Is DHEA dangerous?

30. May 2008 William Davis (17)
















The Fountain of Youth, Louis Cranach the Younger (1546)




In the Track Your Plaque program, we sometimes use the adrenal hormone, DHEA. It is a fascinating and--surprisingly--an over-the-counter hormone that can be useful and safe when used properly.

DHEA can be useful for:

--Reduction of Lp(a)--Though more effective in females, it can also be useful in males. In the women, DHEA often reduces Lp(a) 15-18%, somewhat less in males. The lower the starting DHEA, the greater the Lp(a) reduction.

--Improved libido--in both men and women. The effect is modest. It's magnified when used with other strategies. Although this is not specifically a goal in the program, it sure helps to get side-benefits like this, rather than unwanted side-effects.

--Increased energy and mood--The boost in mood is, for many, the most perceptible effect: More ambition, more stamina, greater staying power in work and exercise.

--Reduction in abdominal (visceral) fat--A modest effect, but one that, over a long period of use (>6 months) can yield improved insulin responses.


Most commonly, I will suggest DHEA supplementation when blood levels allow. Some people, however, Google "DHEA" and come back horrified that I would suggest such a dangerous supplement.

"I read that it makes women grow mustaches and makes their voices deeper!"

And it does--if you take a lot.

10-15 years ago, when the benefits of DHEA became apparent, some people wanted to believe that DHEA was the fountain of youth. People interested in the anti-aging potential for DHEA figured that, if 50 mg per day made you feel energized and vigorous, what would be the effect of 1000 mg, 2000 mg, or 3000 mg per day? A number of clinical trials were conducted using these doses and, interestingly, depression can lift, men and women increase muscle mass, there is a slight increase in bone density, even pain symptoms from rheumatoid arthritis and lupus may improve. But . . . women grow mustaches, become sexually aggressive, and develop deep voices. Men can become hyperaggressive or overly emotional.

No wonder: Any hormone taken in extraordinary, supraphysiologic doses will exert wacky effects. Imagine taking testosterone or estrogen at 50 times the usual dose.

The doses we use for the above benefits, including Lp(a) reduction, range from 25-100 mg per day; most people do fine with 50 mg. We also adjust doses to starting blood levels. In this dose range, I have never seen any of the above side-effects.

The only side-effects I see at these doses are 1) excessive assertiveness or crabbiness, and 2) insomnia if taken at bedtime.

In my experience, DHEA is a benign hormone, provided it is taken in limited doses and not abused. An occasional female younger than 55 years old will be able to tolerate only 10-20 mg per day before developing the edgy side-effects, but I've never witnessed masculinizing side-effects at these low doses, nor have I ever seen excessive increases in testosterone in men or women. (Women can raise testosterone levels slightly, but almost never enough to exert much effect beyond modestly increased libido.)



Copyright 2008 William Davis, MD
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Comments (17) -

  • JoeEO

    5/30/2008 2:31:00 PM |

    I always understood that men should get a PSA test prior to starting DHEA. Is that not the case in your experience?

    Peace

    Joe E O

  • Anonymous

    5/30/2008 3:09:00 PM |

    Well, if I'd been your patient, you would have seen gynomastia in me at 25mg/day after about a month.

    It sure did help my energy and mood, though -- wouldn't I love to be able to take it!  

    Breasts aren't a good look for me, though.

  • Jessica

    5/30/2008 11:48:00 PM |

    "No wonder: Any hormone taken in extraordinary, supraphysiologic doses will exert wacky effects. Imagine taking testosterone or estrogen at 50 times the usual dose."

    Thats why some people are hesitant to take Vitamin D in larger than "usual" doses.

    I take 10,000 IU/day of D3...hope I don't grow a mustache!

    Smile

  • Anonymous

    5/31/2008 2:25:00 AM |

    Are there any interactions between DHEA and any medicines, specifically beta-Blockers?

  • Anne

    5/31/2008 12:22:00 PM |

    I take 5mg of DHEA because testing showed slightly low levels. I can't say I have noticed any difference with this small dose.

  • Anonymous

    5/31/2008 1:36:00 PM |

    I read on the the internet the the largest study ever done on DHEA came up with 2 very interesting findings. This was a double blind study mind you. Finding number 1 supplementing with DHEA did indeed raise blood levels of DHEA in the body. Finding number 2 the ones that received the DHEA and increased their blood levels reported no more of the supposed "positives" than the placebo group. No "better mood, no more energy . . . Authors conclusion: while supplementing with DHEA can raise blood levels its of no use. For those of you out there thinking thtas ridiculus remember we've had examples of this before. Rememeber the big homcystene controversy from a few years back? The higher the homocystene levels the greater the risk of heart attack. We knew that by using Folic Acid among other things we could reduce Homocystene levels and we did. However it din't do anything to lessen the chance for a heart attack. Just manipulating blood levels of substances doesn't mean your doing any good in some cases. Dhea and Homocystene are 2 very good examples. But hey placebo effect can be very real. We just ruin everybodies fun with are silly double blind studies.

  • Anonymous

    6/1/2008 8:10:00 AM |

    Anonymous, do you have a citation for the double-blind study that showed no benefit?  "I read on the internet" is a bit broad.

  • Anonymous

    6/1/2008 3:11:00 PM |

    I'm sorry I didn't cite the citation I was making a brief comment to a message on a blog not my senior thesis. A simple check of DHEA and google takes about 30 seconds to come up with the information. Sorry next time I cite a study I will do the proper citation.

  • Anonymous

    6/1/2008 3:58:00 PM |

    The earlier anonymous posting seems to be true, if you google DHEA there doesn't seem to be alot of supporting evidence for many of the claims made about DHEA, and he's right it took about 30 seconds to see that.

  • Anonymous

    6/2/2008 4:32:00 AM |

    TYP: try Google Scholar...

  • Anonymous

    6/5/2008 9:41:00 PM |

    I recently took a four-month course of DHEA at 3x/d 25mg (75mg total per day) since it's showing some promise in women over forty who have been dubbed "poor responders" without much explanation in previous IVF cycles.  

    It's used to induce a physiological state of PCOS - trapping antral follicles in the ovaries so when ovarian stimulation begins, the number of follicles that mature increases.

    Anyway, for me it did trap antral follicles, but that did not lead to an increase in mature follicular development in the IVF cycle...I remained a "poor responder" to the injectable gonadotropins.

    The side effects were minor for the most part, but the most disturbing was the redistribution of body fat...I went from, without a change on the scale in weight, a classic pear/hourglass to an absolute apple in less than two months, then continued to accumulate abdominal fat for the remaining two months.  This is a known side-effect in women and any woman considering supplemental DHEA needs to consider the risk to benefit for waist-hip ratio and waist circumferance.  

    Other side effects were a loss of hair on my head, slight peach-fizz hair along my face on my hair line and an increase in appetite...although as I said above, I didn't gain weight on the scale, but did wind up with abdominal fat and a loss of LBM as evidenced by my declining muscle tone in my legs and arms.

    Just something to consider if one is thinking about supplementing - perhaps getting tested for levels before supplementing blindly is a better idea than going ahead and not knowing if you're even deficient?

  • Dr. William Davis

    6/5/2008 9:48:00 PM |

    Great observations! Thanks.

  • Dr. B G

    6/6/2008 2:00:00 PM |

    Dear Anonymous,

    What is your 25(OH)D level?

    The reason I ask is because vitamin D has been given to infertile men (low sperm count). And I bet it works for some women as well.  (In animal studies, both vitamin A and D are used to 'reverse' infertility).

    Did you know that silent celiac disease can cause infertility (which was news to me!)? (I had an article that discusses silent celiac disease recently).

    Regards, G

  • Anonymous

    6/7/2008 2:56:00 PM |

    What is your 25(OH)D level?

    The reason I ask is because vitamin D has been given to infertile men (low sperm count). And I bet it works for some women as well. (In animal studies, both vitamin A and D are used to 'reverse' infertility).

    My levels were within normal when we tested it in October and since it was winter, I was supplementing daily with 2000IU fish oil derived D3....so the vitamin D was covered.

    Did you know that silent celiac disease can cause infertility (which was news to me!)? (I had an article that discusses silent celiac disease recently).

    Yes!  I recently stumbled on data about celiac and asymptomatic celiac associated with infertility.  At this point, I've totally eliminated all grain based foods and we're seeing what happens.  Thus far we things are looking up - when we did a scan recently to track my ovulation, it looks like this cycle may bear two mature follicles sans any drugs...at my age maturing and releasing more than one egg happens...and we're taking it as possibly a side-effect of the removal of all grains from my diet. Thanks for the heads up though, if I hadn't already stumbled on it as a possibility - it would have been very useful information for me!

  • Anonymous

    11/5/2008 11:21:00 AM |

    I have heard about prostate enlargement by using DHEA.

  • Anonymous

    11/14/2009 3:57:40 AM |

    I recently requested my hormone levels be tested after being prescribed Prozac (don't want it!!) for pain in my back - trigger points - and my DHEA Sulfate level came back at 21.  I'm 39. My progesterone was 3.2.  Would a 20% progesterone cream with additional 15% DHEA 15% Pregnenolone three weeks per month help me???  Thank you for any information!

  • buy jeans

    11/2/2010 8:15:37 PM |

    The doses we use for the above benefits, including Lp(a) reduction, range from 25-100 mg per day; most people do fine with 50 mg. We also adjust doses to starting blood levels. In this dose range, I have never seen any of the above side-effects.

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Disease engineering

Disease engineering

21. March 2008 William Davis (10)
Imagine you catch pneumonia.

You have a fever of 103, you’re coughing up thick, yellow sputum. Breathing is getting difficult. You hobble to the doctor, who then fails to prescribe you antibiotics. You get some kind of explanation about unnecessary exposure to antibiotics to avoid creating resistant organisms, yadda yadda. So you make do with some Tylenol®, cough syrup, and resign yourself to a few lousy days of suffering.

Five days into your illness, you’ve not shown up for work, you’re having trouble breathing, and you’re getting delirious. An emergency trip to the hospital follows, where a bronchoscopy is performed (an imaging scope threaded down your airway) and organisms recovered for diagnosis. You’re put on a ventilator through a tube in your throat to support your breathing and treated with intravenous antibiotics. Delayed treatment permits infection to escape into the fluid around your lungs, creating an “empyema,” an extension of the infection that requires insertion of a tube into your chest through an incision to drain the infection. You require feeding through a tube in your nose, since the ventilator prevents you from eating through your mouth. After 10 days, several healing incisions, and a hospital bill totaling $75,000, you’re discharged only to be face eights weeks of rehabilitation because of the extreme toll your illness extracted. Your doctor also advises you that, given the damage incurred to your lungs and airways, you will be prone to more lung infections in the future, and similar situations could recur whenever a cold or virus comes long.

A disease treatable by taking a 10-day, $20 course of oral antibiotics at home was converted into a lengthy hospital stay that generated extravagant professional fees, testing, and costly supportive care. You’ve lost several weeks of income. You’re weak and demoralized, frightened that the next flu or virus could mean another trip to the hospital. You are susceptible to repeated bouts of such episodes in future.

Such a scenario would be unimaginable with a common infection like pneumonia, or it would be grounds for filing a malpractice lawsuit. But, as horrific as it sounds in another sphere of health care, it is, in effect, analogous to how heart disease is managed in current medical practice.

First, you’re permitted to develop the condition. It may require years of ignoring telltale signs, it may require your unwitting participation in unhealthy lifestyle practices, like low-fat diets, "eat more whole grains," and "know your numbers."

It then eventuates in some catastrophe like heart attack or similar unstable heart situation, at which point you no longer have a choice but to submit to major heart procedures. That’s when you receive your heart catheterization, coronary stents, bypass, defibrillators, etc.

Of course, none of these procedural treatments cures the disease, no more than a Band Aid® heals the gash in your leg. The conditions that were present that created heart disease continue, allowing a progressive disease to worsen. At some point, you will need to return to the hospital for yet more procedures when trouble recurs, which it inevitably does.

A coronary bypass operation costs, on average $67,823. That includes the cost for the heart catheterization performed by a cardiologist to provide the surgical roadmap of your coronary arteries, the surgeon’s fees, the hospital charges. If there are any complications of your procedure, then your hospital bill may total a substantially higher figure.

$67,823 is just the upfront financial pay-off. Over the long run, your life is actually worth far more to the cardiovascular health care system because no heart procedure yields a permanent fix. In fact, repeated reliance on the system is the rule.

In fact, over 90% of people who enter the American cardiovascular health care system do so through a revolving door of multiple procedures over several years. It is truly a rare person, for instance, who undergoes a coronary bypass operation, never to be seen again the wards of the hospital because he remains healthy and free of catastrophe. A much more familiar scenario is the man or woman who undergoes two or three heart catheterizations, receives 3,4, or 6 stents, followed a few years later by a heart bypass, pacemaker, defibrillator, as well as the tests performed for catastrophe management, such as nuclear stress test, echocardiogram, laboratory blood analysis, and consultation with several specialists. The total revenue opportunity is many-fold higher than the initial 60-some thousand dollars, but instead totals hundreds of thousands of dollars per person.

A heart attack alone is a $100,000 revenue opportunity (Agency for Healthcare Research and Quality, 2004).

Of all coronary bypass procedures performed, 25% are “re-do’s”, or bypasses in people who’ve had a previous one, two, or three bypass procedures.

Perhaps it's excessively cynical to label it "disease engineering." But, whether from benign neglect or purposeful failure to diagnose, the fact remains: Heart disease is, all too often by the standard path, undiagnosed and neglected for years until the procedural payoff strikes.


Copyright 2008 William Davis, MD
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Comments (10) -

  • Ketogenic Diet

    3/21/2008 2:44:00 PM |

    This is very well written.  Great perspective.

  • Anonymous

    3/21/2008 4:12:00 PM |

    And how many of these procedures are ABSOLUTELY necessary after they get you into the hospital?  

    I recently changed cardiologists.  The new doctor, after reviewing my history and talking with him (yeah, a dialog!), he made the comment that he wonders why I even had a pacemaker installed (keeps heart rate from dropping below 60)!!  Talk about being left speechless!!  

    You see, I had passed out.  It was discovered that I had severe blockage of the left descending artery.  A stent was inserted.  Then the doctor said that if a pacemaker were not installed I could experience sudden death due to low heart rate.  I can still hear his booming voice that could be heard on the entire floor stressing the words "sudden death."  What would you do?  

    Hey, is the thinking that if it is not really necessary it is at least innocuous, then cha-cling . . . $65,000?  Scary.    

    Anyway, my new doctor said that it is something that needs more study, etc.   I know the "control unit" can be changed out for new batteries but I've never heard of the wiring being removed from the heart muscles.  Geeez.

  • Anonymous

    3/21/2008 6:07:00 PM |

    Ignatius Semmelweiss had the same problem;  He railed against the conventional wisdom that 'knew' there was no reason for handwashing before surgeries.

  • Anne

    3/22/2008 1:33:00 AM |

    "A much more familiar scenario is the man or woman who undergoes two or three heart catheterizations, receives 3,4, or 6 stents, followed a few years later by a heart bypass, pacemaker, defibrillator, as well as the tests performed for catastrophe management, such as nuclear stress test, echocardiogram, laboratory blood analysis, and consultation with several specialists. "

    I think you have been following me around. I am glad to say that I did not go on to pacemaker/defibrillator, but I had all the rest. The day I got my first stent, my doctor told my husband "I fixed her" and proudly handed us a before and after picture. Funny, I did not get any pictures when I had more angioplasies.

    I am so tired of band-aid medicine. Finally, I think that I am on the right track of lifestyle changes, thanks to information here and other forward thinking websites.

  • LJ

    3/22/2008 2:08:00 PM |

    Agreed, great perspective... but my goodness! Pardon this slightly off topic comment, but you just described word for word what a good friend of mine is going through with pneumonia -  except she was sent home from a doctor's office twice. By the time she was admitted to hospital, her blood pressure was about 60/40 and she was in agony from a collapsed lung.

  • Rich

    3/24/2008 5:12:00 AM |

    Brilliant. Where is your monthly column in the Wall Street Journal?

  • Carrie Tucker

    9/15/2008 2:44:00 AM |

    "Perhaps it's excessively cynical to label it "disease engineering." But, whether from benign neglect or purposeful failure to diagnose, the fact remains: Heart disease is, all too often by the standard path, undiagnosed and neglected for years until the procedural payoff strikes."

    What an incredibly ballsy statement!  My hat is off to you.  

    I have been a Respiratory Therapist for 23 years.  To hear a cardiologist make such a statement is the most validating thing I have heard in all these years.

    I have almost been fired more times than I can count, for trying to address a low oxygen level.

    Shoot some docs take everything personally!  I'm not trying to save anyone, just make them feel better while they're on the planet.

    You and I both know that they can save themselves.  It is just a matter of education.

    Many blessings

  • Jenny

    10/20/2008 2:58:00 PM |

    Dr. Davis,

    What makes you think that people who show up with all the symptoms of serious infection get antibiotics?

    One of my kids is permanently deaf in one ear because the pediatrician gave us that speech about how antibiotics just cause bacterial resistance and refused treatment.

    And there have been quite a few stories in the press recently of young people dying of pulmonary MRSA because their initial symptoms were ignored.

    You're a cardiologist so you see this problem in the context of heart disease. But the problem of only treating complications is widespread through all medical specialties.

    Years ago when my blood sugars were routinely going into the 200s after every meal I visited the guy who was supposed to be the "best" endo in our area, who offered me no treatment and told not to come back to see him until I'd spent a year with an A1c over 8%--an A1c high enough to guarantee complications. He told me he didn't bother treating people whose blood sugar wasn't that bad.

    My guess is that this attitude grows out of the way physicians are trained with hospital-based residencies that concentrate on heroic medicine.

    This makes people who are not in the throes of a massive complication look "fine" and keeps them from getting proper preventative treatment.

  • Anna

    10/20/2008 5:02:00 PM |

    Your post and Jenny's comment make the point that people can't be lax about their own care; they need to be willing to learn, be informed, get second and third (or even 4th) opinions sometimes, and to be assertive when the recommended care doesn't seem to match with their intuition or condition.

    There's a continuum between throwing all the available treatments at a condition and waiting to let nature take care of it, and there are cases to be made for approaches on either end and those in between, but it takes good judgement to know when and how to apply the appropriate approach.  Too many people have abdicated their own responsibility in the decision and judgement process.

  • Anonymous

    10/20/2008 5:43:00 PM |

    You could also include thyroid disease in there as a problem that doctors routinely ignore, until it gets to the state where the patient has major problems (full blown hypo/nodules, etc).

    And prevention, for many health problems, seems to be a dirty word to doctors. The system is very flawed across all specialties.

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