Just Right! Long-term Guidelines: DHEA dosing and safety precautions

Properly managed DHEA therapy can be useful for most older men and women to increase energy, vitality, and to foster an overall youthful feeling. However, there are guidelines that should be followed for safe long-term use of DHEA.

When taking oral supplements of DHEA, it is important that antioxidants are available to the liver because DHEA can promote free radicals in liver cells. Animal studies have shown that extremely high doses (from 2,000 to 10,000 mg DHEA daily in human terms) caused liver damage in mice and rats. When antioxidants were given along with the DHEA, liver damage did not occur despite the massive doses of DHEA being administered to these animals. It should be noted that the amount of DHEA shown to cause liver damage is 20 times more than is necessary, to produce anti-aging benefits. Green tea, vitamin E and n-acetyl-cysteine are antioxidants that have been shown to be especially effective in suppressing free radicals in the liver.

The Life Extension Foundation has evaluated thousands of DHEA blood tests to determine the ideal dose of DHEA for both men and women. Our findings indicate that the optimal dosage range for DHEA varies considerably among individuals. Prior recommendations to take DHEA three times a day are now being replaced with a general recommendation that men and women should consider taking a total of 15 to 75 mg a day in one to three divided doses. Most human studies use a daily dose of 50 mg, and this is the typical daily dose the majority of people use DHEA supplements to restore serum DHEA to youthful levels. DHEA supplements can be taken with or without food, though some believe that fat helps DHEA to assimilate better. Some people absorb DHEA better by taking it 20-30 minutes before meals.

A DHEAS (dihydroepiandrosterone sulfate) blood test should be taken 3-6 weeks after beginning DHEA therapy to help determine optimal dosing. Some people neglect to test their blood levels for DHEA and wind up chronically taking the wrong dose. When having your blood tested for DHEA, blood should be drawn three to four hours after the last dose. DHEA testing can save you money if it shows that you can take less DHEA to maintain youthful DHEA serum levels.

The standard blood test to evaluate DHEA status is one that measures DHEAS. The DHEAS is calculated in micrograms per deciliter (mcg/dL) of blood. The youthful ranges of DHEA are as follows:

Men

Women

* 400-560
* 350-430

People over age 40, who do not supplement with DHEA, usually have serum levels below 200, and many are way below 100. Chronic DHEA deficiency is a risk factor for developing the degenerative diseases of aging according to the preponderance of evidence existing in the scientific literature.

Some people obtain a baseline DHEAS blood test before beginning DHEA replacement therapy, however, based upon numerous DHEA blood tests evaluated by The Life Extension Foundation, anyone over age 40 who does not supplement DHEA is already deficient in serum DHEA. Therefore, it may be more economical to have the first DHEA blood test 3-6 weeks after initiating DHEA replacement therapy. There are precautions that should be observed that are different for men and women.

Men

Before initiating DHEA therapy, men should know their serum PSA (prostate specific antigen) level and have passed a digital rectal exam. Men with prostate cancer or severe benign prostate disease are advised to avoid DHEA since DHEA can be converted into testosterone (and estrogen). These sex hormones and their metabolites can promote benign and malignant prostate cell proliferation. It is important to understand, however, that well-controlled studies show that serum DHEA levels are usually lower in men with malignant prostate disease compared to healthy control subjects. Therefore, men are advised to have a PSA and digital rectal exam before initiating DHEA therapy to rule out existing prostate disease, not because DHEA causes the disease. To the contrary, there is evidence indicating that maintaining youthful levels of DHEA may protect against prostate cancer. To reduce the risk that hormone modulation with DHEA could contribute to a prostate problem, men taking DHEA are also advised to take:

Vitamin E

400-800 i.u. a day

Selenium

200-600 mcg a day

Mega Soy Extract

135 mg twice daily

(40% isoflavone extract)

Lycopene Extract

20-40 mg a day

Saw Palmetto Extract

160 mg, twice daily

Pygeum Extract

50 mg, twice daily

Nettle Extract

120 mg, twice daily

Note: An aromarase inhibitor should be considered if serum estrogen levels are high. Refer to the Male Hormone Modulation Protocol for complete information about suppressing excessive estrogen levels.

Men over 40 should consider checking their PSA and DHEAS serum levels every six to twelve months thereafter. Men should also periodically check their blood levels of free testosterone and estrogen to make sure that DHEA is following a youthful metabolic pathway. Men taking DHEA should refer to the Male Hormone Modulation Protocol to learn about additional hormone balance testing that can be done at the same time serum DHEA and PSA levels are being tested.

Women

DHEA can increase serum estrogen levels in women and eliminate the need for estrogen replacement therapy in some women. To help protect cells (especially breast cells) from excessive proliferation in response to estrogen, women taking DHEA should also take:

Melatonin

500 mcg to 3 mg

(every night)

Vitamin E Succinate 40-800 IU per day

Mega Soy Extract

135 mg, twice daily

Indole-3-carbinol 200 mg, twice daily

Vitamin D3

1000-1400 IU a day

Women should consider estrogen and testosterone testing when they take their DHEA blood test in order to evaluate DHEA's effect on their blood levels of estrogens.

Women who have been diagnosed with an estrogen-dependent cancer should consult their physicians before beginning DHEA therapy. Some studies indicate that higher serum DHEA protects against breast cancer, but no adequate studies have been done to evaluate the effects of DHEA in breast cancer patients. If DHEA where to elevate estrogens too much, this could theoretically increase the risk of breast cancer. Women taking DHEA should refer to the Female Hormone Modulation Protocol at www.lef.org for information about restoring youthful hormone balance.

Liver disease

Men or women with existing liver disease (such as viral hepatitis or cirrhosis) should consider taking DHEA sublingually (under your tongue) or use a topical DHEA cream to reduce the amount of DHEA entering the liver. DHEA is converted by the liver into DHEAS. Those with liver disease should carefully monitor liver enzyme levels to make sure that DHEA therapy is not making existing liver disease worse.

DHEA is best taken early in the day or possible insomnia could result. DHEA is normally produced by the adrenal glands early in the day and converted by the liver to DHEAS by mid-day when the DHEA/DHEAS ratio is usually stabilized (10% DHEA/90% DHEAS).

We again recommend that those taking DHEA have a DHEA blood test to make sure they are taking the precise dose to suit their individual biochemistry. Some people only need to take a small amount of DHEA in order to restore blood levels to that of a 21 year old, while others need to take higher levels of DHEA. Those with existing prostate or breast cancers should not take DHEA unless closely supervised by a knowledgeable physician who understands DHEA's metabolic pathways.

Some people supplement with the hormone pregnenolone in lieu of, or in addition to, DHEA. Since pregnenolone naturally converts into many of the same hormones as DHEA, some of the precautions we advise for DHEA may apply to pregnenolone.

If DHEA replacement sounds complicated, it is compared to other preventive supplement programs. We suggest weighing the documented anti-aging benefits of maintaining youthful serum DHEA levels when deciding whether to embark on a DHEA replacement regimen. Or stated differently, review the degenerative effects of chronic DHEA deficiency to decide whether this program is worth your time and money.

Life Extension Foundation.

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