Jess was near tears when she told me her story: “The other morning, I was frantically searching for my glasses near the nightstand where I always put them when I go to bed. I knew they should be there but they’d disappeared! I was really freaking out…then my husband told me that I was wearing them!”
As a middle-aged woman who had recently gone through menopause, she was terrified of what this kind of “forgetfulness” meant. She had family members with dementia, and this felt like just the kind of incident that could be an early warning sign.
When I dug a little deeper with Jess, I could tell that this experience was just her last straw. She’d been dealing with chronic pain, irritability, fatigue and simply not feeling like herself for quite some time.
I could see she didn’t believe me when I told her we could get to the root of these uncomfortable symptoms – and that it likely wasn’t a sign of early onset dementia! That’s when I knew I had to fill her in on DHEA, as well as other important hormones that could explain a lot of her issues. She needed to understand the impact that imbalanced hormones could have on an otherwise healthy brain and body.
What is DHEA?
Dehydroepiandrosterone (DHEA) is the most abundant steroid hormone that circulates in the body, for both men and women. It is produced and released primarily by the adrenal glands, which is where the stress hormone cortisol is manufactured. These two hormones have opposing functions (more on that later) and the ratio between the two is a very important aspect of hormonal balance and overall health.
DHEA levels are highest at birth, and slowly decline throughout your life. This natural decline happens to everyone, and is not a cause for supplementation, or an indication that something is wrong. However, when levels drop too much, you can notice a range of uncomfortable symptoms, including chronic fatigue, irritability, weakness, joint pain, weight gain, infertility and more.
Normal levels of DHEA can vary, and men have naturally higher levels than women. As you age, your body needs less DHEA for optimal functioning, which is why that natural dip I mentioned earlier is okay. But it also means that you really need to work with a professional to learn what your body needs, and whether supplementation is a good choice for you.
So what role does DHEA play in your body’s functioning? It’s necessary for metabolism, energy production, and many other processes. DHEA is also connected to mood regulation, cognitive function, and the body’s stress response. As you can see, it’s critical to be sure you aren’t lacking in this essential hormone!
And, as with all hormones, DHEA doesn’t work in isolation. It’s a precursor to the major sex hormones estrogen, progesterone, and testosterone, so if levels are low, balance among these other hormones can quickly become skewed as well. And as I mentioned before, DHEA also has a strong connection to keeping cortisol levels balanced. Let’s take a quick look at how.
The DHEA-cortisol connection
Like I said, DHEA is produced in the adrenals – and so is cortisol. Cortisol is one of the primary stress hormones. When the natural stress response takes over, production of cortisol takes priority, meaning DHEA production can drop off. And because your body needs DHEA to make other hormones, soon you may experience a whole range of symptoms related to hormonal imbalance!
Unfortunately, chronic stress is a real problem for women these days. Even before the pandemic and civil upset happening across the country, stress was ever present. During the pandemic, despite a forced slowing down, anxiety and stress increased tenfold – and it hasn’t subsided.
That means that most of the women I see are dealing with some form of adrenal dysfunction, and likely have DHEA levels that are lower than they should be.
When levels are where they should be, cortisol is a powerful anti-inflammatory hormone. It follows, then, that when cortisol dysfunction occurs due to adrenal fatigue, inflammation can explode as the proinflammatory stress response is reactivated.
DHEA counteracts the effects of cortisol, which is why balance is so critical. When a proper ratio is maintained between cortisol and DHEA, inflammation (and many other important functions) can stay regulated.
DHEA and Inflammation
Inflammation is a natural response to injury or infection, and it is key to a healthy healing process. When inflammation occurs, immune cells and essential nutrients are sent to the areas that need them most. That’s what’s happening when you see swelling or feel pain when you sprain an ankle, for instance.
But just as chronic stress can send a healthy response spiraling, if that immune response is always activated you’ll end up with chronic inflammation that can result in major issues such as arthritis, heart disease, depression, cancer and even Alzheimer’s disease.
There are a lot of factors that contribute to chronic inflammation, including weight, stress, and poor lifestyle choices. Many of those lead to chronically imbalanced hormones, including DHEA.
Decades of research have provided valuable information on the impact of DHEA on inflammation.
One study showed that DHEA levels are significantly lower in patients who have chronic inflammatory disease due to several mechanisms in the body. This study also demonstrated why this deficiency is important to osteoporosis, and called for a combined therapy approach that includes DHEA supplementation for chronic inflammatory disease.
Another study showed that DHEA supplementation decreased the systemic inflammatory response due to bilateral femoral fracture. The authors concluded that treatment with DHEA may be a good option for reducing systemic inflammation after musculoskeletal injuries.
A 2023 study showed positive impacts of DHEA and its metabolites on the inflammatory response in primary Biliary Cholangitis.
In 2018, a review of studies in the journal of neuroinflammation indicated that there is a significant modulatory role of DHEA/DHEAS through the way it binds to a wide range of receptors in the body. The studies reviewed showed that DHEA is beneficial in limiting the progression of neurodegenerative diseases associated with inflammation.
Should I supplement with DHEA?
The potential benefits that proper DHEA levels have in mitigating the effects of inflammation clearly demonstrate the need to keep these levels balanced. But is supplementation the answer? Sometimes.
I want to be clear that I don’t consider DHEA a “miracle drug.” No such drug exists! But supplementation, under close supervision from a health care professional, and in conjunction with lifestyle and diet changes CAN make a big difference.
Still, treatment with DHEA supplements is just one piece of the puzzle and shouldn’t be considered a long-term solution. My goal is to help women understand how much power they have over their own health through the choices they make every day. But for short periods of time, as a piece of the overall treatment plan, DHEA supplementation can be the boost some women (like Jess) need to feel like themselves again.
If you think that might be you, it’s critical to be cautious about both dose and quality of the supplement you choose. Over the counter options aren’t ideal. Sometimes, they contain a much higher dose of DHEA than is warranted. I always test my clients to be sure we are using only the amount they need – after all, too much DHEA is as bad as too little; the goal is to achieve the right balance. It’s best to discuss the dose needed with a healthcare professional and use a supplement made at a compounding pharmacy so you can be precise about the amount you receive.
Side effects are possible, and there can be medication interactions with DHEA supplements. Pregnant and nursing women should not use DHEA supplements, and those with hormone sensitive conditions, history of heart disease or stroke, along with other specific conditions, should also avoid DHEA use. That’s why it’s so important to talk to a trusted health care professional about whether it’s the right option for you.
I consider DHEA supplementation to be a short-term bridge to help women regain vitality and the energy needed to increase DHEA naturally through lifestyle changes.
Lifestyle strategies to increase DHEA production
Once you understand how DHEA can impact your health, it’s time to examine your personal choices and find small ways to encourage your body to produce the DHEA it needs naturally. These tips can help you get started:
- Avoid inflammatory foods such as sugar, soda, dairy, gluten and processed foods. These stress your body, which can set off the cortisol cascade that ends up suppressing DHEA production.
- Use anti-inflammatory herbs to add flavor to your food. Instead of sugar or excess salt, try spicing up your recipes with herbs that have the power to reduce inflammation naturally. Turmeric, ginger, and rosemary are all well-known anti-inflammatory herbs. And they’re delicious! Herbal teas can also soothe your nerves, help you sleep, and increase DHEA. Adaptogenic herbs like rhodiola, eleuthero, and ginseng are also great for regulating the stress response.
- Don’t skimp on sleep. Loss of sleep is one of the biggest stressors your body can face. Striving for 7-9 hours of quality sleep each and every night will keep your stress response in check and promote healthy hormonal balance. Nothing is important enough to make skipping sleep a good choice.
- Take care of gut problems. Leaky gut syndrome or dysbiosis are both strong contributing factors to the development of adrenal fatigue and dysfunctional stress response. If you don’t heal these issues first, you will have a hard time healing. And without healing, it’s hard to achieve the balanced hormone levels you need to feel your best.
- Be sure you are getting the nutrients your body needs. Like with poor gut health, nutrient deficiencies can make it difficult, at best, to recover from adrenal fatigue. Work with your practitioner to determine which nutrients you may be lacking, and the best supplements to replenish your supply. Vitamins B5 and B6, C, D and magnesium are all crucial components in DHEA production and hormonal balance.
- Explore how medication might be impacting your hormones. Prescription medications can really impact adrenal function and hormonal balance. While you shouldn’t stop taking medications without discussing the pros and cons of each with a trusted health care provider, it’s certainly worth looking at!
- Healthy fats are important. Contrary to popular belief, fat is not the enemy. In fact, healthy fats like avocado, nuts, seeds, coconut oil or olive oil allow your body to produce the cholesterol (also not the enemy) which your body needs to make DHEA. If you find it hard to consume enough of these healthy fats, consider a high-quality Omega 3 fish oil supplement.
- Exercise, gently. Moderate exercise can help reduce inflammation, boost DHEA and balance hormones. But if you overdo the exercise, especially if your adrenal glands are already overstretched, you may make the problem worse, so be attentive to what your body can handle. Outdoor exercise is an even better option – there’s a lot to be said for the healing benefits of fresh air!
- Find joy in what you do every day. Of course, you won’t be joyful about every moment of every day. But you must be joyful for at least some of those moments on a daily basis. Taking care of yourself (whatever that looks like for YOU) is probably the most important advice I can give you.
After I talked with Jess about stress, hormonal balance, and the possibility of low DHEA, she agreed to needed testing. I wasn’t at all surprised when those tests showed she was indeed in need of a little help to increase her DHEA levels.
After a few weeks of a very small dose of DHEA, along with making several of the lifestyle changes I recommended, Jess came in happy to report that she hadn’t had any more concerning incidents of brain fog. She no longer stayed awake at night worrying that dementia was lurking nearby. Even better, she said, her aches and pains had subsided, and she finally had the energy to go hiking again, which brought her great peace and joy.
Inflammation can be behind so many uncomfortable, chronic conditions. But with a little guidance and a commitment to live your best life, you can naturally boost DHEA, balance hormones, and thrive – just like Jess!
Reviewed by Dr. Mark Menolascino, MD