DHEA – yet another medical acronym to know in the bioidentical hormone restoration therapy space… another scientific name that if it ended up on a spelling bee contest, I’m sure it would stump most! DHEA, or dehydroepiandrosterone specifically, is a hormone produced predominantly by the adrenal glands in the adrenal cortex (the outer layer ”skin” of your adrenal glands). Other factory sources of DHEA in your body include the gonads (ovaries and testes) and the brain.
In the sex-hormone cascade, aka the hormonal-hierarchy, pregnenolone is akin to the “grandparent” whereas DHEA acts as the “parent” in the family tree. Estradiol, progesterone and testosterone are respectively then, the children of the community, which laughably makes sense when you think about who gets the most attention in the nuclear family (and all the chatter in the social media scene)! DHEA is technically a “precursor” hormone, meaning it comes before the production of others and it can progenate into estradiol and testosterone depending on your XX or XY chemistry.
DHEA serves multiple purposes in the human body. Two of its most powerful functions rest in its ability to decrease joint pain and inflammation. DHEA can also help boost your T-cell (a type of immune system cell) productivity, giving DHEA anti-cancer properties. Additionally, DHEA can reduce your cardiovascular risk indirectly by promoting the process of lipolysis, the destruction of fat, assisting with regulating proportionate body composition. In a female, DHEA will make a little more testosterone whereas in a male, DHEA will support estradiol production – both serving the intentions of longevity. DHEA may also help lower cortisol in significant times of bodily stress. Finally, DHEA boosts memory and mood energetically, which can counteract “brain fog” and low mood states chronically.
When searching for DHEA in your blood serum chemistry – there are two independent lab markers measuring its quantities. Your Total DHEA will aggregate all sources of DHEA (gonads, brain, adrenal) while your DHEA-S (S = sulfate) captures the total level of DHEA originating from the adrenal glands ONLY. DHEA-S is more stable than Total DHEA and therefore DHEA-S is a more reliable blood marker of long term adrenal function. Most bioidentical hormone therapy replacement providers will check your DHEA-S on their initial lab panel slips and discuss this result with you when considering hormone replacement therapy.
Generally speaking, optimal levels for a female of DHEA-S range between 250-300mcg/dL and 500-600mcg/dL for males, using LabCorp reference ranges. If you are found to be deficient in these zones per your lab work and you have symptoms correlating (such as joint pain, fatigue, poor immune health, brain fog and/or depressed mood) then supplementing your system with DHEA may be a simple solution for you.
As a bioidentical hormone replacement therapy provider, I often lean towards procuring DHEA from compounding pharmacies to secure the most potent & pure, powdered forms (ie. a veggie capsule with a sustained release component to provide steady levels throughout the day) rather than recommending over the counter (OTC) formularies, of which there are many. And, the surprising thing is, the cost difference between compounded, powder form oral DHEA & OTC oral capsule DHEA differs not by much. However, you may also compound DHEA into transdermal cream applications, sublingual lozenges and – what we’ll talk about more in depth coming up – vaginal suppositories, for the ladies.
Both age, sex and menstrual status (if female) category guide my algorithm for choosing appropriate dosing and applications of DHEA supplementation. In general, DHEA used in a pre-menopausal female can be more provocative of side effects. Menstrual irregularities, acne, hair growth (in pubertal areas and the chin) and mood irritation are most commonly witnessed in this subset population of DHEA supplementation users. It’s unfair, I know!, but predictable. That does not mean we can’t give it “the old college try” in pre-menopausal females but from my experience, peri-menopausal and post-menopausal women get along more fine with DHEA as do men of all ages. Again, unfair, yes it is! The exception to this rule comes along when discussing vaginal DHEA in suppository form. Vaginal DHEA suppositories’ active DHEA ingredient stays local to the vaginal cavity tissue, mostly, and can be less incriminating of systemic side effects as listed above.
Let’s side track for a minute and talk about DHEA suppositories as they pertain to vaginal health. Men, don’t tune out, this tidbit may just help a lady whom you know! Commercially available is a product called Intrarosa (prasterone) – which is a vaginal suppository containing… you guessed it: DHEA. Its primary use is scripted for vaginal atrophy, dryness and dyspareunia. Intrarosa targets the vaginal walls by assisting with decreased inflammation, lubrication production and strengthening of the vaginal tissues. With insurance, it can be pricey – as much as $300 for 28 inserts! Did you know, though, that you can procure a vaginal DHEA suppository supply, in 36-ish count, from a compounding pharmacy for around $90-$100? Steal deal, by comparison.
Compounded vaginal DHEA also has the select advantage over Intrarosa to be dose manipulated individually (ie. 2.5mg, 6.5mg or 10 mg etc) rather than being limited to the uniform 6.5mg DHEA content provided by each Intrarosa insert. Caveat: compounded products are not always FDA approved – whereas Intrarosa is. However, the compounding pharmacy does have to meet FDA compliant, regulatory requirements for any hormone product production, so you can be relatively assured that efficacy, safety and potency exists.
You can use a DHEA suppository nightly or as needed. I have clinically found this vaginal health solution to be VERY effective for women – and actually, come to think of it, not one client has complained of its inefficiency after trialing it, yet. Intravaginal DHEA can be a particularly useful solution in application of bioidentical hormone therapy for women who are either unable to or not desiring to use the full enchilada of bioidentical hormone therapy when it comes to estradiol, progesterone and testosterone products. Additionally, another plus: as the DHEA vaginal insert stays local to the vaginal cavity, you do not have to monitor serum blood DHEA levels routinely as the inserted DHEA product will not largely absorb systemically throughout your bloodstream to target & affect other organs.
A quick disclaimer: Who is DHEA NOT for? Anyone experiencing a hormonally active cancer such as breast, ovarian, endometrial or prostate cancer. Breastfeeding clients and pregnant women likewise are not candidates for DHEA supplementation.
So if you’re curious about DHEA, its applications and forms of uses, reach out to our bioidentical hormone therapy providers at Kalon West – and mention this quick educational primer. We’d love to talk with you more about it and see if DHEA is the right fit to support your hormonal health.