Published April 21 2014
Dehydroepiandrosterone (DHEA) is the most abundant steroid hormone in humans, and is mostly secreted by the adrenal glands. There is also a sulfated form called DHEA-S. Many people take DHEA due to its “anti-aging” effects. I test the adrenals of most of my patients, and it’s common to see my patients with depressed or borderline low levels of DHEA. Low levels of DHEA are common in people with thyroid and autoimmune thyroid conditions. However, this doesn’t mean that everyone who has low levels of DHEA should take this hormone. In this article I’ll discuss the pros and cons of DHEA, and of course will discuss the role it plays in thyroid health.
As I mentioned before, DHEA is mostly secreted by the adrenal glands, specifically in the adrenal cortex. However, smaller amounts of DHEA are secreted by the testes and ovaries. DHEA-S is produced by the sulfation of DHEA, and serum concentrations are 250 to 500 times higher than DHEA. DHEA and DHEA-S interconvert, and both DHEA and DHEA-S can be converted in peripheral tissues to the male hormones androstenedione, testosterone and dihydrotestosterone, and these are converted to estrogens in a process called aromatization (1).
There are numerous functions of DHEA. DHEA modulates endothelial function, reduces inflammation, improves insulin sensitivity, blood flow, cellular immunity, body composition, bone metabolism, sexual function, and physical strength in frailty and provides neuroprotection, improves cognitive function, and memory enhancement (2). So as you can imagine, a deficiency of DHEA can lead to many different problems. What I’d like to do is discuss some of the benefits of DHEA in greater detail.
DHEA and insulin sensitivity. These days, many people have blood sugar imbalances. And while the main cause of this is due to eating too many refined foods and sugars, one also need to consider the impact of low DHEA levels. One study looked at the effects of DHEA on insulin sensitivity in hypoadrenal women, and found that taking 50mg of DHEA for 12 weeks significantly increased insulin sensitivity in hypoadrenal women, suggesting that taking DHEA could help to prevent type 2 diabetes (3). I almost never give doses this high to my patients, but this does demonstrate the impact DHEA has on insulin sensitivity.
Another small study looked to see the influence of DHEA therapy on insulin resistance and serum lipids in men with coronary heart disease (4). The study involved thirty men between the ages of 41 to 60, and this required even higher doses of DHEA, as they took 150 mg per day for 40 days. DHEA administration resulted in a decrease in insulin levels by 40% and fasting insulin resistance index by 47%. In addition, total cholesterol levels and LDL levels decreased significantly.
DHEA and fatigue. Having depressed DHEA levels can cause fatigue. This isn’t the case with everyone, as I personally experienced depressed DHEA levels when I was diagnosed with Graves’ Disease, yet felt fine from an energy standpoint. One study looked at the effect of DHEA supplementation on people with Addison’s disease, and found that mood and fatigue improved significantly (5). However, no effects on cognitive or sexual function, body composition, or bone mineral density were observed. Another study showed a correlation between fatigue and low levels of DHEA in people with progressive multiple sclerosis (6). Another study showed that patients with impaired function of the hypothalamic-pituitary adrenal (HPA) axis have low DHEA levels (7). Although it has been suggested that chronic fatigue syndrome may be associated with low DHEA levels, one study showed that DHEA levels were higher in patients with CFS (8).
DHEA and bone mineral density. There is also evidence that DHEA can help to improve bone mineral density. One randomized, double-blinded trial looked to determine whether taking DHEA can increase bone mineral density. The study involved 70 women and 70 men who had low serum DHEA-S levels, and the study showed that taking 50mg/day of DHEA for 12 months improved bone mineral density in older adults (9). Another study showed a positive correlation between DHEA-S levels and bone mineral density (10). However, another recent study investigated the effects of the administration of DHEA on bone mineral density, as well as other factors, and upon giving 100mg of DHEA there was no improvement in bone mineral density (11). On the other hand, an older study showed that treating osteoporosis in men with 100mg of DHEA-S can improve bone mineral density (12).
DHEA and Immunity. Inflammatory cytokines play a role in people with Graves’ Disease and Hashimoto’s Thyroiditis, as well as in other autoimmune conditions. I spoke about this in a previous blog post entitled “The Role of Cytokines In Autoimmune Thyroid Conditions“. A few different studies have shown that DHEA can modulate the immune system and lower inflammatory cytokines (13) (14) (15). There is also evidence that oxidative stress may diminish DHEA synthesis (16).
One study showed that DHEA supplementation may improve ovarian response and IVF treatment outcome (17). There is also evidence that lower DHEA-S levels are associated with a greater risk of ischemic stroke (18). DHEA might also help with low libido and improve sexual function (19) (20).
Telomeres are ribonucleoprotein complexes which protect the chromosome ends from unscheduled DNA repair and degradation (21). They typically shorten as one gets older, and telomere shortening might play a role in the development of certain health conditions. DHEA has been called an anti-aging hormone, and the main reason is because there is evidence that taking DHEA can increase the length of telomeres (22). What’s interesting is that smaller amounts of DHEA (1.25 to 12.5 mg) might be more effective than larger doses when it comes to increasing the length of telomeres.
What Role Does DHEA Play In Thyroid Health?
I recommend adrenal testing to most of my patients, which includes the cortisol levels, the DHEA, and some additional tests. The DHEA is commonly depressed in people with both hypothyroid and hyperthyroid conditions. As I mentioned earlier, DHEA seems to play a role in immune system modulation and in lowering proinflammatory cytokines. As a result, can low DHEA levels lead to the development of an autoimmune condition? It’s quite possible, although there aren’t any studies which show such a correlation. I think we might be looking at a similar situation as with vitamin D. In people with autoimmune thyroid conditions, vitamin D levels are frequently low. This might make someone more susceptible to developing an autoimmune condition, and the same might be true with DHEA. In other words, depressed DHEA levels might compromise the immune system, making someone with a genetic predisposition for Graves’ Disease or Hashimoto’s Thyroiditis more likely to develop this condition.
One study examined the serum concentrations of DHEA, DHEA-S, and pregnenolone sulfate in patients with thyroid dysfunction (23). The study showed that the serum concentrations of these hormones were decreased in hypothyroidism, whereas DHEA-S and pregnenolone were increased in hyperthyroidism, although DHEA was normal in hyperthyroid patients. As I mentioned earlier, when I was diagnosed with Graves’ Disease, I had depressed DHEA levels, and I’ve had many hyperthyroid patients with depressed DHEA levels.
Testing For DHEA
To no surprise, most medical doctors test for DHEA through the blood. Although this can be an accurate method to evaluate DHEA, keep in mind that most serum DHEA is protein bound, while saliva tests for the free form of the hormone. I’m not suggesting that saliva testing is more accurate than blood testing, but just keep in mind that someone can have low levels of the “free” form of DHEA, but have normal levels of the “bound” form of this hormone. This explains why someone might test normal in the blood for DHEA, but show up as low or depressed on a saliva test.
How To Address A DHEA Deficiency
When DHEA is low on a blood or saliva test, it might seem like a good idea to take DHEA. And while I’m not opposed to people taking DHEA, what you need to understand is that DHEA is not a nutrient. In other words, if someone has a magnesium deficiency, an iron deficiency, a vitamin B12 deficiency, or any other nutrient deficiency, then the person might need to take supplements on a temporary basis to correct the deficiency, although the biggest key to preventing these nutritional deficiencies in the first place is to eat a healthy diet.
The same concept applies with DHEA, as while there is nothing wrong with taking small doses of DHEA to correct a DHEA deficiency, this isn’t doing anything to address the cause of the low DHEA levels. But what’s causing the low DHEA levels? Well, let’s remember that DHEA is secreted by the adrenal glands. And one of the primary factors which leads to compromised adrenal glands is chronic stress. If someone is stressed out for a prolonged period of time, then this will eventually lead to reduced levels of DHEA. And while taking DHEA might help to raise the levels, you of course want to improve your stress handling skills so you won’t need to rely on taking DHEA. Other factors which can compromise the adrenals include eating a lot of refined foods and sugars, as well as getting poor sleep.
Understanding The Hormone Pathways
It’s also important to know the precursors of DHEA. Cholesterol happens to be the precursor to all of the steroid and sex hormones. As a result, abnormally low cholesterol levels can affect the production of hormones such as DHEA, cortisol, progesterone, and estrogen. Cholesterol leads to the formation of the hormone pregnenolone, and this then splits up into two separate pathways. One of these pathways leads to the formation of progesterone, and ultimately to cortisol. The other pathway leads to DHEA, which is a precursor to the male hormones (i.e. testosterone), and these in turn can be converted into the estrogens.
The Risks Of Taking DHEA
In addition to the fact that taking DHEA won’t do anything to address the cause of a DHEA deficiency, one also needs to be aware of the risks of taking DHEA. As I mentioned earlier, DHEA is a precursor to testosterone, which in turn is a precursor to estradiol. As a result, if someone takes large doses of DHEA, this can potentially lead to elevated levels of testosterone and/or elevated levels of estrogen. So taking large doses of DHEA can potentially lead to estrogen dominance. Although I don’t recommend DHEA to my patients frequently, when I do recommend it I almost always have them take smaller doses, such as 5mg to 10mg of sublingual DHEA. It’s not uncommon for other healthcare professionals to recommend 25 to 50mg of DHEA, and in some cases even higher doses. I’m not suggesting that some people can’t benefit from higher doses, but I still think it’s a good idea for those who take DHEA to start with smaller doses.
Natural Alternatives to DHEA
As I mentioned earlier, when I was diagnosed with Graves’ Disease I had depressed DHEA levels. I chose not to take DHEA, yet a few months later my DHEA levels were within a normal reference range. I’ve also worked with many others with low DHEA levels who were able to increase these levels without taking DHEA. So how can one accomplish this? Well, just supporting the adrenals will usually help to increase the DHEA levels. For example, if someone has depressed cortisol levels and a depressed DHEA, eating well, managing stress, and taking certain supplements such as licorice, biotin, vitamin B and vitamin C can help to improve the health of the adrenals and normalize the depressed cortisol and DHEA levels. Sometimes an adrenal glandular might be necessary to take for a short period of time, although in most cases I don’t find this to be necessary.
The herb tribulus can also help to increase DHEA levels in men and postmenopausal women. However, remember that DHEA is a precursor to the male androgens, and so it shouldn’t come to a surprise that some studies show that tribulus can increase testosterone and dihydrotestosterone, and might be beneficial to help with certain conditions, such as sexual dysfunction in men (24) (25). Another thing to consider is that since the production of DHEA is controlled by the pituitary hormone ACTH, problems with the hypothalamus and pituitary gland can also lead to depressed DHEA levels, along with imbalances of the other hormones. As a result, giving HP axis support can be beneficial for many people.
There are times when I will recommend for the patient with depressed DHEA levels to take supplements and/or herbs to help support the adrenals and HP axis, but upon retesting the DHEA doesn’t increase. When this is the case then I usually will resort to using DHEA, although if both cortisol and DHEA are depressed then taking a small dose of pregnenolone is another option to consider. However, even when someone takes bioidentical hormones the goal should be to continue addressing the cause of the problem.
In summary, DHEA is mostly secreted by the adrenal glands, and it has numerous functions. DHEA plays a role in insulin sensitivity, fatigue, bone mineral density, immunity, and other conditions. Many people with thyroid and autoimmune thyroid conditions have low DHEA levels, and so it’s a good idea to test the DHEA levels in people with these conditions. Although taking DHEA or adrenal supplements can help to correct a deficiency, the ultimate goal should be to address the cause of the low levels, which usually are related to chronic stress, poor diet, and/or not enough sleep.