DHEA (Dehydroepiandrosterone)

Other names: dehydroepiandrosterone, dehydroepiandrosterone sulfate

Synonyms and brand names:
Synonyms for Dehydroepiandrosterone are: Dehydroisoandrosterone; 3?-Hydroxy-5-androsten-17-one; 3?-Hydroxyandrost-5-en-17-one; Dehydroisoandrosterone; Hydroxyandrost-5-en-17-one; Prasterone; trans-Dehydroandrosterone.

Brand names for DHEA include Prastera, Fidelin and Fluasterone; supplement versions are manufactured from wild Mexican yam.

Definition: Dehydroepiandrosterone (DHEA) is a natural steroid prohormone produced from cholesterol by the adrenal glands, the gonads, adipose tissue, brain and in the skin (by an autocrine mechanism).The body converts DHEA to male and female sex hormones. DHEA is the precursor of androstenedione, which can undergo further conversion to produce the androgen testosterone and the estrogens estrone and estradiol. DHEA is also a potent sigma-1 agonist.

DHEA levels typically peak by the time people are in their 20s and decline with age, which is why there has been considerable interest in DHEA and its role in aging. In fact, DHEA supplements have been touted as an anti-aging hormone because lower levels of DHEA have been reported in some people with type 2 diabetes, breast cancer, heart disease, osteoporosis, AIDS, adrenal insufficiency, kidney disease and anorexia. Certain medications may also deplete DHEA, such as corticosteroids, insulin, opiates and danazol.

DHEA is manufactured naturally in the body, but DHEA supplements can also be made in a laboratory from a substance called diosgenin, found in soybeans and wild yam. Wild yam cream and supplements are often promoted as being a natural source of DHEA, but the body can’t convert wild yam to DHEA on its own — the conversion must be done in a laboratory.

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Dehydroepiandrosterone sulfate
Dehydroepiandrosterone sulfate (DHEAS) is the sulfated version of DHEA. This conversion is reversibly catalyzed by sulfotransferase (SULT2A1) primarily in the adrenals, the liver, and small intestine. In the blood, most DHEA is found as DHEAS with levels that are about 300 times higher than those of free DHEA. Orally-ingested DHEA is converted to its sulfate when passing through intestines and liver. Whereas DHEA levels naturally reach their peak in the early morning hours, DHEAS levels show no diurnal variation. From a practical point of view, measurement of DHEAS is preferable to DHEA, as levels are more stable.

Production:DHEA is produced from cholesterol through two cytochrome P450 enzymes. Cholesterol is converted to pregnenolone by the enzyme P450 scc (side chain cleavage); then another enzyme, CYP17A1, converts pregnenolone to 17?-Hydroxypregnenolone and then to DHEA. In humans, DHEA is the dominant steroid hormone and precursor of all sex steroids.

Note : DHEA can be synthesized in a laboratory using wild yam extract. However, it is believed that wild yam cannot be converted into DHEA by the body. Therefore, information that markets wild yam as a “natural DHEA” may be inaccurate.

Role
DHEA can be understood as a prohormone for the sex steroids. DHEAS may be viewed as buffer and reservoir. As most DHEA is produced by the zona reticularis of the adrenal, it is argued that there is a role in the immune and stress response.[who?]

As almost all DHEA is derived from the adrenal glands, blood measurements of DHEAS/DHEA are useful to detect excess adrenal activity as seen in adrenal cancer or hyperplasia, including certain forms of congenital adrenal hyperplasia. Women with polycystic ovary syndrome tend to have elevated levels of DHEAS.

Evidence
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence Grade:-
Adrenal insufficiency
Several studies suggest that DHEA may improve well-being, quality of life, exercise capacity, sex drive, and hormone levels in people with insufficient adrenal function (Addison’s disease). Though promising, additional study is needed to make a strong recommendation. Adrenal insufficiency is a serious medical condition and should be treated under the supervision of a qualified healthcare professional, including a pharmacist.

Depression
The majority of clinical trials investigating the effect of DHEA on depression support its use for this purpose under the guidance of a specialist. Further research is needed to confirm these results.

Obesity
The majority of clinical trials investigating the effect of DHEA on weight or fat loss support its use for this purpose. Further research is needed to confirm these results.

Systemic lupus erythematosus
The majority of clinical trials investigating the effect of DHEA for systemic lupus erythematosus support its use as an adjunct treatment. Additional study is needed to confirm these results.

Aging
DHEA may offer some benefit to individuals in terms of aging. Small increases in bone mineral density have been seen, but more study is needed to confirm these findings.

Alzheimer’s disease
Initial research reports that DHEA does not significantly improve cognitive performance or change symptom severity in patients with Alzheimer’s disease, but some experts disagree. Additional study is warranted in this area.

Bone density
The ability of DHEA to increase bone density is under investigation. Effects are not clear at this time.

Cardiovascular disease
Initial studies report possible benefits of DHEA supplementation in patients with cholesterol plaques (“hardening”) in their arteries. There is conflicting scientific evidence regarding the use of DHEA supplements in patients with heart failure or diminished ejection fraction. Other therapies are more proven in this area, and patients with heart failure or other types of heart disease should discuss treatment options with a cardiologist.

Cervical cancer
Initial research reports that the use of intravaginal DHEA may be safe and may promote regression of low-grade cervical lesions. However, further study is necessary in this area before a firm conclusion can be drawn. Patients should not substitute the use of DHEA for more established therapies, and they should discuss management options and follow-up with a primary healthcare professional or gynecologist.

Chronic fatigue syndrome
The scientific evidence remains unclear regarding the effects of DHEA supplementation in patients with chronic fatigue syndrome. Better research is necessary before a clear conclusion can be drawn.

Cocaine withdrawal
Preliminary study shows that DHEA is not beneficial in treating cocaine dependence, but further study is needed before a firm conclusion can be drawn.

Critical illness
Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in critically ill patients. At this time, it is recommended that severe illness in the intensive care unit be treated with more proven therapies.

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Crohn’s disease
Initial research reports that DHEA supplements are safe for short-term use in patients with Crohn’s disease. Preliminary research suggests possible beneficial effects, although further research is necessary before a clear conclusion can be drawn.

Dementia
Early evidence gives conflicting results as to whether DHEA offers benefit to individuals with dementia.

Heart failure
There is conflicting scientific evidence regarding the use of DHEA supplements in patients with heart failure. Other therapies are proven in this area, and patients with heart failure or other types of heart disease should discuss treatment options with a cardiologist.

HIV/AIDS
Although some studies suggest that DHEA supplementation may be beneficial in patents with HIV, results from different studies do not agree with each other. There is currently not enough scientific evidence to recommend DHEA for this condition, and other therapies are more proven in this area.

Induction of labor
Preliminary evidence suggests that DHEA may help to induce labor. Further research is needed and people who are pregnant should not self-treat.

Infertility
DHEA supplementation may be beneficial in women with ovulation disorders. There is currently not enough scientific evidence to form a clear conclusion about the use of DHEA for this condition.

Menopausal disorders
Many different aspects of menopause have been studied using DHEA as a treatment, such as vaginal pain, osteoporosis, hot flashes, emotional disturbances such as fatigue, irritability, anxiety, depression, insomnia, difficulties with concentration and memory, or decreased sex drive (which may occur near the time of menopause). Study results disagree and additional study is needed in this area.

Myotonic dystrophy
There is conflicting scientific evidence regarding the use of DHEA supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn.

Ovulation disorders
Low-quality studies suggest that DHEA supplements may benefit women with ovulation disorders. However, results of research in this area are conflicting, and safety is not established.

Partial androgen deficiency

Restoring DHEA levels to young adult values seems to benefit the age-related decline in physiological functions. However, additional study is required to confirm these preliminary results.

Psoriasis
Study results suggest that DHEA offers no benefit to individuals with psoriasis, but some disagree. Additional study is needed before a firm recommendation can be made.

Rheumatoid arthritis
Preliminary evidence from a case series suggests that DHEA likely offers no benefit to individuals with rheumatoid arthritis. Well-designed clinical trials with appropriate endpoints are required before a strong recommendation can be made.

Schizophrenia
Initial research reports benefits of DHEA supplementation in the management of negative, depressive, and anxiety symptoms of schizophrenia. Some of the side effects from prescription drugs used for schizophrenia may also be relieved. Further study is needed to confirm these results before a firm conclusion can be drawn.

Septicemia (serious bacterial infections in the blood)

Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in septic patients. At this time, more proven therapies are recommended.

Sexual function / libido / erectile dysfunction
The results of studies vary on the use of DHEA in erectile dysfunction and sexual function, in both men and women. Better research is necessary before a clear conclusion can be drawn.

Sjogren’s syndrome
DHEA showed no evidence of efficacy in Sjogren’s syndrome in preliminary study. Without evidence for efficacy, patients with Sjogren’s syndrome should avoid using unregulated DHEA supplements, since long-term adverse consequences of exposure to this hormone are unknown. Further research is needed in this area.

Skin aging
Preliminary study suggests the possibility of using DHEA topically as an anti-skin aging agent. Further research is needed to confirm these results.

Fibromyalgia (postmenopause)
DHEA does not seem to improve quality of life, pain, fatigue, cognitive function, mood, or functional impairment in fibromyalgia.

Immune system stimulant
It is suggested by some textbooks and review articles that DHEA can stimulate the immune system. However, current scientific evidence does not support this claim.

Memory
Studies of the effects of dehydroepiandrosterone (DHEA) on cognition have produced complex and inconsistent results. Additional study is warranted in this area.

Muscle strength
Many study results in this area conflict but overall the current available evidence in this area is negative. Further research is needed before firm conclusions can be drawn

Disputed effects
In the United States, DHEA or DHEAS have been advertised with claims that they may be beneficial for a wide variety of ailments. DHEA and DHEAS are readily available in the United States, where they are marketed as over-the-counter dietary supplements. A 2004 review in the American Journal of Sports Medicine concluded that “The marketing of this supplement’s effectiveness far exceeds its science.” Because DHEA is converted to androstenedione and then testosterone, it has two chances to aromatize into estrogen- estrone from androstenedione, and estradiol from testosterone. As such, it is possible for increases in estrogen levels more than testosterone in men.

Increasing endogenous production
Regular exercise is known to increase DHEA production in the body. Caloric restriction has also been shown to increase DHEA in primates. Some theorize that the increase in endogenous DHEA brought about by caloric restriction is partially responsible for the longer life expectancy known to be associated with caloric restriction

Legality
DHEA supplements were taken off the U.S. market in 1985 because of concerns about false claims regarding its benefits. It became available only by prescription but was reintroduced as a nutritional supplement after the Dietary Supplement Health and Education Act was passed in 1994.

United States
A bill has been introduced, in March 2007, in the U.S. Senate (S. 762) that attempts to classify DHEA as a controlled substance under the category of anabolic steroids. The sponsor is Charles Grassley (R-IA). The cosponsors are Richard Durbin (D-IL), and John McCain (R-AZ).[30] This bill was referred to the Senate Judiciary Committee. Then in December 2007, Charles Grassley introduced the “S. 2470: Dehydroepiandrosterone Abuse Reduction Act of 2007,” in an attempt to amend the Controlled Substances Act to make “unlawful for any person to knowingly selling, causing another to sell, or conspiring to sell a product containing dehydroepiandrosterone to an individual under the age of 18 years, including any such sale using the Internet,” without a prescription. The bill was read twice and referred to the Senate Judiciary Committee.

Canada
In Canada, a prescription is required to buy DHEA

Resources:
http://en.wikipedia.org/wiki/Dehydroepiandrosterone
http://altmedicine.about.com/od/dhea/a/dhea.htm

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