An important study has demonstrated improvements in female sexual function among pre-menopausal women around 40 years old, who supplemented with the hormone dehydroepiandrosterone (DHEA).
This article will discuss the study results, relevant DHEA dosage, and DHEA functions regarding metabolism and hormones.
DHEA Improves Female Sexual Function
The medical journal, Endocrine, has just published a breakthrough study. The October, 2018 investigation confirmed that dehydroepiandrosterone supplementation improved libido, sexual desire, and sometimes, even pain, in thousands of infertile women.
The premenopausal test subjects included 50 infertile pre-menopausal women whose age average 41 years. Female Sexual Function Index (FSFI) questionnaires were completed, and serum hormone levels were analyzed at the beginning of the study and four to eight weeks after initiating DHEA supplementation.
The DHEA supplement dosage was 75 mg of oral micronized DHEA taken as 25 mg TID (three times per day).
DHEA is mainly secreted by the adrenal cortex and is known to influence female fertility, as well as functioning of the cardiovascular and central nervous systems.
Serum androgen hormone levels, including DHEA and testosterone, were shown to increase following DHEA supplementation.
In comparison with pre-treatment scores, FSFI index scores improved by 7%, including a 17% increase in desire, a 12% increase in arousal, and an 8% increase in lubrication.
However, among women whose FSFI scores were among the lowest 25% of the group (those with the greatest degree of sexual dysfunction):
Total FSFI scores increased by 34%, which included a 40% increase in desire, a 46% increase in arousal, and a 33% increase in lubrication. Women in this group also experienced a 54% increase in orgasm, greater satisfaction, and less pain in comparison with pre-treatment values.
While women whose FSFI scores were indicative of sexual dysfunction benefited the most from DHEA, the fact that the study population as a whole experienced mild improvement suggests to the researchers that DHEA supplementation could positively impact the sexual well-being of women in this age group.
The study concluded that “…supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.”
DHEA For Infertility
There was also an interesting study published in January, 2018, demonstrating the effects of DHEA supplementation in women with poor ovarian response during assisted reproductive technology.
The study, published in the Journal of International Medical Research, included 62 women who were diagnosed with poor ovarian response or underwent in vitro fertilization or intracytoplasmic sperm injection. Thirty-four women took 50 mg of DHEA daily for 3 months.
The DHEA supplementation had a positive impact in nearly all the parameters measured. These included hormonal profiles, the quality of the endometrium, the number of oocytes retrieved, the quality of embryos, and pregnancy and live birth rates.
DHEA Benefits the Brain
With declining DHEA-S levels, cortisol levels remain constant, resulting in an increased cortisol/DHEA-S ratio. The unbalanced relationship between the too high cortisol and not enough DHEA-S is serious enough that it can create potentially harmful conditions for the hippocampus and contribute to neurodegenerative disease pathology.
Specifically, brain imaging studies show that the decreased DHEA-S levels are closely associated with decreased hippocampal function in Alzheimer’s disease.
A study on rats published in the journal Acta Biochemica Polonia concluded that its “results clearly indicate a neuroprotective effect of DHEA against Alzheimer’s disease.“
A human epidemiological study published in the British Geriatrics Society’s journal Age and Ageing also found an association between frailty and DHEAS levels. The study results indicated an association between higher DHEA levels and lower frailty status.
Because DHEA acts so powerfully on the brain, it is hardly surprising to find that it is intimately associated with a variety of brain-health issues. Studies show, for example, that people with higher DHEA levels have less mental confusion, lower anxiety, and a less negative mood.
Other studies have found that DHEA levels (in its circulating, sulfated form, DHEA-S) correlate with overall cognitive function in men and women, and with better working memory, attention, and verbal fluency found in women with the highest levels.
DHEA also plays a significant role in mental illness—especially depression. A recent study published in Psychoneuroendocrinology found that among people with major depression, those with higher DHEA levels were more likely to experience remission of their symptoms when treated with antidepressants, suggesting that such drugs may require a particular level of DHEA to be most effective.
Low DHEA levels are also correlated with brain shrinkage in major depression. One 2016 study showed that high cortisol/low DHEA ratios are associated with smaller volume of the hippocampus (the main memory-processing region of the brain) in people with major depression. This could contribute to some of the memory and decision-making problems often experienced by people with depression.
Indeed, low DHEA levels are now associated with multiple brain-related disorders, including stress-induced clinical burnout, bipolar disorder, major depression, anxiety, and chronic fatigue syndrome.
DHEA And Cortisol
It is now well established that chronic stress leads to an out-pouring of cortisol, and with that, a gradual depletion of DHEA. Over time, this hormonal imbalance can lead to hardening of the arteries, thinning bones, increasing waistline girth, and impaired functioning of the immune system.
High cortisol levels also lead to an increase in blood sugar. In response, more insulin needs to be secreted from the pancreas to clear the sugar from the blood and shepherd it into the cells. In chronic situations, alternating high and low blood sugar levels ensues, and eventually the body becomes less sensitive to insulin.
This phenomenon is commonly known as Metabolic Syndrome or Syndrome X. Several detrimental effects of this syndrome include weight gain and obesity, increases in cholesterol and triglyceride levels, and a rise in blood pressure. Adult onset pre-diabetes or diabetes also can result.
Chronic high levels of cortisol can also impair the immune response. The inability to fight infections leads to a higher susceptibility to colds and flu.
The link between cortisol production and DHEA is an important one because, with long periods of chronically high cortisol levels, the ability to produce DHEA diminishes. For example, there is a link between a diminished circulating concentration of DHEA and the progression of immunosuppression and muscle loss in persons with AIDS. These patients also exhibit high cortisol levels.
One of the most significant effects of restoring DHEA seems to be the restoration of the normal balance between DHEA and cortisol.
As DHEA levels increase, the propensity to overproduce cortisol is dampened—along with the spiral of symptoms induced by high cortisol.
DHEA and Dry Eye Syndrome
Another downside of aging is the increased incidence of dry eye syndrome, a condition that causes irritated, red, and itchy eyes. The syndrome seems to be more prevalent in women, especially once they start perimenopause.
Because DHEA has been shown to stimulate sebaceous glands, an eye drop containing DHEA was developed and used to treat women suffering from dry eye syndrome. These women reported less eye irritation and the improved production of natural tears.
A recent study published in the journal Opthamology found that:
“Decreased serum androgens to be highly associated with DED (Dry Eye Disease), and adds important evidence to the growing body of research that links androgens to ocular surface disease and DED.”
DHEA Levels Decrease With Age
Dehydroepiandrosterone (DHEA) is plentiful in the human body: together with its sulfated form (DHEA-S), DHEA comprises the most abundant form of steroid hormones.
In fact, the average concentration of DHEA-S in the bloodstream is about 10,000 times higher than the most potent estrogen – estradiol (typical estradiol levels around 0.1 ng/mL vs 1000 ng/mL for DHEA-S).
Derived from cholesterol, DHEA is produced by the adrenal glands, brain, ovaries and testes, and is a precursor for the major sex steroids (estrogen, progesterone, and testosterone).
Sometimes called the “anti-aging hormone” or even the “fountain of youth,” it’s no wonder that supplementation with DHEA to its mid-normal physiologically youthful levels appears to engender a sense of well-being and reestablish that “zest for life”.
DHEA-S levels peak around mid-twenties and gradually decrease to around 20% by age 70. Unfortunately, once DHEA levels begin to wind down, there are no feedback mechanisms to help restore it.
As DHEA and downstream metabolites decrease, the brain loses the protective effects of sex steroids and becomes increasingly vulnerable to neurotoxic effects of cortisol and other potentially damaging factors.
The DHEA-Sulfate Test
The DHEA-sulfate test measures the amount of DHEA-sulfate in the blood. If you are suffering with sexual function or infertility issues, your doctor may order this blood test.
The DHEA-sulfate test is often done in women who show signs of having excess male hormones. Some of these signs are male body changes, excess hair growth, oily skin, acne, irregular periods, or problems becoming pregnant.
It may also be done in women who are concerned about low libido or decreased sexual satisfaction who have pituitary or adrenal gland disorders.
Other symptoms of DHEA deficiency can include:
- prolonged fatigue
- poor concentration
- a diminished sense of well-being
Normal DHEA Ranges for Females:
- Ages 18 to 19: 145 to 395 micrograms per deciliter (µg/dL) or 3.92 to 10.66 micromoles per liter (µmol/L)
- Ages 20 to 29: 65 to 380 µg/dL or 1.75 to 10.26 µmol/L
- Ages 30 to 39: 45 to 270 µg/dL or 1.22 to 7.29 µmol/L
- Ages 40 to 49: 32 to 240 µg/dL or 0.86 to 6.48 µmol/L
- Ages 50 to 59: 26 to 200 µg/dL or 0.70 to 5.40 µmol/L
- Ages 60 to 69: 13 to 130 µg/dL or 0.35 to 3.51 µmol/L
- Ages 69 and older: 17 to 90 µg/dL or 0.46 to 2.43 µmol/L
Fortunately, DHEA supplements are inexpensive, and numerous studies show that supplementation can directly oppose loss of brain function.
This is why DHEA is commonly prescribed to female (and male) patients presenting with low androgen symptoms in combination with low circulating DHEA-S and/or low testosterone levels.
DHEA replacement therapy can certainly impede the ravages of aging – adequate levels help ramp up the levels of downstream sex steroids, enhance the ability to adapt to stress, increase libido, improve the body fat ratio, and boost the immune system.
There a quite a few DHEA supplement options at your pharmacy or online.
I like Jarrow Formulas DHEA, because it’s available in 10 mg capsules, which allows you to more finely titrate your dosage (most formulas are 25 mg and higher).
Also, Jarrow has been manufacturing supplements since 1977 and has a solid reputation.
The recommended dosage of oral DHEA supplementation varies widely based on what it’s being taken for. The studies I researched indicate 50-75 mg per day.
Be sure to talk to your doctor about what dosage may be appropriate for you. You may also want to check with your pharmacist, as DHEA can have negative interactions with multiple medications, including antidepressants and other drugs that alter serotonin levels or function. Serotonin syndrome is a possibility.
DHEA may change the way your liver processes drugs, so be sure to ask your doctor and pharmacist about whether this increases risks of problems from your other medications.
The higher the dosage, the higher the likelihood of side effects.
DHEA is a hormone. Use of this supplement might increase levels of androgen and have a steroid effect. DHEA also might increase the risk of hormone-sensitive cancers, including prostate, breast and ovarian cancers. If you have any form of cancer or are at risk of cancer, don’t use DHEA.
Don’t use DHEA if you’re pregnant or breast-feeding.
Consider avoiding use of DHEA if you have high cholesterol or a condition that affects the supply of blood to the heart (ischemic heart disease). DHEA might reduce high-density lipoprotein (HDL), or “good,” cholesterol levels.
Use Caution With These Combinations:
The body changes DHEA to estrogen in the body. Anastrozole (Arimidex) is used to help lower estrogen levels in the body. Taking DHEA along with anastrozole (Arimidex) might decrease the effectiveness of anastrozole (Arimidex). Do not take DHEA if you are taking anastrozole (Arimidex).
The body changes DHEA to estrogen in the body. Exemestane (Aromasin) is used to help decrease estrogen in the body. Taking DHEA along with exemestane (Aromasin) might decrease the effectiveness of exemestane (Aromasin). Do not take DHEA if you are taking exemestane (Aromasin).
Some types of cancer are affected by hormones in the body. Estrogen-sensitive cancers are cancers that are affected by estrogen levels in the body. Fulvestrant (Faslodex) is used for these types of cancer.
DHEA might increase estrogen in the body and decrease the effectiveness of fulvestrant (Faslodex) for treating cancer. Do not take DHEA if you are taking fulvestrant (Faslodex).
Insulin is used to lower blood sugar. Insulin can also lower the amount of DHEA in the body. By lowering DHEA in the body, insulin might lower the effectiveness of DHEA supplements. Monitor your blood sugar level carefully if you are taking insulin.
Some types of cancer are affected by hormones in the body. Estrogen-sensitive cancers are cancers that are affected by estrogen levels in the body. Letrozole (Femara) is used for this type of cancer. DHEA might increase estrogen in the body and decrease the effectiveness of letrozole (Femara) for treating cancer. Do not take DHEA if you are taking letrozole (Femara).
Medications changed by the liver
Some medications are changed and broken down by the liver. DHEA might decrease how quickly the liver breaks down some medications. Taking DHEA along with these medications might increase their effects and side effects. Before taking DHEA, talk to your healthcare provider if you are taking any medications that are changed by the liver.
Some medications changed by the liver include lovastatin (Mevacor), simvastatin (Zovor), ketoconazole (Nizoral), itraconazole (Sporanox), amiodarone (Cordarone), citalopram (Celexa), and many others.
Medications for depression (Antidepressant drugs)
DHEA increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking DHEA along with these medications might increase serotonin too much.
Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), amitriptyline (Elavil), imipramine (Tofranil), duloxetine (Cybalta), venlafaxine (Effexor) and others.
Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
DHEA might slow blood clotting. Taking DHEA along with medications that also slow clotting might increase the chances of bruising and bleeding.
Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), rivaroxaban (Xarelto) and apixaban (Eliquis).
Some types of cancer are affected by hormones in the body. Estrogen-sensitive cancers are cancers that are affected by estrogen levels in the body. Tamoxifen (Nolvadex) is used to help treat and prevent these types of cancer.
DHEA increases estrogen levels in the body and might decrease the effectiveness of tamoxifen (Nolvadex). Do not take DHEA if you are taking tamoxifen (Nolvadex).
The body breaks down triazolam (Halcion) to get rid of it. DHEA might decrease how quickly the body breaks down triazolam (Halcion). Taking DHEA with triazolam (Halcion) might increase the effects and side effects of triazolam (Halcion).
Taking DHEA might reduce the effectiveness of the tuberculosis vaccine. Do not take DHEA if you getting a tuberculosis vaccine.
Herbs and Supplements that Might Slow Blood Clotting
Using DHEA along with herbs that can slow blood clotting might increase the risk of bleeding in some people. These herbs include angelica, clove, danshen, garlic, ginger, ginkgo, and Panax ginseng.
Licorice increases levels of DHEA in the body, so it might increase any potential side effects of DHEA.
Soy may increase or decrease DHEA levels in the body.
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