An abbreviated account of some aspects of the biochemistry of DHEA, 1934-1995

Dehydroepiandrosterone sulfate supplementation in health and diseases

Dehydroepiandrosterone sulfate (DHEAS) is a hormone produced by the zona reticularis of the adrenal gland and the ovaries. Initially considered as an inert compound merely serving as an intermediate in the conversion of cholesterol to androgens, interest in DHEA began to grow in the 1960s when it was found that DHEAS is the most abundant steroid hormone in human plasma and that its levels decline with age. In many countries, DHEA is considered a nutritional supplement. It has been used for a multitude of conditions which include sexual dysfunction, infertility, genitourinary syndrome of menopause, musculoskeletal disorders, cardiovascular diseases, ageing, neurological diseases, autoimmune conditions, adrenal insufficiency, and anorexia nervosa. We describe an overview of the historical evolution of DHEA, its physiology, and the disease states where it has been evaluated as a supplement.

Should Dehydroepiandrosterone Be Administered to Women?

CONTEXT

Androgen prohormones such as dehydroepiandrosterone (DHEA) increase in early puberty, peak in the second and third decade, and thereafter decline, independent of menopausal status. Investigators have examined their potential beneficial effects in normal women and those with DHEA-deficient states.

EVIDENCE ACQUISITION

A review of the literature from 1985 to 2021 on the potential benefits and risks of androgen prohormones in women.

EVIDENCE SYNTHESIS

Studies have examined the potential benefit of DHEA therapy for anti-aging, sexual dysfunction, infertility, metabolic bone health, cognition, and wellbeing in hormone-deficient states such as primary adrenal insufficiency, hypopituitarism, and anorexia as well as administration to normal women across the lifespan.

CONCLUSIONS

Data support small benefits in quality of life and mood but not for anxiety or sexual function in women with primary or secondary adrenal insufficiency or anorexia. No consistent beneficial effects of DHEA administration have been observed for menopausal symptoms, sexual function, cognition, or overall wellbeing in normal women. Local administration of DHEA shows benefit in vulvovaginal atrophy. Use of DHEA to improve induction of ovulation response in women with diminished ovarian reserve is not recommended. Risks of high physiologic or pharmacologic use of DHEA include androgenic and estrogenic side effects which are of concern for long-term administration.

CLINICAL CASE

A 49-year-old woman with Addison's disease who is on low dose estrogen with cyclic progesterone therapy for menopausal symptoms returns for follow-up. She is on a stable glucocorticoid replacement strategy of hydrocortisone 10 mg in the morning and 5 mg in the early afternoon and fludrocortisone 0.05 mg each morning. She has read on the internet that additional therapy with DHEA may help her overall quality of life and libido. She asks whether she should add this therapy to her regimen and at what dose.

Effect of dehydroepiandrosterone on atherosclerosis in postmenopausal women

In China, cardiovascular disease (CVD) has surpassed malignant tumours to become the disease with the highest mortality rate, and atherosclerosis (AS) is an important pathological cause of CVD. Dehydroepiandrosterone (DHEA) is the most abundant steroid hormone in circulating human blood and is a precursor of estrogen and androgen. DHEA is converted into a series of sex hormones in local peripheral tissues where its acts physiologically. DHEA also acts therapeutically, thereby avoiding the adverse systemic reactions to sex hormones. DHEA inhibits AS, thus inhibiting the development of CVD, and it improves the prognosis for CVD. The incidence of CVD in postmenopausal women is substantially higher than that in premenopausal women, and that incidence is believed to be related to a decrease in ovarian function. The current review analyzes the mechanisms of postmenopausal women's susceptibility to AS. They tend to have dyslipidemia, and their vascular smooth muscle cells (VSMCs) proliferate and migrate more. In addition, oxidative stress and the inflammatory response of endothelial cells (ECs) are more serious in postmenopausal women. This review also discusses how DHEA combats AS by countering these mechanisms, which include regulating the blood lipid status, protecting ECs (including coping with oxidative stress and inflammatory reactions of the vascular endothelium, inhibiting apoptosis of ECs, and inducing NO production) and inhibiting the proliferation and migration of VSMCs. As a result, DHEA has great value in preventing AS and inhibiting its progression in postmenopausal women.

DHEA in bone: the role in osteoporosis and fracture healing

Dehydroepiandrosterone (DHEA) is a metabolic intermediate in the biosynthesis of estrogens and androgens with a past clouded in controversy and bold claims. It was once touted as a wonder drug, a fountain of youth that could cure all ailments. However, in the 1980s DHEA was banned by the FDA given a lack of documented health benefits and long-term use data. DHEA had a revival in 1994 when it was released for open market sale as a nutritional supplement under the Dietary Supplement Health and Safety Act. Since that time, there has been encouraging research on the hormone, including randomized controlled trials and subsequent meta-analyses on various conditions that DHEA may benefit. Bone health has been of particular interest, as many of the metabolites of DHEA are known to be involved in bone homeostasis, specifically estrogen and testosterone. Studies demonstrate a significant association between DHEA and increased bone mineral density, likely due to DHEA's ability to increase osteoblast activity and insulin like growth factor 1 (IGF-1) expression. Interestingly, IGF-1 is also known to improve fracture healing, though DHEA, a potent stimulator of IGF-1, has never been tested in this scenario. The aim of this review is to discuss the history and mechanisms of DHEA as they relate to the skeletal system, and to evaluate if DHEA has any role in treating fractures.

The Association between Dehydroepiandrosterone Sulfate (DHEA-S) and Bone Mineral Density in Korean Men and Women

Background

The relationship between dehydroepiandrosterone sulfate (DHEA-S) and bone mineral density (BMD) is controversial. And findings of most studies that have investigated this relationship are restricted to postmenopausal women. In this study, we investigated the relationship between serum DHEA-S and BMD in both men and women.

Methods

This cross-sectional study evaluated a total of 294 healthy Korean participants through a medical examination program. And a subgroup of 154 participants was subjected to a longitudinal analysis. We measured BMD by dual energy X-ray absorptiometry and assayed DHEA-S by a chemiluminescent immunoassay.

Results

We evaluated the association between serum DHEA-S concentration and BMD at the femur trochanter after adjusting for cofounders such as age, body mass index, lifestyle factors, serum cortisol level, serum insulin-like growth factor 1 (IGF-1) level, and sex. Through our longitudinal study, we found that the changes in BMD at the total spine, at the femur neck, and at the femur trochanter were all smaller in the ΔDHEA-S <0 group than in the ΔDHEA-S >0 group.

Conclusions

We found that there was a positive correlation between serum DHEA-S and femur BMD, which suggests that controlling serum DHEA-S levels may retard age-related BMD reduction in Koreans.

Dehydroepiandrosterone (DHEA): hypes and hopes

Dehydroepiandrosterone (DHEA) and its sulfated form dehydroepiandrosterone sulfate (DHEAS) are the most abundant circulating steroid hormones in humans. In animal studies, their low levels have been associated with age-related involuntary changes, including reduced lifespan. Extrapolation of animal data to humans turned DHEA into a 'superhormone' and an 'anti-aging' panacea. It has been aggressively marketed and sold in large quantities as a dietary supplement. Recent double-blind, placebo-controlled human studies provided evidence to support some of these claims. In the elderly, DHEA exerts an immunomodulatory action, increasing the number of monocytes, T cells expressing T-cell receptor gamma/delta (TCRγδ) and natural killer (NK) cells. It improves physical and psychological well-being, muscle strength and bone density, and reduces body fat and age-related skin atrophy stimulating procollagen/sebum production. In adrenal insufficiency, DHEA restores DHEA/DHEAS and androstenedione levels, reduces total cholesterol, improves well-being, sexual satisfaction and insulin sensitivity, and prevents loss of bone mineral density. Normal levels of CD4+CD25(hi) and FoxP3 (forkhead box P3) are restored. In systemic lupus erythematosus, DHEA is steroid-sparing. In an unblinded study, it induced remission in the majority of patients with inflammatory bowel disease. DHEA modulates cardiovascular signalling pathways and exerts an anti-inflammatory, vasorelaxant and anti-remodelling effect. Its low levels correlate with increased cardiovascular disease and all-cause mortality. DHEA/DHEAS appear protective in asthma and allergy. It attenuates T helper 2 allergic inflammation, and reduces eosinophilia and airway hyperreactivity. Low levels of DHEAS accompany adrenal suppression. It could be used to screen for the side effects of steroids. In women, DHEA improves sexual satisfaction, fertility and age-related vaginal atrophy. Many factors are responsible for the inconsistent/negative results of some studies. Overreliance on animal models (DHEA is essentially a human molecule), different dosing protocols with non-pharmacological doses often unachievable in humans, rapid metabolism of DHEA, co-morbidities and organ-specific differences render data interpretation difficult. Nevertheless, a growing body of evidence supports the notion that DHEA is not just an overrated dietary supplement but a useful drug for some, but not all, human diseases. Large-scale randomised controlled trials are needed to fine-tune the indications and optimal dosing protocols before DHEA enters routine clinical practice.

Theoretical study of DHEA: comparative HF and DFT calculations of the electronic properties of a complex between DHEA and serotonin

Molecular parameters (interatomic distances and angles, total atomic charge, dipole moments) of DHEA (Dehydroepiandrosterone), serotonin and of their putative complex including its heat of formation, have been computed in an ab initio comparative study involving HF and DFT calculations. The 6-31G* basis set and the B3LYP functional were employed. The aim of this study is to emphasize by DFT calculation the possible existence of a complex between DHEA and serotonin that may have the properties of a new drug. A Natural Bond Orbital analysis description offers supplementary details for the structure of the molecular units and their interaction.

C19‐5‐ene Steroids in Nature

Dehydroepiandrosterone (DHEA), produced from cholesterol in the adrenals, is the most abundant steroid in our circulation. It is present almost entirely as the sulfate ester, but the free steroid is the form that serves as a precursor of estrogens and androgens, as well as 7- and 16-oxygenated derivatives. Mammalian tissues reduce the 17-keto Group of DHEA to produce androstenediol-a weak estrogen and full-fledged androgen. Its androgen activity is not inhibited by the anti-androgens commonly used to treat prostate cancer. It is probably responsible for the growth of therapy-resistant prostate cancer. DHEA is hydroxylated at the 7 alpha position, and this derivative is oxidized by 11 beta-hydroxysteroid dehydrogenase to form 7-keto DHEA. The latter is reduced by the same dehydrogenase to form 7 beta-hydroxy DHEA. When fed to rats, each of the latter three steroids induce the formation of two thermogenic enzymes in the liver. The late-term human fetus produces relatively large amounts of 16 alphahydroxy DHEA, which serves the mother as a precursor of estriol.

Induction and modulation of hepatic preneoplasia and neoplasia in the rat by dehydroepiandrosterone

Dehydroepiandrosterone (DHEA), the main adrenal steroid in humans and a precursor in androgen and estrogen biosynthesis, acts as a peroxisome proliferator and as a hepatocarcinogen in rats. Neoplasms emerge from a glycogenotic/amphophilic/basophilic preneoplastic cell lineage. A higher female tumor incidence suggests a relevant influence of sex hormones. DHEA enhances hepatocarcinogenesis induced by N-nitrosomorpholine (NNM), which is characterized by the glycogenotic/basophilic cell lineage. The tumor promoting effect is related to an additional amphophilic/basophilic preneoplastic lesion sequence and to faster proliferation of the basophilic preneoplastic lesions. Nevertheless, hepatocellular carcinomas provided under DHEA treatment seem to have a less malignant phenotype compared to tumors induced by NNM only. Further, DHEA treatment reduces growth and generation of glycogen storage foci (GSF) in initial NNM-treated rats. Thus, DHEA treatment results in both, a growth stimulation of the late basophilic lesion type with an additional amphophilic lesion sequence, and in a growth inhibition of early preneoplastic lesions, addressing especially GSF. DHEA also inhibits the growth of physiologically proliferating liver tissue. This might be explained by a DHEA related cellular metabolism, which results in significant energy consumption. Additionally, a DHEA-induced alteration of cytokine levels might contribute to this growth inhibition as well.

Involvement of steroids and cytochromes P(450) species in the triggering of immune defenses

In vertebrates the wide variety of cytochromes P(450) (P(450)) is a key for elimination of low molecular weight xenobiotics and for the production and metabolism of steroid hormones. In contrast, xenobiotics of large molecular weight are processed and eliminated after the immune response. The suppression of immune response by native P(450)-produced glucocorticoid (GC) hormones constitutes a first link between P(450) and immunity. In the last decade, mechanisms and molecules responsible for the triggering of immune response were investigated and results showed that many tissues and organs transform native 3beta-hydroxysteroids into 7-hydroxylated metabolites that trigger immunity. Present data suggest that 7-hydroxysteroids are native anti-GCs that block the GC-induced immunosuppression. Because specific P(450) are responsible for the production of 7-hydroxylated steroids resulting into increased immunity, a second link exists between P(450) and immunity. Taken together, these findings support the proposal that P(450) are keys to all of the known defense mechanisms of vertebrates against all xenobiotic forms.

Copper deficiency halves serum dehydroepiandrosterone in rats

DHEA (dehydroepiandrosterone) is a hormone often taken as a dietary supplement to prevent the normal decline with age and in the hope of preventing heart attacks. Rats in two experiments were made deficient in copper by standard methods and criteria. Copper deficiency decreased DHEA in serum by approximately 50%. People who associate higher serum concentrations of DHEA with health probably should eat a diet adequate in copper.

Vitamin E prevents induction of carbonyl group formation in microsomal protein by dehydroepiandrosterone

The effect of dehydroepiandrosterone (DHEA), a free radical- and lipid peroxide-inducing agent, and of vitamin E (alpha-tocopherol), a free radical chain terminator, on protein carbonyl group formation was investigated in rat liver microsomes. Administration of alpha-tocopherol at 25-50 mg/kg diet for seven days resulted in high Fe(2+)-NADPH-ADP-dependent production of protein carbonyl groups in liver microsomal protein isolated from otherwise untreated rats. However, alpha-tocopherol administered at > 100 mg/kg diet caused a decrease in the production of protein carbonyl groups. In animals simultaneously receiving alpha-tocopherol at 50 mg/kg diet and DHEA at 500 mg/kg diet, no additional stimulatory effect of the steroid on microsomal protein carbonyl group production was observed. Protein carbonyl group production was significantly enhanced by DHEA in rats given a diet containing 400 mg alpha-tocopherol/kg diet. Microsomes isolated from rats fed 1,000 mg alpha-tocopherol/kg diet with DHEA (500 mg/kg diet) and without DHEA produced small but similar amounts of protein carbonyl groups. These results provide evidence that vitamin E is an important protective agent against DHEA-mediated oxidative damage of intracellular components, including proteins.

Wellness in women after 40 years of age: the role of sex hormones and pheromones

In the past twenty years hundreds of peer-reviewed studies have provided a significant body of information to guide the health care of women in the second halves of their lives. The harmonic nature of the fertile reproductive system forms the background against which hormonal replacement therapy can be understood to best serve women. In addition, the 1986 discovery of human pheromones and the subsequent 1998 confirmation of their existence increases certain sexual options for maturing women. Not all hormonal replacement therapies and wellness regimens serve women well. Some regimens have the potential to produce disease, especially over-the-counter remedies like dehydroepiandrosterone and the formulas that contain estrogen. Some regimens profoundly improve the quality of life of many women; some women do not need or want such regimens. All sex hormones affect physiologic systems including the cardiovascular system, bone metabolism, cognitive function, sexual response, and sexual attractiveness. The 7 years before menopause have recently been revealed to be an extremely complex era. During this period, some women increase their estrogen levels to new lifetime highs; others start an unequivocal decline, and still others vary from month to month. Coupled to this variability in estrogen is an equally variable set of changes in progesterone secretion by the ovary as androgen secretion patterns also change. Many women show increases in circulating androgens while many others show deficiencies. Both the adrenal and the ovarian sources of these hormones show age-related changes that alter a woman's capacity to attract sexual attention through both her physical appearance (and condition) and her pheromonal excretions. The complex contributions to the overall health of a woman may not always be understood. Often a hysterectomy can exacerbate--rather than ameliorate--the conditions that led to the surgery. One in 2 American women is offered a hysterectomy, a rate 5 times higher than that of the European countries for which data are available. Ninety percent of hysterectomies are not related to cancer; they are elective procedures. Avoidance of elective hysterectomy helps prevent its side effects: sexual deficits, acceleration of cardiovascular and bone disease, and more rapid aging. No efficacy data exist that suggest that elective hysterectomy works better than the alternative approaches that do not induce these side effects. The health and well-being of women who have already had hysterectomies, with or without ovariectomies, can be improved by a recognition of the cascade of difficulties that must addressed. Estrogen, progesterone, and androgens all tend to be compromised by hysterectomy; all should be considered for replacement. Because hormonal regimens can be prescribed to enhance the quality of life, the review of the available research can allow the medical art to greatly benefit mature women. Not surprisingly, the emerging conclusion reveals that structurally human hormones, prescribed appropriately, almost always best serve the patient.

Oxygen free radical scavenger properties of dehydroepiandrosterone

The microsomes from dehydroepiandrosterone (DHEA)-supplemented animals are good hydroxyl radical scavengers, as demonstrated through electron spin resonance and deoxyribose degradation. The ability of DHEA-supplemented microsomes to react with superoxide radical was also demonstrated through the inhibition of nitroblue-tetrazolium reduction determined by superoxide radicals produced in a hypoxanthine-xanthine oxidase system. DHEA-enriched microsomes, obtained from acutely DHEA-treated rats, become resistant to iron-dependent lipid peroxidation triggered by H2O2/FeSO4 and ascorbate/FeSO4. The direct addition of DHEA to microsomes from untreated rats failed to prevent iron-dependent lipid peroxidation, even if the microsomes were preincubated with DHEA for up to 15 min, indicating that in vivo transformation is required before antioxidant action can be exerted.