DHEA therapy in .NET

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DHEA therapy
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DHEA replacement in adrenal insuf ciency and pan-hypopituitarism
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Traditionally, adrenal insuf ciency, resulting from Addison s disease, has been treated with glucocorticoids and mineralocorticoids, while secondary adrenal insuf ciency, resulting from pan-hypopituitarism, has been treated with glucocorticoids alone, as aldosterone production is regulated separately by the renin angiotensin system [298] However, management of the adrenal androgen de ciency associated with both conditions with DHEA replacement is still not considered to be the standard of care It has been shown that despite stable and longstanding conventional therapy with glucocorticoids with or without mineralocorticoids, many patients with adrenal insuf ciency display a highly signi cant impairment of health-related quality of life [299] Such patients have reported a reduced general health perception, decreased vitality, increased fatigue, reduced physical function, and sexual dysfunction [284,299,300]
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Metabolic effects of DHEA therapy in euadrenal subjects
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Much controversy exists as to whether or not the DHEA-de cient state may contribute to a dysregulation of metabolism and hence may be associated with conditions such as diabetes and states of insulin
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Hormones, Metabolism, Aging, and Men s Health resistance, atherosclerosis, and eventual vascular complications Therefore, there has been great interest in studying the metabolic effects of DHEA supplementation in euadrenal subjects Once again, study results have been inconsistent and con icting A recent review of the effects of endogenous and exogenous DHEA on cardiovascular disease risks reiterates the inconsistencies regarding the metabolic effects of DHEA supplementation, discusses the shortcomings of several studies, and suggests that the effects of DHEA on cardiovascular disease risk (either favorable or unfavorable) should be considered more modest than previously believed [313]
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other agency There is no pharmaceutical grade DHEA product and, therefore, no guaranteed consistency in DHEA content between brands, and even among different batches of the same brand of DHEA As of the time of this writing, newer legislation is being introduced in an attempt to eliminate this loophole The main objection is that estrogens are produced from DHEA and there are no warnings that this might not be in the best interest of women who have had estrogen-receptor positive breast cancer Also, if women of reproductive age take DHEA while pregnant, it does cross the placenta and can potentially harm the reproductive development of the fetus
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Other proposed uses for DHEA therapy
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In addition to theoretical anti-aging effects and potentially bene cial metabolic effects of DHEA supplementation, the effects of exogenous DHEA administration have been studied in other conditions Bene cial effects on mood have been observed while using DHEA as treatment for depression and dysthymia [314,315] DHEA supplementation in Alzheimer disease has been shown to cause only minor and transient improvements in cognitive performance [316] In terms of bone health, the bene cial effects of DHEA supplementation are felt to be minor and limited to women [314] DHEA supplementation has been shown to reduce the frequency of ares, and to decrease steroid dose requirements, in women with systemic lupus erythematosus [314,316] DHEA has also been studied as a potential chemopreventive, anticarcinogenic agent [317] The potential for immunoregulatory effects of DHEA has been demonstrated by the presence of speci c binding found in murine T cells [318] Speci c binding of DHEA on muscle cells suggests the possibility of DHEA therapy in muscular disorders [319]
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Conclusions
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DHEA is one of the most abundant circulating hormones DHEA has been shown to exert its effects via downstream conversion to the steroid sex hormones, neuromodulation, improvement in endothelial function, and perhaps by means of action on a cell membrane-bound receptor DHEA de ciency has been correlated with various endocrine, age-related, and other non-hormonal medical conditions DHEA supplementation has been shown to be bene cial in patients with primary and secondary adrenal insuf ciency However, studies looking at the effects of DHEA supplementation on well-being, metabolism, and sexual function, in euadrenal subjects (including premenopausal and postmenopausal women with androgen insuf ciency) have been inconsistent to date Further research, in the form of randomized, blinded, placebo-controlled studies, is needed to better elucidate the ef cacy and safety of DHEA supplementation for the treatment of androgen insuf ciency in women
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