DHEA Replacement in Postmenopausal Women

In addition to declines in estrogen and progesterone well known to occur at menopause, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) are adrenal steroids that decline with age, independent of cortisol production. Peak DHEA and DHEA-S levels occur at age 18-25, then gradually decline up to 90% by age 70. Animal studies indicate a diversity of actions for DHEA, including age-attenuating, immune-augmenting, insulin-sensitizing, anti-obesity, cardioprotective, and anti-osteoporotic effects.

Clinical trials on DHEA effects are limited and sometimes conflicting. Unblinded trials of DHEA in HIV-infected and SLE patients indicate some clinical improvements. Single-dose oral DHEA prior to influenza vaccination improved immune response.

Although DHEA products are sought after by the lay public because of animal data indicating anti-obesity effect, data on humans are unconvincing. On the other hand, decline in fat mass, without substantial decrease in overall body weight, has been seen in studies of men.

Long-term safety of DHEA is uncertain. Animal data indicate hepatic enzyme effect, and DHEA is suspected to be a hepatocarcinogen. In humans, one subject is reported to have developed jaundice after one week of DHEA orally, 150 mg/d. Of equal concern is the in vitro effect of DHEA as an accelerant of prostate cancer culture cells. In postmenopausal women, decreases in HDL have been seen, similar to the decreases occurring with oral androgens.

The role of DHEA in clinical medicine remains inadequately defined. Clinicians dealing with requests for use of DHEA or DHEA-S may wish to inform patients of the current incomplete knowledge base and potential toxicity. Persons who take DHEA or DHEA-S supplements may be recommended to monitor testosterone, LFTs, and lipids.

Casson PR, et al. J N Am Menopause Soc 1997;4:225-231.