Updated 10/01/2023

“It was mortifying! I stopped for gas, like I’ve done hundreds of times before. I went in for a few items, so I was paying inside – no bypass pin option available – and I totally blanked. After trying to enter my PIN three times, it was clear the clerk thought something was up. I paid in cash – which I had withdrawn using that very card an hour earlier – and left. I was so embarrassed – and also freaked out! Plus, I had to call the bank to reset my PIN – just one more thing to add to my to-do list!”

That’s the story Marcia told me at her recent appointment. Although she felt self-conscious and freaked out, it’s a story I’m sure many can relate to. I reassured her that we have all been there. But I knew what was really on her mind. When we reach a certain age, and we start to forget more things, experience more brain fog, or feel “low” more often, it’s common to start to worry about whether our brain health is starting a long downhill spiral. Short answer: no! But that’s probably not the reassurance you are looking for, so let me tell you more about what I mean.

The thing is, very few of the things that we think of as negative effects of aging are actually inevitable. Of course, our bodies, our hormones, and our brains naturally change as we get older, but if we nourish and support our bodies throughout every stage of life, it is absolutely possible to maintain health, vitality, and cognitive function well into our later years.

I really want to help women feel excited about stepping into a new phase of life as they get a little bit older. It doesn’t have to be a time of fear, and it definitely doesn’t have to be a time of loss! You might even find yourself feeling happier, healthier, and more vibrant than ever during perimenopause and after menopause.

DHEA: an overview

Have you heard of DHEA? Production of this steroid hormone is just one of the things that changes as we get older. There’s been some media buzz about DHEA in recent years, and if you aren’t familiar with it, you should be! This hormone is a precursor to other essential hormones like estrogen and testosterone, and it wears a number of different hats when it comes to disease prevention and overall health.

DHEA levels naturally decrease throughout our lives. Depending on a few other factors, lower levels can begin to become problematic in your 40s, 50s, 60s, or later.

A significant body of research has linked lower DHEA levels with chronic conditions including cardiovascular disease, metabolic syndrome, diabetes, and neurodegenerative disorders. DHEA has also been shown to have anti-inflammatory and antioxidant effects.

People often talk about DHEA in relation to weight loss and healthy aging, but this hormone also plays a major role in mood regulation, memory, the body’s stress response, and cognitive function.

Beyond the natural age-related decline, there are other factors that can influence how much DHEA a person is producing. One of the big ones is stress! Prolonged stress has been shown to lower DHEA levels, which can lead to big problems.

DHEA is produced and released in large part by the adrenal glands, which are also responsible for producing the stress hormone cortisol. The ratio between cortisol and DHEA, which essentially have “opposite” functions, is one of the most important aspects of hormonal balance and health.

When a woman is experiencing adrenal fatigue (caused by chronic stress), it’s not just cortisol production that’s out of whack. We also start to see a pattern of imbalance between cortisol and DHEA, and lower DHEA levels. Basically, our bodies and hormones are focusing so much energy on fighting off the stressor that they’re putting our other essential functions and processes on hold. This is totally normal during times of acute stress, but when stress becomes chronic, it can be problematic.

Just about all of my patients have some degree of adrenal fatigue, which means their DHEA levels are probably not optimal. And when you combine this stress-induced decrease in DHEA with the fact that levels are already reduced due to aging, you might start to see some trouble.

DHEA and Cognitive Function

Brain fog, memory loss, difficulty focusing… I hear about these symptoms all the time when talking with clients. The constant “where did I put my keys?!” moments that seem to come along with menopause are frustrating in and of themselves, but many women I work with are also worried that it will just get worse. They fear they’ll never get their sharpness back, or that their cognitive function and memory will just continue to decline.

I’ve spent decades learning about the things we can do to help keep our minds sharp, largely with the help of diet and lifestyle modifications. So much IS within our control – despite what we may have been told.

When a woman comes to me with brain fog or mild cognitive concerns, I always look at her adrenal function, hormonal balance, and more specifically, her ratio of DHEA to cortisol. In many cases, low DHEA is a key piece of the puzzle!

Research has shown that DHEA levels are correlated with things like attention, working memory, perception, verbal fluency, and other cognitive skills.

Some studies have found that supplementation with DHEA can enhance cognitive skills and memory in postmenopausal women, and increase cognitive scores in older women with mild to moderate cognitive impairment.

DHEA has benefits for so many different aspects of wellbeing that I think some people wonder if it’s too good to be true. First of all, there is still no miracle pill that will prevent all disease and cure all ailments, and DHEA is no exception! DHEA levels can often be raised in large part through diet and lifestyle changes, and when I do recommend supplementation, it’s in moderation, for a short period of time, and as one part of a comprehensive and holistic treatment approach.

The thing about DHEA is that its effects on metabolism, inflammation, the immune system, blood sugar levels, and hormonal balance do have an impact on the whole body, including the brain. In other words, some of the same mechanisms that may allow DHEA to help lower the risk of chronic diseases like diabetes may also be playing a role in protecting the brain. Remember, everything is connected!

DHEA and mood

One of the most promising benefits of DHEA that’s been studied is its effect on depression and mood. Research has found that higher DHEA levels are correlated with lower levels of anxiety and a better mood, while lower levels have been associated with anxiety, depression, Chronic Fatigue Syndrome, and clinical burnout.

Research among individuals taking antidepressants has shown that those with higher DHEA levels may experience more improvement in symptoms than those with lower DHEA levels. Studies have also shown that DHEA may benefit those with less severe depression, who are not taking antidepressant medication.

The treatment response to DHEA compared to a placebo in middle aged individuals with mild, chronic depression has been found to be significant. In middle aged and older patients with major depression, boosting DHEA levels has also been shown to lead to significant improvements in symptoms.

What’s also really interesting is that DHEA has been found to improve mood in general, including among people who are not clinically depressed, or who are experiencing mild depressive symptoms or low mood.

It’s also been studied with positive results for depressed mood in other conditions including schizophrenia, Alzheimer’s, HIV/AIDS, and adrenal insufficiency.

An imbalanced cortisol to DHEA ratio has actually been associated with physical changes to the brain related to depression, including a smaller volume of the hippocampus (a part of the brain involved in memory processing).

Because DHEA is a powerful hormone with so many different effects, improvements in mood are usually combined with other benefits. Some of the common reported “side benefits” of DHEA supplementation for depression and mood disorders are enhanced libido and memory. Many people who suffer from depression or adrenal fatigue experience low sex drive and challenges with memory, and these changes can lead to a huge difference in quality of life!

Anxiety, low mood, and brain fog are common symptoms of adrenal fatigue, which involves an imbalanced DHEA to cortisol ratio.

This is a great example of a situation where DHEA supplementation might be used in moderation to help someone get back on their feet. Sometimes, I work with women who are so exhausted and burned out that it’s a significant challenge for them to jump into the lifestyle changes they want to make in order to get better.

If boosting DHEA can help to boost things like mood and attention, it might be just what somebody needs to gather the energy and motivation that’s necessary to make healthy, long term changes. And the great news is that these healthy lifestyle changes can help to naturally boost DHEA!

Should you take DHEA?

There has been a lot of heated debate about DHEA supplements over the years! The question about whether or not any individual should take a DHEA supplement is best discussed with a functional medicine or holistic health practitioner who can run (and interpret!) tests related to DHEA and cortisol levels, and help to determine if, how, and for how long DHEA should be taken.

The doses of DHEA that have been given to subjects in studies vary quite a bit, and there are a lot of factors that go into determining an optimal dose.

In any case, DHEA supplements should always be used cautiously. Many of the supplements sold in health food stores come in shockingly high doses, and nobody should be going out and taking high doses of DHEA without consulting with a practitioner!

There are possible side effects of DHEA supplementation, and it should not be taken with some medications. Women who are pregnant or nursing should not supplement with DHEA, and those with certain conditions, including hormone sensitive conditions and history of heart disease or stroke, should also avoid them. Make sure to speak with your doctor about whether or not DHEA is right for you.

When you take DHEA supplements, your levels of DHEA will increase, but because DHEA is also converted into other hormones like estrogen and testosterone in the body, levels of these hormones may also increase. The body will do what it needs with the DHEA it’s given!

When I prescribe DHEA supplements for my patients, it’s in personalized doses, after reviewing lab results, and it’s usually just a way to give someone a short term boost so that she can regain the vitality and energy she needs to start making changes and boost DHEA naturally.

I think it’s empowering to know just how much we can do to improve our health and lives by balancing our hormones. I want to make sure women know that they don’t need to kiss their mental clarity or healthy mood regulation goodbye during or after menopause!

After reviewing Marcia’s lab results, I suggested several lifestyle changes and short-term supplementation with a small dose of DHEA. She took that recommendation and ran with it. The increased DHEA gave her the energy she needed to shift some other things in her life – including reducing the constant stress her body was under. When I saw her for a follow up appointment, she was happy to report that her cognitive concerns had all but disappeared (though she still lost her keys now and then…but who doesn’t?). She was thriving – and you can too!


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