Typically, when we talk about HRT we are referring to estrogen alone or estrogen with progesterone. Some women also take a low dose testosterone supplement. (See my blog on using testosterone.) Another hormone that women hear about that may be used in menopause treatment is DHEA.
DHEA is short for dehydroepiandrosterone, which is a hormone made by the adrenal glands. Its main role in the body is to be converted into a number of other hormones – primarily testosterone and estrone. Strangely, we know relatively little about other actions that DHEA plays in the body.
The DHEA level peaks around age 20 and then slowly declines so that by age 80 it is only about a quarter of its original level. Unlike estrogen and progesterone, it doesn’t drop dramatically at the time of menopause.
Some health care providers are proponents of DHEA and believe that everyone over 35 take DHEA claiming that it may slow down the aging process and keep us more fit and energetic. Others specifically recommend adding it to HRT regimens along with estrogen and progesterone touting that it boosts our hormone activity. Currently traditional medical organizations do not recommend DHEA as a supplement because there is very little research on its use in women and so the benefits and risks of long-term therapy are unclear.
DHEA is sold over-the-counter as a nutritional supplement and so a prescription or authorization from a doctor is not required. So this opens the door for women to simply decide to take it on their own.
However, I think it is important for women to be informed about the benefits and risks before embarking on this course. So in this blog I will try to summarize what we know based on a number of studies that I have reviewed.
What dose should women consider taking?
The studies include women taking anywhere from 10 to 250 mg per day. Most of the DHEA gets converted into male hormones, so the higher the dose, the more likely a woman will experience male-like side effects (see below). These may start to appear at doses of 50 mg per day.
Does DHEA raise estrogen levels?
I reviewed a number of studies looking at this and it appears that taking DHEA will slightly raise estrogen levels in women. To get a perspective on this, the estrogen level in women prior to menopause fluctuates throughout the menstrual cycle between 30 and 400 picograms per milliliter (pg/ml). After menopause the levels are generally around 5 to 25 pg/ml. Women taking 50 mg of DHEA may see their levels go up by 3 – 5 pg/ml, whereas a estradiol 0.05 mg patch raises the level to 40 – 60 pg/ml. While taking more DHEA would seem likely to raise estrogen levels higher, this does not appear to be the case as in one study women taking doses over 50 mg actually saw a decrease in their estrogen levels.
Does measuring DHEA levels help determine optimal dosing?
We know that DHEA levels slowly decline over time. But the level in the blood stream does not correlate with how much is converted into estrogen and testosterone because this is occurring inside our cells. The best way to know how DHEA is affecting women is more subjective, such as if it helps with the hot flashes or other symptoms. Similarly, if women are noticing pronounced male-type symptoms, that may indicate they are taking too much.
What are the side effects?
As noted, since most of the DHEA is converted into male-type hormones, the side effects would be of this nature. This includes abnormal hair growth on the face and chest, oily skin and acne. Excessive doses could lead to voice changes, increased muscle mass, thinning hair, and frontal balding.
What are the risks
The risks would be related to an increase in either the estrogen or testosterone levels. As noted, the rise in estrogen is very modest, much less than taking estradiol replacement. However, some oncologists would advise that women with breast
cancer not take this risk. It is unlikely that the small rise in estrogens would increase blood clots, but this is a remote concern since oral DHEA may act somewhat like oral estrogen in this regard. It is also unclear if high doses of DHEA can increase the risk of diabetes or heart disease, which can be seen in women taking high doses of testosterone.
What are the benefits
As noted, DHEA supplementation will not produce very much estrogen and would be unlikely to treat hot flashes. It may have a slight benefit on the bone, but not as much as estrogen replacement. Since it increases testosterone, it may help with libido. Some proponents claim that it boosts energy and helps with weight maintenance.
Oral DHEA will not have much effect on the vaginal tissues, but an intravaginal DHEA product called prasterone is available that is beneficial. The DHEA is taken up into the vaginal cells and converted into estrogen which promotes beneficial effects on the vaginal tissues. Since the prasterone is also converted into testosterone, this may provide additional benefits which may improve sexual responsiveness. Near negligible levels of these hormones gets from the vagina into the blood stream, so it is not believed that this product would cause male like side-effects or any estrogen effects in the rest of the body. However, some oncologists are hesitant to use prasterone in breast cancer patients.
The bottom line
We have very little research on DHEA and menopause, especially regarding long-term use. Most of the articles I read conclude that oral DHEA therapy should not be routinely recommended for postmenopausal women with normal adrenal function.
However, low doses up to 50 mg taken for a short term appear to be relatively safe for women who are curious to see if it helps them feel better with respect to any menopausal symptoms.
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