DHEA: The anti-aging pill that got away

DHEA has been extensively studied, and in every instance the evidence for benefits is inconclusive or nonexistent.

Claims, Benefits: Slows aging, reduces body fat, builds muscle, treats depression, improves sex drive, prevents chronic diseases.

Bottom Line: This human hormone may have powerful positive or negative effects -- it's too soon to know. The best evidence concerns depression. If the supplement really works like a hormone, then it's risky business.

Over-the-counter anabolic steroids, touted as muscle builders for athletes, are now a thing of the past -- in theory anyway. These supplements were outlawed by the U.S. Congress as of January (see Wellness Letter, April 2005).

As a way to build muscles, hit home runs, win gold medals, and otherwise excel in sports, androstenedione ("andro," made famous by home-run slugger Mark McGwire) had already been banned by the Olympics, the World Anti-Doping Agency and other sports organizations.

Political connection

Oddly enough, one steroid is still available in health-food stores and drugstores -- DHEA.

Congress deliberately exempted it -- not because it is so different from the supplements just taken off the shelves, and certainly not with an eye to the health of the American public, but because its manufacturers wield plenty of political clout.

According to the New York Times, DHEA sales amounted to $47 million in 2003. This steroid is marketed just as andro was ("beat fat, build muscle, increase sex drive!"), but is often pitched to older people as a means of staying youthful.

Indeed, its chief protector in Congress, Senator Orrin Hatch of Utah, has cited its benefits as an "anti-aging" pill. "It has given health and vigor to millions," the Senator wrote to the New York Times, repeating the claims of the National Nutritional Foods Association. This industry group employs Scott Hatch, the Senator's son, as a lobbyist. The supplements industry is heavily concentrated in Utah.

But what does independent research tell us?

Looking for the fountain of youth

DHEA, or dehydroepiandrosterone, marketed as the "mother of all hormones" or the "superhormone," is produced naturally by the adrenal glands in humans and other primates. (The DHEA supplements on the market, by the way, are usually manufactured from wild yams.) In the human body, it can also take a related form, DHEAS, dehydroepiandrosterone sulfate.

Either way, it's a "precursor" hormone or "prohormone." That is, it contains the raw materials for other hormones. It can be turned into androstenedione, or into testosterone, estrogen or other chemicals we need.

Some is produced in the fetus; then production stops at birth and resumes at about age seven. After age 25 production begins to decline. By age 70 it falls to much lower levels. Although this hormone is associated with youth and vigor, it does not necessarily follow that replacing it might slow down or even reverse the process of aging.

People sometimes think that dietary supplements get no respect from mainstream medicine, but this is not the case for DHEA, which has been extensively studied, both in lab animals and humans.

The Natural Standard (a consortium of researchers, including some from the Harvard Medical School, that examines and compiles the best evidence for all "alternative" medical approaches) lists 21 conditions for which DHEA has been studied -- such as Addison's disease, hardening of the arteries, depression, heart failure, menopausal symptoms, infection, sexual dysfunction and Alzheimer's disease.

In every instance the evidence for benefits is inconclusive or nonexistent. "Does not offer any benefit" and "better research needed" are two of the most oft-repeated phrases, though "additional study" is said to be warranted for DHEA against Alzheimer's. Almost nothing is known about the safety and effectiveness of DHEA for a very long list of other conditions, including aging, obesity, and colon cancer.

The side effects of taking DHEA can include fatigue and headache. For women, rarer side effects may include facial hair growth, scalp hair loss, deepening of the voice, and increased girth. Men may experience a rise in blood pressure or breast enlargement. Of course, none of this may happen at low doses.

The trouble with any hormone treatment, however, is that side effects don't always appear right away. According to many experts, high levels of DHEA might promote breast or prostate cancer over time.

Good news and bad

There has been some positive news about DHEA. A recent study in the Archives of General Psychiatry found it effective against mild depression (it was tested against a placebo, not other drugs). A study in the Journal of the American Medical Association found it might play some role in treating metabolic syndrome, a disorder that may accompany obesity. But in both studies the researchers warned that DHEA should be taken only under medical supervision.

And there was discouraging news, too, from other studies: DHEA did not boost immune function in middle-aged men; did not build muscle in healthy subjects; did not prevent osteoporosis; and did not improve cognitive performance in Alzheimer's patients. And those were only a few of the negative findings. But studies continue around the world, and there's hope that DHEA might prove useful against such disorders as lupus or AIDS.

Bottom line

There's no scientific evidence for DHEA as a general "tonic" against the signs and symptoms of aging or, so far, against other ills. It has not been shown to reduce body fat, build muscle, improve sex drive, prevent Alzheimer's or bone loss, or make you feel younger than your years.

As a treatment for depression, it's no better than drugs we already have, and we know far less about DHEA's long-term effects. And then there's the other problem: DHEA is unregulated, and thus you have no idea whether the pills contain the amount of DHEA they claim -- or any at all. It can interact with many drugs, including Tamoxifen (a breast cancer drug), insulin, and Halcion (a sleeping pill).

Reprinted with permission, University of California Berkeley.

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