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Consensus # 4 DHEA Therapy of Adrenal Androgen Deficiency in Adult

December 11, 2005

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After a literature review and discussions with physicians from all over the world who are well-versed in treating patients with endocrine abnormalities, we, the members of the Consensus Group of Experts of the International Hormone Society, think the time is ripe to consider treating DHEA deficiency in adults.

Up to now, no international society has officially acknowledged the need and value of treating deficiencies in adrenal androgens with DHEA. Some, rare, national institutions in the world have published reports with prudent and reserved opinions on DHEA treatment. In general, these reports concluded that the time was not yet ripe to supplement patients with DHEA. They were of the opinion that the scientific literature on DHEA was too scarce and its efficacy was uncertain. They also expressed a concern that DHEA supplementation might be harmful to humans with the potential of reducing HDL cholesterol and increasing the incidence of genital cancer.

We have carefully reviewed the literature on DHEA, and read and discussed the negative institutional reports, and have not found solid scientific evidence to support the view that DHEA would present a significant danger.

We acknowledge and approve the undertaking of an increasing number of studies where men and women with severe adrenal deficiency are being treated with DHEA in addition to glucocorticoids. In these studies on severely DHEA deficient patients, DHEA supplementation significantly increases mental and physical health. In adults with a less severe DHEA deficiency such as "normal" elderly persons, the effects of DHEA have not always been as evident. In some reports only moderate effects, of borderline significance, were observed with DHEA supplementation, and in some rare studies no improvements were noted.

The fact that no improvement or only a moderate improvement was seen with the addition of physiological doses of DHEA in patients with mild deficiency in some studies, does not imply that DHEA treatment is worthless or dangerous. Indeed, the duration of treatment of many of the "no significant effect of DHEA"- studies was often too short to show any effects (several negative studies on DHEA's effect on memory were of two weeks or less duration for example). Besides the minority of negative studies, a greater number of positive studies with significant beneficial results with the use of DHEA in humans can be found. In addition, the overall conclusion of the positive studies is that DHEA, the most abundant hormone in our blood, is one of the safest of all hormones. Controlled studies of DHEA treatment concluded that no harmful side effects were seen with physiologic doses and that if any side effects were found, they generally were due to excessive doses. The most typical signs of DHEA were signs of excess androgens such as oily skin and hair.

In many studies with DHEA treatment significant beneficial effects were obtained on bones, skin, the immune system, as well as on serum glucose, insulin and lipid levels, etc. Positive effects were also noted on mental and emotional issues such as quality of life, fatigue, and depression. In animal and some human studies the effects of DHEA treatments included, among others, a beneficial effect on cardiovascular diseases, diabetes, obesity, and osteoporosis and even in animal studies agaInst cancer .

In the opinion of the members of the IHS's consensus group, the following arguments support DHEA treatment of deficient adults:
  • DHEA is natural to humans and in fact is our most abundant hormone. DHEA is fully adapted for our bodies and under stressful conditions it is greatly increased.
  • DHEA has several significantly beneficial effects on mental and physical health parameters, and against the development of age-related diseases.
  • DHEA is relatively safe.
  • Pharmaceutical grade-DHEA can be purchased in pharmacies in many countries.
  • DHEA is relatively inexpensive.
Therefore, we estimate that DHEA treatment of adults, who have low DHEA sulphate levels, is justified.

To increase the safety of DHEA treatment, we recommend that physicians do a regular check-up of their patients, including a good clinical interview and examination, and laboratory tests every six to twelve months depending on the patient's needs. The Consensus Group of Experts of the International Hormone Society concludes that it is essential to do a regular cancer screening, including breast and prostate examination, every six months to once a year, including an ultrasound examination or mammography when necessary. Although DHEA has not been shown in a valid human study to promote prostate cancer, there are two studies where a high serum DHEA sulphate level was found too be significantly and positively associated with an increased risk of breast cancer in postmenopausal women, while in premenopausal women a "safe" inverse relationship is found. For this reason, the IHS consensus group proposes the avoidance of DHEA treatment in postmenopausal women without safe female hormone replacement therapy.

In our experience, the best method to diagnose a DHEA deficiency is to check the serum levels of DHEA sulphate and the urinary excretion of the 17-ketosteroid DHEA metabolites (measured by gas chromatography). Safe doses for DHEA treatment are the physiological doses, namely between 20 and 60 mg per day for men, and between 5 and 30 mg per day in women.

In conclusion, we have found no convincing evidence against the use of DHEA in adults presenting with low DHEA levels, except in cases of postmenopausal women who are not taking female HRT. On the contrary, enough beneficial effects have been reported to recommend the use of physiological doses of DHEA to correct well diagnosed DHEA deficiencies in adults in a program with regular follow-ups.

The addition of a physiological dose of DHEA may be particularly justified when glucocorticoids are used in order to safely neutralize any excessive catabolic effects of glucocorticoids as shown in animal studies.

References

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18 signatures for this petition
 
1 to 10

03/14/2015
Rachel Jones
United Kingdom
I want a FULL life, steroids alone are NOT THE ANSWER please help?
09/30/2014
Marina Ussai
Italy
(no comment)
01/21/2014
Janet Butler
United Kingdom
My son has adrenal problems from birth, but has not been re-tested in over 30 years.
01/20/2014
Melanie Chilver
United Kingdom
(no comment)
03/29/2013
Clément Demaria
France
(no comment)
10/14/2008
Alenka Radelj
Slovenia
(no comment)
05/07/2008
Erika Gray
United States
(no comment)
05/07/2008
Darwin Nicol
United States
(no comment)
05/07/2008
Patt Nicol
United States
(no comment)
05/07/2008
Alan Turbin
United States
(no comment)

 

 

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