All About Adrenopause: The Decline of DHEA Levels With Age

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As we age our hormone levels drop, causing health complications ranging from muscle loss to cardiovascular disease. Doctors tend to focus on declining testosterone and estrogen levels in males and females, respectively. While these are two prominent sex steroid hormones in the human body, little attention is given to dehydroepiandrosterone (DHEA) levels.

DHEA is a sex steroid hormone naturally produced by the human body. Adrenopause is characterized by declining or deficient dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) levels with little to no change in adrenocorticotropic hormone (ACTH) and cortisol levels. [1]

DHEA is responsible for preventing the human body’s synthesis of pro-inflammatory proteins like interleukin-6 (I-6). [2] DHEA levels peak in adolescence may fall as low as 10% to 20% of this peak level. [2] Such a rapid decline of dehydroepiandrosterone levels can quickly lead to clinical DHEA deficiency. Declining or deficient DHEA levels may cause suppressed immune function, osteoporosis, cognitive decline, muscle loss, and cardiovascular diseases. [1][3]

This article will discuss the cause(s) of, dangers of, and treatment options for adrenopause.

What Causes Adrenopause

FatiguedAdrenopause can occur in otherwise healthy individuals as a result of the normal gaining process. DHEA and DHEA-S are the most abundant sex steroid hormones in the human body. [2]

DHEA is predominantly produced in the adrenal gland so it’s a component of the critical hypothalamic-pituitary-adrenal axis. [4] DHEA production is also stimulated by the adrenocorticotropic hormone (ACTH) and male testis but to a lesser degree. [2]

DHEA levels in the blood and saliva slightly and slowly decrease beginning after adolescence. After age 40 DHEA significantly decreases each subsequent decade. [5] While infection or illness may decrease circulating DHEA, many researchers believe the primary driver is the body’s natural aging process.

For 18 to 40 year old males and females DHEA levels range between 1.33 ng/mL and 7.78 ng/mL. This range drops to 0.63ng/mL and 4.7ng/mL after age 40 for both males and females. [2] To detect adrenopause as early as possible begin closely monitoring DHEA levels in your 40s and beyond.

DHEA saliva levels are up to 150% higher immediately upon awakening compared to 11:00am levels and significantly drop again prior to bedtime. [5] It’s important to test DHEA levels at both the peak and valley time to see the average level and daily fluctuation.

The Dangers of Adrenopause

If left undetected or untreated the decline of DHEA and DHEA-S levels poses a number of critical health risks. Adrenopause may expedite the weakening of bones, the build-up of fatty plaque material on the inner walls of the arteries, and lower the body’s natural ability to fight sickness and infection. [1]

Researchers found a strong association between low DHEA levels in men and erectile dysfunction as well as cardiovascular-related death. [2] Postmenopausal women with low DHEA-S have significantly increased risk of overall and cardiovascular-related death. [2] Adrenopause also contributes to muscle tissue loss, decreased bone density, and decreased brain function. [3]

All of these health complication degrade your quality of life and may substantially increase the risk of serious illness or even death. Luckily there’s very straightforward and affordable ways to raise DHEA levels throughout the entire body.

Aging Man

Treatment of Adrenopause

DISCLAIMER: If you suspect symptoms of adrenopause please consult your healthcare profession before beginning any treatment option.

The most affordable and straightforward treatment method for adrenopause is exogenous DHEA supplementation. Unlike growth hormone replacement therapy (GHRT) and testosterone replacement therapy (TRT), DHEA is sold over-the-counter in the United States legally and without a prescription but it’s considered a hormone in Europe. [2] However, exogenous DHEA supplementation is prohibited at all times by the World Anti-Doping Agency. [6]

DHEA can be consumed orally or injected underneath the skin (subcutaneously). The recommended dose of exogenous DHEA varies based on your age, gender, natural DHEA levels, and reason for supplementation.

The Mayo Clinic provides the following recommended dose ranges for a variety of well-known health issues: [7]

  • Increase Muscular Strength: 50-150mg/day by mouth
  • Prevent Muscle Wasting and Weakness: 100-400mg/day by mouth or inject 200mg/day of DHEA-S in to the vein
  • Improve Libido and Sexual Dysfunction: 20-400mg/day by mouth
  • Treat Adrenal Insufficiency Symptoms: 20-200mg/day by mouth
  • Improve Immune System Function: 50mg/day by month
  • Treat Chronic Fatigue Syndrome: 500mg/day by mouth
  • Increase Bone Density: 50-200mg/day by mouth
  • Treat Depression: 5-500mg/day by mouth
  • Slow or Reverse Skin Aging: 0.1-2% DHEA topical solution applied 1-2 times daily to the face, hands, upper chest, and thighs

*Please note that the dose duration varies based on health issue. Please do not begin high-dose, long-term DHEA supplementation without consulting your healthcare professional.

Fit Couple RunningThere’s a growing body of research on orally administered DHEA supplementation. At a high level exogenous DHEA may improve lipid metabolism, muscle mass, strength, perceived well-being, hormone levels, cognitive function (as measured by verbal fluency), and bone metabolism. [8][2]

The findings are mixed based on the patients’ age and gender, but DHEA seems most effective for those older than 40 going through adrenopause. Daily doses of 25 to 100mg per day, irrespective of weight and gender, are most commonly used to treat adrenopause. [9]

In both males and females DHEA supplementation improves mobility, decreases fall and fracture risk, improves physical performance, and decreases symptoms of depression. [2] DHEA can also increase insulin-like growth factor 1 (IGF-1) levels by 10-20% in both genders. [10] Increasing IGF-1 minimizes your likelihood of developing somatopause as well as improves brain function and body composition.

In 40 healthy males with more than one year of weight training 50mg of DHEA administered twice per day for 12 weeks increased lean body mass by 0.8kg and strength by 6.8kg above placebo without harmful effects on the prostate, liver, or lipid blood levels. [11] Ten males with an average age of 23 consumed 50mg of DHEA and experience androstenedione blood level increases of 150% 60 minutes post-DHEA consumption. [12]

A study of two male soccer players ages 19 to 22 found that DHEA significantly increased testosterone but also increased estradiol, the primary female sex steroid hormone. [13] In middle-aged males DHEA appears to significantly increase DHEA-S and free testosterone levels after performing high intensity interval training (HIIT) without affecting total testosterone levels. [14]

Free testosterone is generally a better indicator of hormonal health and function. A study on 24 males with an average age of 65 consumed 50mg of DHEA or placebo daily at bedtime for two months; those consuming DHEA experienced increased platelet cyclic guanosine-monophosphate (cGMP) concentration, testosterone, and oestradiol while decreasing plasminogen activator inhibitor (PAI)-1 antigen and LDL (bad) cholesterol levels. [15]

These findings suggest DHEA is an effective treatment for altering hormone levels, increasing blood flow, and decreasing risk of cardiovascular disease. While moderate DHEA supplementation benefits males of all ages, extremely caution should be taken for those with normal natural DHEA levels.

In women 25mg/day of DHEA for 12 months increased HDL (good) cholesterol, decreased LDL (bad), cholesterol, and lowered triglyceride levels. [2] 50mg of DHEA per day doubled testosterone levels, improved bone turnover, skin quality, well-being, and libido in women over 60 years old. [10] Their skin showed improved hydration, epidermal thickness, sebum production, and pigmentation. [16]

A study of 99 older women which low DHEA-S levels experienced significantly improved lower body strength and function after combining 50mg of DHEA daily with twice weekly light exercise. [17] While DHEA supplementation may not be the fountain-of-youth, it does offer a number of promising benefits, particularly in older adults experience adrenopause.

Oral DHEA supplementation between 25 and 1,600mg is well tolerated in both males and females. [2] Most users take between 25 to 100mg of DHEA making the likelihood of side effects extremely low.

One study Moderate doses of DHEA for extended time periods don’t increase prostate volume or prostate-specific antigen (PSA) in older men. [2] This is great news for males looking to improve their hormone profile without increasing their risk for prostate cancer.

The most common side effects in women are mild acne, dermatitis, facial hair growth, and ankle swelling. [2] These side effects were rarely reported and significantly decreased or disappeared after discontinuing DHEA supplementation.

While DHEA supplementation appears to offer numerous benefits it effects vary based on gender. While DHEA may positively affect both androgen and estrogen production, it appears to increase androgens to a greater degree in women and estrogens to a greater degree in men. [2]

Males may want to stack DHEA with an aromatase inhibitor compound that promotes DHEA-induced testosterone increases and lowers estrogen level increases by up to 33%. [18] Many online fitness supplement retailers sell high-quality DHEA capsules for oral consumption. The top 3 DHEA supplements on Tiger Fitness are listed below:

While oral DHEA supplementation is the least expensive and most easily accessible option, it does pose a major drawback – absorption by the body (bioavailability). If we consider subcutaneous DHEA injection the golden standard with 100% bioavailability, oral DHEA bioavailability may be as low as 3%. [19]

Those looking for a quick-fix to increase DHEA and DHEA-S blood levels should consider injection over oral consumption. However, numerous logs and testimonials across the Internet support the oral form of DHEA as an effective way to build muscle, drop fat, and increase sex drive.

Is 7-Keto DHEA the Same as DHEA?

Not exactly. While the names sound similar, 7-keto DHEA has a difference chemical structure compared to DHEA. 7-keto DHEA is a byproduct or metabolite of DHEA commonly used for fat loss due to its metabolic rate-increasing properties. [20] If you’re looking to maximize the potential benefits of DHEA discussed above you should choose a full DHEA supplement over a 7-keto DHEA product.

References

1) Szkróbka, W., R. Krysiak, and B. Okopień. “Adrenopause.” National Center for Biotechnology Information. Pol Merkur Lekarski., July 2008. Web.
2) Samaras, Nikolaos et al. “A Review of Age-Related Dehydroepiandrosterone Decline and Its Association with Well-Known Geriatric Syndromes: Is Treatment Beneficial?” Rejuvenation Research 16.4 (2013): 285–294. PMC. Web.
3) Valenti, G. “Adrenopause: an Imbalance Between Dehydroepiandrosterone (DHEA) and Cortisol Secretion.” National Center for Biotechnology Information. J Endocrinol Invest, 2002. Web.
4) Nawata, H., et al. “Adrenopause.” National Center for Biotechnology Information. Horm Res, 2004. Web.
5) Ahn, Ryun-Sup et al. “Salivary Cortisol and DHEA Levels in the Korean Population: Age-Related Differences, Diurnal Rhythm, and Correlations with Serum Levels .” Yonsei Medical Journal 48.3 (2007): 379–388. PMC. Web.
6) “2016 List of Prohibited Substances and Methods.” World Anti-Doping Agency. N.p., 2016. Web.
7) “DHEA Dosing.” Mayo Clinic. The Natural Standard Research Collaboration, 1 July 2014. Web.
8) Ohnaka, K., and R. Takayanagi. “Hormone Replacement Up-to-date. Adrenopause and DHEA Replacement Therapy.” National Center for Biotechnology Information. Clin Calcium, Sept. 2007. Web.
9) Römmler, A. “Adrenopause and Dehydroepiandrosterone: Pharmacological Therapy Versus Replacement Therapy.” National Center for Biotechnology Information. Gynakol Geburtshilfliche Rundsch, Apr. 2013. Web.
10) Martin-Du Pan, R. C. “Is There an Indication for Dehydroepiandrosterone (DHEA) Treatment in Elderly Women with Addison Disease? Beneficial and Adverse Effects of DHEA.” National Center for Biotechnology Information. Rev Med Suisse Romande, Sept. 2001. Web.
11) Wallace, M. B., et al. “Effects of Dehydroepiandrosterone Vs Androstenedione Supplementation in Men.” National Center for Biotechnology Information. Med Sci Sports Exerc., Dec. 1999. Web.
12) Brown, Gregory A., et al. “Effect of oral DHEA on serum testosterone and adaptations to resistance training in young men.” Journal of Applied Physiology. N.p., 1 Dec. 1999. Web.
13) Ostojic, S. M., J. Calleja, and M. Jourkesh. “Effects of Short-term Dehydroepiandrosterone Supplementation on Body Composition in Young Athletes.” National Center for Biotechnology Information. Chin J Physiol., Feb. 2010. Web.
14) Liu, T. C., et al. “Effect of Acute DHEA Administration on Free Testosterone in Middle-aged and Young Men Following High-intensity Interval Training.” National Center for Biotechnology Information. Eur J Appl Physiol., July 2013. Web.
15) Martina, V., et al. “Short-term Dehydroepiandrosterone Treatment Increases Platelet CGMP Production in Elderly Male Subjects.” National Center for Biotechnology Information. Clin Endocrinol (Oxf)., Mar. 2006. Web.
16) Baulieu, Etienne-Emile. “Dehydroepiandrosterone (DHEA), DHEA Sulfate, and Aging: Contribution of the DHEAge Study to a Sociobiomedical Issue.” Proceedings of the National Academy of Sciences. N.p., 11 Apr. 2000. Web.
17) Kenny, A. M., et al. “Dehydroepiandrosterone Combined with Exercise Improves Muscle Strength and Physical Function in Frail Older Women.” National Center for Biotechnology Information. J Am Geriatr Soc, Sept. 2010. Web.
18) Frank, Kurtis, and Sol Orwell. “Dehydroepiandrosterone.” Examine.com. N.p., 2016. Web.
19) Labrie, C., et al. “High Bioavailability of Dehydroepiandrosterone Administered Percutaneously in the Rat.” National Center for Biotechnology Information. J Endocrinol, Sept. 1996. Web.
20) Frank, Kurtis, et al. “7-Keto DHEA.” Examine.com. N.p., 2016. Web.

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Name: Nick Ludlow

Bio: When it comes to fitness I enjoy reading about historic weight lifters, non-conventional weightlifting approaches, nutritional protocols, and the science behind supplements.