Who Should Not Take DHEA

DHEA is often talked about as a "natural hormone of youth," and this creates the illusion that it suits everyone. In reality, the list of situations in which taking DHEA is inappropriate or dangerous is fairly long. The editorial team has systematized the contraindications mentioned in the instructions for registered prasterone preparations, clinical guidelines, and reviews, and explained the logic of each of them.

Why DHEA contraindications are contraindications of sex hormones

DHEA by itself interacts weakly with sex hormone receptors. However, in tissues it is converted into androstenedione, testosterone, dihydrotestosterone, estrone, and estradiol. Therefore, everything that can be harmed by an excess of androgens or estrogens potentially concerns DHEA as well.

It is important that the intensity of this conversion differs between tissues and between people. Adipose tissue, skin, the mammary gland, the prostate gland, and the endometrium have their own enzyme systems. Because of this, even with "normal" blood tests, the local hormonal action in a sensitive tissue may be significant.

The logic of contraindications is built on caution: if a tissue or disease depends on sex hormones, adding their precursor without medical need is not justified. This is exactly how the warnings are formulated in the instructions for prescription vaginal prasterone, even though its systemic action is minimal.

Below we divide contraindications into absolute — when taking DHEA is impermissible — and relative, when the decision is made by a doctor after weighing the risks and conducting an examination.

Hormone-dependent tumors

The most important absolute contraindication is existing or past hormone-dependent malignant tumors: cancer of the breast, endometrium, ovaries, prostate. In these tissues DHEA can be converted into both estrogens and androgens, and the growth of tumor cells often depends precisely on these hormones.

For women after breast cancer treatment who take aromatase inhibitors or tamoxifen, taking DHEA may contradict the goal of therapy — to reduce estrogenic stimulation as much as possible. The instructions for vaginal prasterone directly warn against its use in women with a history of breast cancer.

In men the same logic applies to prostate cancer, the treatment of which often consists of suppressing androgens. Taking an androgen precursor in such a situation is dangerous. Even in benign prostatic hyperplasia, the advisability of DHEA should be assessed by a urologist.

The same group includes unexplained vaginal bleeding, ovarian tumors of unknown nature, and other conditions where a hormone-dependent process has not yet been ruled out. First diagnostics, then any hormonal agents.

Pregnancy, PCOS, and young age

During pregnancy and breastfeeding DHEA is contraindicated. Sex hormones affect the sexual differentiation of the fetus, and there are no data on the safety of additional DHEA during this period. A separate topic is the use of DHEA in reproductive medicine in cases of reduced ovarian reserve, but this decision is made by a reproductive specialist within the framework of a treatment protocol, not by the patient on her own.

Polycystic ovary syndrome (PCOS) is often accompanied by an excess of androgens, and in some women it is precisely DHEA-S of adrenal origin that is elevated. Additional DHEA may intensify acne, hirsutism, and cycle disturbances. Therefore, in PCOS and other hyperandrogenic conditions, use is inappropriate.

DHEA is not indicated for children and adolescents. At this age the body's own production of the hormone is high, and puberty and the closure of bone growth zones are sensitive to sex hormones. Interference in this process may have irreversible consequences.

For young adults with a normal level of DHEA-S, use is also pointless: there is no deficit that needs to be compensated, but there is a risk of pushing hormones beyond the norm.

Psyche, liver, heart, and interactions

DHEA and its sulfate act as neurosteroids and affect the excitability of the nervous system. The medical literature describes cases of hypomania and mania against the background of DHEA use, particularly in people predisposed to bipolar disorder. Therefore, in bipolar disorder, psychotic states, and marked anxiety, the decision should be made by a psychiatrist.

The liver plays a key role in the metabolism of oral steroids. In chronic liver diseases the metabolism of DHEA and its metabolites may change unpredictably. Although DHEA is not a 17-alpha-alkylated steroid, people with liver damage should avoid taking it on their own.

The effect on lipids, in particular the possible decrease in HDL cholesterol in women, makes caution appropriate in cardiovascular diseases and marked dyslipidemia. There is no reliable data on cardiovascular risk, neither toward harm nor toward benefit.

As for interactions, the greatest concern is the combination with other hormonal agents.

• estrogen or testosterone hormone replacement therapy — risk of hormone excess;
• antiestrogens, aromatase inhibitors, antiandrogens — DHEA may counteract the treatment;
• glucocorticoids in adrenal insufficiency — use only within an endocrinologist's plan;
• psychotropic drugs — possible mood changes, a psychiatrist's supervision is needed;
• other "hormonal boosters" — additive side effects.

Athletes and doping control

For athletes subject to anti-doping rules, DHEA is a prohibited substance at all times — in-competition and out-of-competition. On the WADA Prohibited List, prasterone (DHEA) is classified as an endogenous anabolic androgenic steroid.

Laboratories can detect the intake of exogenous DHEA by changes in the steroid profile and with the help of isotope mass spectrometry, which distinguishes synthetic and endogenous origin of steroids. A reference to the fact that the product was bought as a "dietary supplement" does not exempt from responsibility.

Besides the legal aspect, for young athletes taking DHEA is pointless from a physiological standpoint as well: controlled studies did not show any rise in testosterone, strength, or muscle mass.

If an athlete has a confirmed medical condition requiring DHEA, the matter is resolved through the therapeutic use exemption (TUE) procedure with appropriate documentation, not by taking it on one's own.

Editorial conclusions

Taking DHEA is impermissible in hormone-dependent tumors, during pregnancy and breastfeeding, in children and adolescents, and for athletes under doping control.

In PCOS, mental disorders, liver diseases, cardiovascular problems, and while taking hormonal drugs, the decision can be made only by a doctor.

Even in the absence of contraindications, it is reasonable to start with a DHEA-S test: without a deficit, use makes no sense.

Also read our materials "Side Effects of DHEA," "Myths About DHEA," and "How to Take DHEA: Dosage, Timing, Duration."

References

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3. U.S. Food and Drug Administration. Intrarosa (prasterone) vaginal inserts: prescribing information. 2016.
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7. World Anti-Doping Agency. Prohibited List. Montreal: WADA; чинна редакція.