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Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is a weak androgenic hormone produced by the adrenal glands of both males and females that is converted into estrogen and testosterone by peripheral tissues. DHEA synthesis peaks in the mid - 20’s and then decreases about 2% each year, until it falls to 10 to 20% of peak level by age 70.

In 1984, the FDA banned non-prescription sale of DHEA because of its hepatotoxicity. However, passage of the US Dietary Supplement Health and Education Act in 1994 allowed it to be marketed once again as a health supplement. Although DHEA is not currently approved for any clinical indication, it is widely available in health food stores. The media has popularized the use of DHEA by claiming that it can prevent aging, promote weight loss, prevent osteoporosis, and strengthen the immune system.Some athletes use DHEA in the belief that it can enhance testosterone synthesis.Competitive athletes abuse it to normalize the testosterone to epitestosterone ratio, which is a test for exogenous testosterone use.

DHEA’s lack of efficacy would be less unsettling, if there were not serious concerns about adverse drug reactions in patients taking more than 50 mg per day. The most common clinical manifestations are acneiform rash, weight gain, hirsutism, and deepening of the voice. The most common adverse metabolic effects include hepatotoxicity, increased insulin resistance, reduction of high-density lipoprotein levels, and stimulation of prostate tissue growth. These adverse effects can be detected by periodically ordering a hepatic panel, lipid panel, blood glucose, and testosterone level. Male DHEA users should also have an annual prostate examination and PSA level.

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