are utterly tapped. Without adequate support, they spiral downward into adrenal imbalance and eventually adrenal exhaustion.

Most of the women I see at my practice have some indication of adrenal imbalance, including symptoms of low DHEA levels (see below).

But simply adding more DHEA to the equation is not the answer—despite what some popular products claim. DHEA alone can’t fix adrenal imbalance. But it can be an important factor in a combination approach that includes hormonal and nutritional support, lifestyle changes, and proper rest.

DHEA is just one stop along the metabolic pathway. It doesn’t work in a vacuum. The way it gets converted comes down to your individual biochemistry—some women may use it to make more estrogen, while others may make more testosterone.

Just throwing a pill into the mix without understanding the bigger picture is never a wise choice. Having too much DHEA, or converting DHEA into too much of one hormone and not enough of another, can be as upsetting to your body as not having enough.

A delicate balance

DHEA supplementation is not a standalone solution. DHEA is just one part of the whole concert of hormones at work every moment in your body. Before you tinker with that balance, it’s a good idea to understand what’s going on in your life on all levels—physiologically and emotionally.

After menopause or a hysterectomy, when the adrenals become the primary hormone factory, we see women in whom the ratio of DHEA converted into testosterone outweighs what’s converted into estrogen and progesterone. This can cause bouts of increased irritability and unusual body hair growth, especially when DHEA supplements are given without prior and follow-up testing of total and free testosterone levels.

Free testosterone is the portion of the hormone that is biologically active in your bloodstream. After menopause, a woman may have volatile levels of free testosterone at work, which accounts for some of the annoying male-pattern facial hair that’s common during the transition.

Most doctors test only total testosterone levels, not the combined amount. Adding DHEA to this scenario can tip the scale drastically.

On the other hand, I’ve also seen patients who convert most of their DHEA into estrogen. In this case, DHEA supplements create a different kind of estrogen-progesterone imbalance with symptoms similar to PMS (premenstrual syndrome), including breast tenderness and mood swings.

The trouble with DHEA supplements

DHEA is available over the counter in a confusing variety of doses and combinations. The labels claim it will help you lose weight, rev up your libido, lift depression and restore the strength, immunity and stamina you had when you were 20—the age at which our bodies naturally produced the most DHEA.

While on the surface this is appealing (who wouldn’t want to feel 20 again?), it’s obviously not what nature intended. We also don’t know enough about DHEA to be conducting such a large, unregulated public experiment. DHEA is a potent steroid—that’s why it made headlines and why it should be approached with due diligence.

Without a comprehensive medical test, it’s impossible to know what your DHEA levels are. Just because you’re getting older doesn’t automatically mean you’re deficient. Remember, this is a natural substance—our bodies can produce more or less of it depending on our nutrient support, metabolism, hormonal balance, activity level and emotional state.

Also remember that any time you buy a supplement at a health food store, you have no guarantee that what you’re buying is the real deal. This is why I formulated my own supplements, made by a manufacturer who tests every single batch.

Many of the DHEA supplements I see at my local store have dosages that are way too high for most women—often as much as 20 times what I start my patients on. I believe it’s unwise to experiment with DHEA at these levels without medical supervision.

What’s more, taking DHEA alone won’t do any good if your adrenals are exhausted. You need to know the status of your adrenal function and your other hormones before you can even begin to know what kind of support your body needs.

That said, if you’ve been taking a DHEA product, don’t worry! Just call your doctor or medical practitioner and ask to get your hormones tested—then you’ll know how to proceed.

DHEA testing

Saliva adrenal profiles can be used to look at DHEA along with cortisol levels. If I suspect adrenal imbalance, hormonal imbalance or a DHEA irregularity in a patient, I often order an adrenal panel.

Using blood tests, I check estradiol in the follicular phase (usually days 3–9 of a menstrual cycle), progesterone in the luteal phase (days 14–28), DHEA sulfate, and both free and total testosterone levels. I like to see estrogen, progesterone and DHEA for women in the upper quadrant of normal.

What many conventional medical practitioners consider normal is a little low in my opinion. I think there are many women who fall just shy of the bell curve in either direction, but still in the “normal” range by current standards, who have legitimate health problems. And when they go to a conventional practitioner feeling awful, they’re told there’s nothing wrong.

But I don’t just go by the numbers. I always listen to how a woman is feeling and find out what demands she’s placing on her body—particularly her adrenals. I also ask about her emotional state. Sometimes a woman can test normal by conventional standards and still need a slight, temporary boost.

Dosing with DHEA

If tests indicate the need for DHEA supplementation, I start patients off with as little as 1–5 mg under the tongue twice a day. It’s possible to slowly increase the dosage if further tests warrant it, but I find I rarely need to use more than 10–12 mg sublingual per day—a physiological dose. I do not suggest any woman exceed 25 mg per day of capsule forms.

I use only pharmaceutical-grade DHEA compounded by a reputable pharmacy. That way I can be confident that what I’m prescribing is actually what the patient will get.

The kind I use comes in liquid sublingual drops—I prefer them to tablets. If your doctor is unaware of a reliable compounding pharmacy in your area, check the International Academy of Compounding Pharmacists website (a4pc.org) to access their referral service.

Once a patient is taking DHEA, I closely monitor how she is metabolizing the hormone through regular tests and face-to-face checkups. Many women don’t need to take it for an extended period—once our bodies return to balance and we make lifestyle changes, we’re usually more than capable of making what we need.

Many of my patients in menopause who are taking bioidentical hormones also take DHEA to promote a good overall balance and vice versa. DHEA can be a great bridge through menopause. Again, once balance has been restored and symptoms even out, most women produce enough DHEA on their own.

Balancing DHEA production naturally

Many studies show you can improve your DHEA levels naturally by getting adequate sleep8 and exposure to sunlight,9 exercising regularly (including sexual activity),10 and fostering more “downtime” in your life.11

It also helps to consume foods that give your body what it needs to make the hormone. For example, vitamin C is key to adrenal function, and zinc is necessary for hormone production. Foods with healthy fats, like avocado, nuts and salmon, ensure you have enough cholesterol, the raw material your adrenals use to make DHEA.

And finally, you can balance your DHEA production by avoiding things that lower it. Prescription drugs like statins and hormone therapies,12 high blood sugar13 and stress14 all decrease production.

Symptoms of low DHEA levels

  • Extreme fatigue
  • Decrease in muscle mass
  • Decrease in bone density
  • Depression
  • Aching joints
  • Loss of libido
  • Lowered immunity

The best way to make more DHEA

It’s possible to measurably boost your body’s own production of DHEA naturally.

Studies show that people with higher stress in the long term have lower DHEA levels1 and that supplementing with DHEA improves their mood and outlook,2 which is why it’s often called “the happy hormone.”

It follows that getting chronic stress under control may increase your body’s ability to balance DHEA production. Here are some ideas for improving your stress management and resiliency and, in turn, your DHEA levels:

Connection. Human beings are social creatures. Connecting with family and friends in a healthy, loving way is one of the best joy-makers around. Think about what you like to do for pleasure and reach out. Join a local class or group that shares your interest.

Exercise. Moving your body,3 even through deep breathing and mild stretching,4 can lift your mood and your DHEA levels. But it also reduces stress, oxygenates your cells and boosts mood-elevating substances in your bloodstream called endorphins. This process can actually change your body chemistry for the better. Meditation is also useful in this way.

Spirituality. The ability to entertain the idea of some sort of larger power, be it natural or divine, is a powerful component of joy. Rituals of worship and contemplation, from a walk in the woods to yoga to prayer, help us make space in our busy lives to focus on what is truly meaningful to us and who we really are.

Play. Is it a coincidence that our levels of DHEA decline as we enter the grown-up world of work and responsibility? Who knows? But one thing is certain: playtime shouldn’t be just for kids. Sometimes I actually write out a prescription that reads “PLAY” so a patient can have fun without guilt. You, too, have my medical permission: go out and play. Kick up your heels—it’s good for your health!

References
 
  1. Geriatr Gerontol Int, 2010; 10(4): 280–7; Clin Pract Epidemiol Ment Health, 2016: 12: 24–37
  2. Biochim Biophys Acta Mol Cell Res, 2020; 1867(2): 118600
  3. J Clin Endocrinol Metab, 1997; 82(10): 3498–505; Mech Ageing Dev, 2002; 123(8): 1107–14
  4. Am J Psychiatry, 1999; 156(4): 646–49
  5. Aging Cell, 2012; 11(5): 876–84; J Clin Endocrinol Metab, 2010; 95(11): 4985–92; N Engl J Med, 1986; 315(24): 1519–24
  6. JAMA, 2004; 292(18): 2243-8; Saudi Med J, 2003; 24(8): 837–41
  7. Eur J Clin Nutr, 1999; 53(10): 771–75
  8. Sleep, 1997; 20(10): 865–70
  9. Proc R Soc B, 2015; 282(1819): 20152080; Melatonin Res, 2019; doi: 10.32794/mr11250016; Sarah Myhill, “Melatonin—the Sleep Hormone,” June 2022, drmyhill.co.uk
  10. Age (Dordr), 2013; 35(2): 395–405
  11. PLoS One, 2013; 8(8): e72460
  12. J Clin Endocrinol Metab, 2019; 104(10): 4600–6; J Obstet Gynaecol, 2018; 38(2): 231–35
  13. Fertil Steril, 2009; 91(5): 1848–52
  14. Encephale, 2002; 28(2): 139–46
The best way to make more DHEA
  1. Stress, 2022; 25(1): 105–12
  2. Neuropsychopharmacology, 2013; 38(9): 1798–1807
  3. Isr Med Assoc J, 2018; 20(6): 335–39
  4. Clin Transl Sci, 2021; 14(6): 2360–9
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