DHEA (prasterone)

What It Is

DHEA (dehydroepiandrosterone), also known by its pharmaceutical name prasterone, is a naturally occurring steroid hormone produced primarily by the adrenal glands, with smaller amounts made in the gonads (testes and ovaries) and the brain. It serves as a precursor (or prohormone) for the synthesis of key sex hormones—testosterone and estrogen.

DHEA levels peak in early adulthood (around the mid-20s) and then gradually decline with age, sometimes dropping to a small fraction of youthful levels by age 70 or 80. Because of this, DHEA is often marketed as an “anti-aging” supplement or therapy. In medicine, the synthetic version (prasterone) is used under controlled conditions for specific therapeutic purposes, such as treating vaginal atrophy in postmenopausal women and in some experimental settings for adrenal insufficiency or depression.

How It Works

DHEA functions primarily as a hormonal precursor—a building block that the body converts into androgens (like testosterone) and estrogens (like estradiol) depending on individual needs, tissue types, and enzymatic activity.

• In Men: DHEA can be converted to testosterone, which influences muscle mass, libido, and mood.
• In Women: It can convert to estrogens, contributing to bone density, vaginal tissue integrity, and energy levels.
• In the Brain: DHEA also acts as a neurosteroid, influencing mood regulation, cognition, and stress response by modulating neurotransmitter activity and protecting neurons from oxidative damage.

Beyond hormone production, DHEA is involved in:

• Immune function: Supporting immune balance and reducing inflammatory markers in some studies.
• Metabolism: Potentially influencing insulin sensitivity and fat distribution.
• Bone and muscle health: Supporting anabolic (tissue-building) effects, particularly in older adults.

However, these effects vary widely between individuals, and not all purported benefits are strongly supported by clinical evidence.

Why It’s Important

DHEA plays a foundational role in hormonal balance and overall vitality. Its importance lies in several physiological domains:

1. Hormonal Homeostasis: It serves as a reservoir from which the body can synthesize both male and female sex hormones, helping to stabilize endocrine function as levels of other hormones fluctuate.
2. Aging and Well-being: Because DHEA declines with age, low levels are often associated with fatigue, decreased libido, reduced bone density, and cognitive changes. Restoring or supporting normal levels may improve aspects of quality of life, although results differ across studies.
3. Immune and Stress Modulation: DHEA counterbalances some effects of cortisol (the “stress hormone”), helping the body maintain resilience under chronic stress.
4. Neurological and Psychological Roles: It has been investigated for its neuroprotective and antidepressant effects, possibly due to modulation of serotonin and dopamine pathways.
5. Sexual and Reproductive Health: In postmenopausal women, intravaginal prasterone is clinically approved for treating dyspareunia (painful intercourse) caused by vaginal atrophy—improving lubrication and tissue elasticity through local estrogenic effects without significantly raising systemic hormone levels.

Considerations

While DHEA supplementation can offer benefits, it comes with important precautions and uncertainties:

• Hormonal Side Effects: Because it can raise testosterone and estrogen levels, DHEA may cause acne, hair loss, oily skin, increased facial hair in women, or voice changes. In men, it can lead to estrogen-related effects such as breast tenderness.
• Cancer Risks: Individuals with hormone-sensitive cancers (like breast, ovarian, or prostate cancer) should avoid DHEA, as it can stimulate tumor growth in tissues responsive to sex hormones.
• Variable Efficacy: Clinical evidence for many of DHEA’s claimed effects—such as anti-aging, improved cognition, or athletic performance—is mixed. Benefits may depend on baseline hormone levels and age.
• Dosing and Regulation: Over-the-counter DHEA supplements are not strictly regulated in many countries, leading to inconsistencies in purity and potency. Prescription-grade prasterone, however, is standardized and used for specific conditions under medical supervision.
• Interactions: DHEA may interact with hormone therapies, corticosteroids, diabetes medications, and antidepressants, necessitating careful monitoring.
• Testing First: Because DHEA levels naturally decline but vary widely among individuals, testing blood levels (DHEA-S) before supplementation is advised to determine whether deficiency truly exists.