Low-Dose DHEA Increases Androgen, Estrogen Levels in Menopause

Mindy Hung

December 12, 2003

Dec. 12, 2003 — Low-dose dehydroepiandrosterone (DHEA) administration increases adrenal hormone plasma levels in early and late menopause, according to results of a prospective case study published in the December issue of Fertility and Sterility.

"Although DHEA supplementation is not yet considered a medical treatment, this steroid has been demonstrated to induce specific metabolic effects and to increase both androgen and estrogen plasma levels in postmenopausal women," write Alessandro D. Genazzani, MD, PhD, and colleagues from the University of Modena in Italy.

The Italian team selected 20 healthy, postmenopausal patients, age 50 to 65 years, who were not using hormone replacements, for the 12-month prospective study. All patients received an ultrasound examination and a mammogram before the start of the study to exclude organic disease.

Dr. Genazzani and colleagues divided patients by age into two groups: early (aged 50-55 years, n = 10, group A) who were two to three years postmenopausal; and late (aged 60-65 years, n = 10, group B) who were five or more years postmenopausal. Five of the women were mild smokers.

All patients took 25 mg/day DHEA supplementation for 12 months. Every three months throughout the trial period, the investigators evaluated patients and drew blood samples to determine plasma levels of LH, FSH, E 2, DHEA, DHEAS, androstenedione (A), testosterone, dihydrotestosterone, progesterone, 17 alpha-hydroxyprogesterone (17-OHP), allopregnanolone, estrone (E1), sex-hormone binding globulin (SHBG), cortisol (F), beta-endorphin, growth hormone (GH), and insuline-like grown factor-1 (IGF-1).

Investigators also conducted a transvaginal ultrasound examination in each patient before and after 6 and 12 months of treatment to evaluate endometrial thickness. In addition, the researchers administered a Kupperman questionnaire to evaluate subjective vasomotor and psychological symptoms before and after 3, 6, and 12 months of therapy.

Younger postmenopausal subjects (group A) demonstrated higher levels of DHEA, DHEAS, testosterone, and beta-endorphin levels than older subjects ( P < .05). Significant changes in endocrine levels were observed with therapy. DHEA treatment eliminated endocrine differences observed between the two groups at baseline.

Testosterone and dihydrotestosterone plasma levels, and plasma E 1 and E 2 levels increased significantly and progressively in both groups. Investigators found no changes in SHBG concentrations in either group despite significant changes in A and E plasma concentrations. Allopregnanolone and beta-endorphin concentrations significantly increased in both groups.

Cortisol F plasma levels progressively decreased throughout the study. Both groups also experienced significantly reduced LH and FSH plasma levels. GH and IGF-1 levels significantly increased in both groups. Supplementation did not induce changes in endometrial thickness.

At baseline, group A had higher values for subjective vasomotor disturbances and psychological disturbances than group B, whereas the latter had a higher score for psychological variables. Scores significantly improved in both groups during therapy.

"The present study demonstrates the efficacy of low-dose DHEA administration of endocrine and psychoneuroendocrine parameters in early and late menopause and confirms that a low-dose DHEA supplementation increases adrenal androgens plasma levels (mainly DHEA and DHEAS), which are significantly impaired during menopause," Dr. Genazzani and colleagues write.

"These data support and confirm that DHEA must be considered a valid compound and drug for [hormone therapy] in postmenopausal women and not just a 'dietary supplement,' " they add.

Fertil Steril. 2003;80:1495-1501

Reviewed by Gary D. Vogin, MD

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