DHEA For Low T: Facts and Warnings

I have treated many men with low testosterone and many ask for a solution that does not involve testosterone replacement therapy. This blog will discuss the use of DHEA in men and how effective it may be for solving the symptoms of low T.

DHEA is a hormone that is naturally made by the human body. It can be made in the laboratory from chemicals found in wild yam and soy. However, the human body cannot make DHEA from these chemicals, so simply eating wild yam or soy will not increase DHEA levels.

Athletes and other men use DHEA to increase muscle mass, strength, and energy. But DHEA use is banned by the National Collegiate Athletic Association (NCAA).

DHEA is also used by men for erectile dysfunction (ED) and in men who have low levels of testosterone in order to improve well-being and sexuality.

Like many dietary supplements, DHEA has some quality control problems. Some products labeled to contain DHEA have been found to contain no DHEA at all, while others contained more than the labeled amount.

How does DHEA work?
DHEA is a “parent hormone” produced by the adrenal glands near the kidneys and in the liver. In men, DHEA is also secreted by the testes. It is changed in the body to a hormone called androstenedione. Androstenedione is then changed into the major male hormones including testosterone.

DHEA levels seem to go down as people get older. Some researchers think that replacing DHEA with supplements might prevent some diseases and conditions.

DHEA is Possibly Effective for:
• Aging skin. Some research shows that taking DHEA by mouth increases the thickness and hydration of the top layer of the skin in elderly people. Early research shows that applying DHEA to the skin for 4 months improves the appearance of skin.

DHEA has Insufficient Evidence for:
• Aging. Taking DHEA does not seem to improve body shape, bone strength, muscle strength, insulin sensitivity, or quality of life in people older than 60 who have low DHEA levels.
• Hormone deficiency in men (partial androgen deficiency). Early research suggests that taking 25 mg of DHEA daily for one year might improve mood, fatigue and join pain in older men with hormone deficiency.
• Physical performance. Some research shows that older adults who take DHEA have improved measures of muscle strength. However, other research has found no effect of taking DHEA on muscle strength.
• Sexual dysfunction. Evidence on the effectiveness of DHEA for sexual dysfunction is inconsistent. Taking DHEA by mouth for 24 weeks seems to improve symptoms including erectile dysfunction and overall satisfaction in men. However, it does not seem to be helpful if erectile dysfunction is caused by diabetes or nerve disorders.
• Weight loss. Early evidence suggests that DHEA seems to help overweight older people who are likely to get metabolic syndrome to lose weight. It is not known if DHEA helps younger people to lose weight.

Bottom Line: DHEA is probably not a panacea for low T or a treatment for ED or erectile dysfunction.

Restoring The Fountain of Youth-DHEA Just May Be The Youth Hormone For Women

American women (men too) are always looking to find a way to turn back the biologic clock. We all would like to look like the women in Cosmopolitan and Vogue Magazines. If your goal is to look younger, feel better, and improve energy level, then you might consider the benefits of DHEA.

DHEA, dehydroepiandrosterone, is a hormone produced in the adrenal gland, the small triangular structure that sits on top of the kidneys. DHEA is made by the adrenal glands and is then converted to androgens, estrogens and other hormones. These are the hormones that regulate fat and mineral metabolism, sexual and reproductive function, and energy levels. DHEA levels increase until our mid to late 20′s then gradually decline. 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). DHEA is called the “mother hormone” — the source that fuels the body’s metabolic pathway.

When DHEA levels are low, your body does not have enough working material for proper endocrine function. This throws off your hormone production and you feel a general sense of malaise, along with other symptoms of hormonal imbalance — how severe depends on how many other demands are being made on your body at the same time.
There is a growing body of evidence that healthy levels of DHEA may help stave off Alzheimer’s disease, cancer, osteoporosis, depression, heart disease and obesity, but there is still no clear-cut consensus. There may be some increased risks associated with DHEA for women with a history of breast cancer — all the more reason to take DHEA under medical supervision.

Symptoms of low DHEA include extreme fatigue, decrease in muscle mass, decrease in bone density, depression, aching joints, loss of libido, and lowered immunity.
DHEA is stated to be possibly effective for these conditions:
1. Aging Skin – Taking DHEA orally seems to increase epidermal thickness, sebum production, skin hydration, and decrease facial skin pigmentation in elderly men and women
2. Osteoporosis – Taking DHEA orally 50-100 mg per day seems to improve bone mineral density (BMD) in older women and men with osteoporosis or osteopenia.
3. DHEA is also thought to contribute to a sense of well-being when used by those with adrenal and/or androgen insufficiency.
4. It may also support lean body mass in postmenopausal women.

DHEA has many potential benefits but does also have some side effects, which include hair loss, hair growth on the face (in women), aggressiveness, irritability and increased levels of estrogen. Calcium channel blockers may increase DHEA levels and those using calcium channel blockers should avoid supplementation. Anyone with a history of hormone-related cancer such as estrogen sensitive breast cancer should definitely avoid DHEA due to the probability of increased estrogen levels.

If you don’t feel DHEA is appropriate for you, it may be possible to increase the body’s natural production of DHEA with regular exercise and restricting the number of calories you consume. Calorie restriction is associated with a longer life span and the increase in DHEA production may be partially responsible. In fact, there are many studies that show you can improve your DHEA levels naturally by maintaining a body mass index of 19-25, getting adequate rest and exposure to sunlight, exercising regularly (including sexual activity), and fostering more “downtime” in your life — but more on that in a moment.

Without a medical test it’s impossible to know what your DHEA levels are. Using blood tests, your doctor can check for estradiol in the follicular phase (usually days 3–9 of a menstrual cycle); progesterone in the luteal phase (days 14–28); DHEA-S; and both free and total testosterone levels.
Treatment With DHEA Supplements

If tests indicate the need for DHEA supplementation, you may start off with as little as 1-5 mg, twice a day. The dosage can be slowly increased to 10–12 mg per day. Most doctors do not suggest any woman exceed 25 mg per day if capsule forms are used. Once balance has been restored and symptoms even out, most women produce enough DHEA on their own.

Bottom Line: Many women are suffering from hormone imbalance. Decreased DHEA can be a cause of many problems affecting middle age women and can even impact her libido and her energy levels. DHEA should never be taken casually or unsupervised, but its benefits are real for the women who need it.

Sex Drive In the Tank? Then Filler Up With DHEA

Nearly every doctor and every patient believes that their sex drive or libido comes from their testosterone level and that restoring testosterone with injections, gels, or pellets will restore a man’s virility. The answer is yes and no. Yes, testosterone is responsible for a man’s sex drive but so is the ratio of testosterone to estrogen. A testosterone/estrogen imbalance can severely inhibit sexual desire and sexual performance.

In a man’s youth, low amounts of estrogen are used to shut down the powerful cell stimulating effects of testosterone. As estrogen levels increase with age, testosterone cell stimulation may be locked in the “off” position, thus turning off sexual arousal and sensation and resulting in a loss of libido in aging men.

Another concern is that aging men sometimes convert testosterone to estrogen. The increase in estrogen is taken up by testosterone receptor sites in the cells and prevents circulating testosterone from gaining access to the cells where it can do its greatest function.

Testosterone is responsible for the sex drive in both men and women. In order for testosterone to do its job, it must be in the free form and not bound to other circulating proteins like sex hormone binding globulin (SHBG). SHBG increases with age and grabs the free testosterone making it unavailable to the cells where it is needed to initiate sex-stimulating centers in the brain. Also excess estrogen increases the production of SHBG and blocks the testosterone-receptor sites. These are the two mechanisms that impact a man’s libido associated with aging.
Therefore, it is necessary to suppress excess levels of SHBG and estrogen while increasing free testosterone to the level of a younger more youthful man. By restoring the normal ratio of testosterone to estrogen ratio a man’s libido and sexual performance often improves.

One of the easiest ways to accomplish this restoration of the normal T\E ratio is to prevent testosterone from being converted into excess estrogen. Too much estrogen plays havoc with a man’s sex life by binding to testosterone receptor sites and also the associated increase in SHBG, which decreases the freely available testosterone.
Certainly estrogen is a necessary hormone for men just as testosterone is necessary hormone for women.

The problem of an abnormal ratio of T\E can easily be diagnosed with a simple blood test for estradiol. Levels that are greater than 30pg/ml are abnormal and would benefit from treatment that lowers the estrogen level and the SHBG levels.

Treatment of elevated estradiol in men can be accomplished with a prescription medication, Armidex, which is aromatase inhibitor and blocks the conversion of testosterone to estrogen. The dosage is 50mg\day. Studies have demonstrated that this dosage decreases the estrogen level in approximately one month.

Bottom Line: Testosterone deficiency is a common problem affecting many middle age and older men. Often this is due to an imbalance of testosterone\estrogen ratio. This can be easily treated with oral aromatase inhibitors. So if you are middle age and your doctor prescribed testosterone and it isn’t working, I suggest you speak to him or her about getting an estradiol level and if it is elevated, then treatment with an aromatase inhibitor.

Dr. Neil Baum is a physician practicing at Touro Infirmary and can be reached at his office, 504 891-8454, or via his website, http://www.neilbaum.com

Sex Drive In The Tank? DHEA Is An Option

Women with a decreased sex drive or decreased libido now have treatments that can restore their interest and enthusiasm for sexual intimacy. Options include testosterone, yes the hormone produced in the testicles of men, but also produced in small amounts in women and is responsible for a women’s sex drive. Testosterone is available in pills, lozenges, patches, gels injections, and small rice-sized pellets inserted underneath the skin. Although there are advantages and disadvantages to each, most gynecologists and urologists will not prescribe pills, which can increase the risk of liver toxicity and lower levels of HDL (the “good” cholesterol).

A slightly “milder” alternative to testosterone is DHEA (dehydroepiandrosterone). This steroid hormone is converted to testosterone. Supplementary DHEA, which is available in pill or cream form, increases testosterone levels by one-and-a-half to two times. So it’s not surprising that DHEA provides many of the same therapeutic benefits, including increased sexual interest and enhanced physical and mental satisfaction.

If you think you might be a candidate for testosterone therapy, here’s what to do:
Have your testosterone, DHEA and estrogen levels measured. Normal concentrations of testosterone range from between 25 and 100 nanograms per milliliter of blood.
Eat a well-balanced diet to stabilize your hormones Fiber and foods rich in minerals, such as potassium and magnesium can help balance hormones. Tofu, tempeh and other soy products are excellent sources of phytoestrogens, plant compounds that behave like mild estrogens in the body, helping relieve menopausal symptoms. Other sources of phytoestrogens include apples, alfalfa, cherries, potatoes, rice, wheat and yams. A diet rich in fruits and vegetables will also help maintain optimal health as you transition into menopause.
If you begin androgen therapy, be sure to report any side effects, such as acne, deepening of your voice, go to your doctor so he or she can monitor your progress and decrease your dosage as necessary.

Bottom Line: Although it is not for everyone, emerging research may reveal androgen to be one of the most promising therapies available to menopausal women. Sexuality and vitality need not be passing pleasures of youth.

This was modified from “Testosterone: A Major Breakthrough for Menopausal Women”. This article appeared in Fit & Health and can be accessed at: http://health.howstuffworks.com/wellness/women/menopause/testosterone-major-breakthrough-for-menopausal-women5.htm