DHEA Info Sheet
What Is It Really?
DHEA is a naturally occurring hormone produced in your adrenal gland. No one has yet figured out everything that it does or how important it is, but among other things, it is part of the process by which testosterone is produced. DHEA has been around a long time and has been studied for its effects on heart disease, cancer, mood, viral infections and weight, mostly in test tube and animal studies. It has been available on and off again on the underground for several years, has been used in a few small HIV studies but never in a sizeable long term study that would give us some clear answers about if and how it works, and at what dose.
DHEA and HIV
DHEA has been looked at as a possible HIV treatment for some time now primarily because studies document that many HIV positive men have significantly lower than usual levels of DHEA in their blood. A 1991 retrospective study noted an increased risk for AIDS in HIV-infected men with 200-499 T cells with lower than normal DHEA levels and concluded that DHEA may have some protective effect against progression to AIDS.
How's It Work
Exactly how this gradual depletion of DHEA affects progression to disease is unknown. However, DHEA may play a role in the immune system. Some test tube studies suggest that the loss of DHEA may be part of the process that shifts the immune system balance from responses that control HIV to inflammatory responses that actually stimulate HIV (often associated with the "bad" cytokines TNF-alpha and IL-6). These studies report that DHEA is a potent enhancer of gamma-interferon and IL-2 production by activated T cells, while reducing production of TNF-alpha. Still, other test tube studies report that DHEA has direct antiviral effects in HIV-infected lymphocytes and macrophages, but this may be mediated by DHEA's effect on the immune system. Yet another test tube study suggests that DHEA can keep TNF-alpha, oxygen free radicals and proteins from other viruses such as herpes from "turning on" latent HIV in infected cells. Other researchers including Dr. Don Kotler are interested in DHEA's role as a testosterone precursor, since levels of this hormone also tend to drop, particularly in people with wasting syndrome. While sort of a which-came-first-the-chicken-or-the-egg-scenario, it is possible that the loss of DHEA may have something to do with the shift in metabolism in PWAs that causes the loss of lean muscle mass. Kotler thinks that someone should do a study to see whether restoring, or keeping DHEA levels constant will keep testosterone levels from falling, and/or have an anabolic (muscle building) effect in men and women. (Especially, since DHEA may have less masculinizing effects than anabolic steroids.)
DHEA Studies in PWAs
A drug company (Elan) sponsored a study in Europe using their formulation of DHEA. The trial found no significant anti-HIV effect (as measured by p24) but there were CD4 cell boosts in 5 out of 13 PWAs taking it. The company's subsequent studies reportedly showed no benefit and their program was discontinued. Meanwhile, researchers in San Francisco ran a sixteen week study in 31 HIV positive men with CD4 cell counts between 250-600. The doses ranged from 750 mg/day to 2,250 mg/day. There were no serious toxicities. There was no significant antiviral effect or increases in CD4 cell counts. The most interesting thing the researchers found was that the level of DHEA in the blood didn't increase much with the higher doses. A small study using lower doses has been run in PWAs by a researcher in Texas. A poster at Yokohama presented data from the twelve people taking 75 mg DHEA per day. Two PWAs died before a year had passed, but nine out of ten of the remaining patients had an incr! ease in CD4 cell counts. Of course, these little uncontrolled studies are impossible to interpret. There are no studies of DHEA in HIV- positive women because of concern about its side effects (see below). Although women naturally have less DHEA than men, depressed levels have been associated with increased risk for breast and ovarian cancers. As there is no published data on how DHEA works in large numbers of PWAs and people with HIV, particularly in the long run, we do not know how DHEA affects the course of HIV infection.
A study was recently published that evaluated the effects of small amounts of DHEA (50 mg/day) in men and women aged between 40-70, since people produce less DHEA as they get older. The researchers came up with the dose by calculating how much DHEA it would take to get people up to the levels produced in their twenties. After two weeks on DHEA, people's DHEA blood levels almost doubled. Women on DHEA saw their level of masculinizing hormones, such as testosterone increase. Interestingly, only one woman reported increased facial hair -- but so did one on placebo. There was no change in libido, but people on DHEA did feel significantly better both physically, and moodwise. They slept better, felt more relaxed, had increased energy and a better ability to handle stress. Another interesting change was an increase in insulin-like growth factor levels, a hormone that stimulates anabolism (the construction of body tissue, including muscle but not fat). However, no change in weight or body fat percentage was seen over the three months on DHEA. DHEA has been studied as a weight loss drug in young women. Ironically other studies have shown that it could increase lean muscle mass in young men. Subsequent studies could not verify either of these results. However, as a precursor to testosterone (which has anabolic effects) it is possible that DHEA mildly stimulates an anabolic process in people, which means the body burns fat for its energy while converting new food into muscle. The studies of DHEA for weight gain or fat loss may be flawed because they didn't take into account participants physical activity -- important since no anabolic steroid can help you build muscles unless you exercise. Regardless, none of these studies involved PWAs so we do not know how DHEA affects PWAs' altered metabolism.
Side Effects and Toxicity
1. Only minor side effects have been reported for men with short term use, such as nasal congestion and mild insomnia (reported by one person taking 2250 mg a day in the dose-ranging study). For women, DHEA may have testosterone-like effects, such as increased facial hair and menstrual changes. 2. DHEA may elevate IL-2 levels in people, and we know from clinical trials that IL-2 has been shown to increase viral load in PWAs with less than 200 CD4 cells. It is possible that DHEA may also activate CD4 cells leaving them more susceptible to infection with HIV. So despite its anti-HIV effects, it is remotely possible that over the long run, DHEA might speed up T cell decline. It's impossible to say right now since there is no data on long term use of DHEA. Because of this concern, the PWA Health Group requires a prescription to be sure that a doctor is watching your viral load and T cells counts.
We don't have a clue what the proper dose of DHEA is. DHEA sappears to be fairly easily absorbed, although much of it is rapidly excreted in the urine. It may be that the body can only absorb so much, and simply flushes the rest. For example, the San Francisco study reported no proportional increase in the amount of DHEA that was absorbed with the higher doses. Meanwhile, the study in the 40-70 year old people reported that a dose as low as 50 mg a day was adequate to restore DHEA levels to what to normal. Anecdotally, people have been taking between 750 mg/day and 1500 mg/day, but everyone could be taking way too much. If you can afford it, most labs can monitor your hormone levels, so it may make sense to see what your DHEA levels are first. Then choose a dose, take it for a few weeks, and get tested again to see whether your DHEA levels are back to normal.
What We Carry
Each batch of the DHEA we carry is pharmaceutical grade DHEA that we analyze in a high tech laboratory to check for potency and purity. Copies of the quality control reports are available for your inspection.
This article was provided by PWA Health Group.