Except for emergency contraception (“morning after pills”), you can’t buy steroid sex hormones such as estrogen and testosterone over the counter—they are sold as prescription drugs, largely because of their potential dangers. For instance, long-term use of menopausal estrogen/progestin therapy can increase the risk of breast cancer, strokes, and blood clots, while testosterone therapy has been linked to elevated risk of heart disease and possibly prostate cancer.
Oddly enough, one steroid hormone is sold as a dietary supplement—DHEA, or dehydroepiandrosterone. Touted as the “superhormone” or even “nature’s antidote to aging,” DHEA is widely promoted in anti-aging programs and clinics. We last reported on it a decade ago, when it was exempted from classification as a controlled substance by Congress, thanks to powerful industry lobbying (DHEA’s chief protector was Senator Orrin Hatch of Utah, where supplement makers are heavily concentrated). In Canada and many other countries, DHEA is available only by prescription.
It’s time for us to take another look at this problematic supplement.
Hoping for the fountain of youth
DHEA is the most abundant steroid hormone in the body and is produced mainly by the adrenal glands, which sit atop the kidneys. The supplements are made in labs from chemicals found in wild yams and soybeans.
DHEA is sometimes called a “parent” or “master” hormone because it is converted into other hormones, notably testosterone and estrogen. Many of its purported benefits (and possible risks) are due to its potential conversion to these hormones. However, swallowing DHEA doesn’t have the same effects in everyone. The biochemistry is complex, and the results are highly variable and largely unpredictable (a scary word when you’re dealing with hormones). DHEA appears to also have biological effects independent of its conversion into other hormones.
After age 25, DHEA production begins to decline, and by age 70 it typically has fallen by about 80 percent. People with certain major chronic diseases tend to have more rapid declines in DHEA. Many hormones and other compounds in the body also decline with age and are similarly promoted as anti-aging supplements. But while DHEA is associated with youth and vigor, it does not follow that supplements will reverse or even slow age-related processes.
Risky DHEA: Gambling with Hormones
The list of known or potential risks from DHEA is even longer than the proposed benefits. Some studies have found no serious adverse effects, but they have been small and lasted only several months.
Putting it to the test
DHEA has been extensively studied—in test tubes, lab animals, men, and women. Overall, the human research does not support the anti-aging claims, with the possible exception of a small increase in bone mineral density.
- General “anti-aging” effects. One of the longest studies on DHEA was a well-designed two-year Mayo Clinic trial of people over 60 in the New England Journal of Medicine in 2006. It found that DHEA supplements did not improve muscle strength, physical performance, body composition, blood sugar control, or quality of life (there was a “minimal and inconsistent” improvement in bone mineral density, however). Several studies since then have also failed to support the anti-aging claims.
- Cardiovascular disease. Most studies have found that DHEA has no significant effects on blood cholesterol, blood pressure, or other cardiovascular risk factors.
- Aging muscles. Some studies have found that DHEA helps counter loss of muscle mass and strength in older people. But at least as many have found no improvements. A 2011 review in the Journal of the American Geriatrics Society concluded that the research on muscle strength and physical function remains inconclusive.
- Aging bones. Studies have produced conflicting or inconsistent findings regarding bone mineral density, according to a 2013 review in Osteoporosis International. In some studies, only older women benefited (modestly), for instance; findings also differ in which skeletal sites showed improvement.
- Sexual function. Again, studies have yielded inconsistent but mostly negative results. For instance, an Australian study in the Journal of Sexual Medicine in 2009 found that DHEA did not improve sexual function in postmenopausal women with low libido. A 2013 Italian meta-analysis on DHEA for older men found no improvements in sexual function or desire—or any benefits in terms of cholesterol, blood sugar, or bone health.
- Athletic performance. Most studies have not shown a benefit. Still, DHEA is banned by the World Anti-Doping Agency and thus in the Olympics and most professional and collegiate sports because it is considered an anabolic steroid.
- Cognitive function. A Cochrane review looked at five clinical trials and concluded that DHEA does not improve cognitive function in older people. Two studies actually linked DHEA to poorer performance on certain memory tests.
We strongly advise against taking DHEA, since its benefits are unproven and its potential risks are numerous. There are very few medical indications for it, and in those cases it should be taken under medical supervision. There is no logical reason why DHEA is not regulated as a drug like other sex hormones. Because it’s sold as a supplement, if you did need to take it, you wouldn’t know if it really contained DHEA and in the amount listed on the labels.
Published October 20, 2014