Q&As
DHEA
[Q&As are placed in reverse chronological
order. In other words,
the latest Q&As come first. Earlier ones are further down the
page.]
June 7, 2003
Question: I read your
June 6, 2003 answer to another patient who takes DHEA. You wrote that
you can’t conclude that DHEA will lower a patient’s cortisol level. But
I’ve been reading Dr. Barry Durrant-Peatfield’s book The
Great Thyroid Scandal and How to Survive It.[1]
On page 99, he explains how DHEA lowers the cortisol level. How do you
reconcile that your opinion is different from his?
Dr. Lowe:
You’ve misunderstood the statement by Dr. Durrant-Peatfield on page 99 of
his book. Dr. Durrant-Peatfield, of course, is extremely knowledgeable about
cortisol and DHEA, and his statement on that page—like the content of his
entire book—is clear, which this is one of many reasons that I
strongly recommend the book to patients. Despite its clarity, however, I
can see how you might misinterpret the statement.
Inside the cells of the adrenal cortex is an enzyme that’s dependent on
the vitamin panthothenic acid. When cholesterol enters the adrenal cells,
this enzyme converts it to pregnenolone. Dr. Peatfield explains quite
correctly that pregnenolone is the "pro-hormone" of the adrenal
cortex. This means that it’s the hormone from which all the other hormones
of the adrenal cortex are derive.
Some of the pregnenolone is converted to cortisol. But some patients’
adrenal cortex cells don’t convert pregnenolone to cortisol at a normal
rate. As a result, the patients’ cortisol levels may decrease. As Dr.
Durrant-Peatfield writes, in these patients, the pregnenolone that would
have been converted to cortisol may instead be converted to DHEA. This may
raise the patients’ DHEA levels, and it may increase the ratio of DHEA to
cortisol. Researchers have found this pattern—an increased ratio of DHEA
to cortisol—in patients with panic disorder.[2]
In summary, cells of the adrenal cortex may use less pregnenolone to
produce cortisol, and this may divert more pregnenolone into the pathway
that leads to DHEA. If so, lab tests may show a low ratio of cortisol to
DHEA. This does not mean, however, that DHEA has suppressed the
cortisol level. As Dr. Durrant-Peatfield suggests, it simply means that the
cells of the adrenal cortex have increased their production of DHEA at the
expense of cortisol.
References
[1] Durrant-Peatfield, B.: The
Great Thyroid Scandal and How to Survive It. London, Barons Down
Publishing, 2002.
[2] Fava, M., Rosenbaum, J.F.,
MacLaughlin, R.A., et al.: Dehydroepiandrosterone-sulfate/cortisol ratio in
panic disorder. Psychiatry Res., 28(3):345-350, 1989.
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Continued from
bottom of left column . . .
June
6, 2003
Question: I’ve read that taking
DHEA lowers patients’ cortisol levels. My doctor measured my level and
said it is borderline low. For several years, I’ve taken 10 mg of DHEA.
This is supposed to be a small dose, but do you think the 10 mg of DHEA is
the cause of my borderline low cortisol level?
Dr. Lowe:
The question of whether DHEA will lower a patient’s cortisol level is
interesting. Unfortunately, it’s one for which we don’t have a definite
answer. The reason is that study results are contradictory.
In one study, the cortisol level of healthy older men and women was lower
after they took 200 mg of DHEA each day.[1]
In another study, though, the secretion of cortisol at night in healthy men
didn’t decrease after they took a single dose of 500 mg of DHEA.[2]
In another study, perimenopausal women took 50 mg of DHEA for three months.
Their blood cortisol level was 13% lower at the end of the study.[3]
But in still another study, the cortisol level of schizophrenic patients
taking 100 mg of DHEA each day didn’t decrease.[4]
Also, researchers gave 12 health rhesus monkeys huge amounts of DHEA for
eight weeks. The equivalent dose of DHEA for a 150-pound human being would
be 4090 mg for the first four weeks and 5114 mg for the second. During the
eight weeks, the monkeys' cortisol levels decrease.[5]
With such mixed study results, we simply can’t conclude that DHEA will
or won’t lower a particular patient’s cortisol level. To learn whether
it will or won’t, we must test the patient’s cortisol response to DHEA
on an individual basis.
References
[1] Kroboth, P.D., Amico, J.A.,
Stone, R.A., et al.: Influence of DHEA administration on 24-hour cortisol
concentrations. J.Clin. Psychopharmacol., 23(1):96-99, 2003.
[2] Friess, E., Trachsel, L., Guldner,
J., et al.: DHEA administration increases rapid eye movement sleep and EEG
power in the sigma frequency range. Am. J. Physiol., 268(1 Pt
1):E107-E113, 1995.
[3] Barnhart, K.T., Freeman, E.,
Grisso, J.A., et al.: The effect of dehydroepiandrosterone supplementation
to symptomatic perimenopausal women on serum endocrine profiles, lipid
parameters, and health-related quality of life. J. Clin. Endocrinol. Metab.,
84(11):3896-3902, 1999.
[4] Strous, R.D., Maayan, R., Lapidus,
R., et al.: Dehydroepiandrosterone augmentation in the management of
negative, depressive, and anxiety symptoms in schizophrenia. Arch. Gen.
Psychiatry, 60(2):133-141, 2003.
[5] Haffa, A.L., MacEwen, E.G.,
Kurzman, I.D., et al.: Hypocholesterolemic effect of exogenous
dehydroepiandrosterone administration in the rhesus monkey. In Vivo.,
8(6):993-997, 1994.
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