Natural Treatments for Elevated DHEA

Dehydroepiandrosterone (DHEA) is the principal human C-19 steroid. DHEA has very low androgenic potency but serves as the major direct or indirect precursor for most sex steroids. DHEA is secreted by the adrenal gland and production is at least partly controlled by adrenocorticotropic hormone (ACTH).

The bulk of DHEA is secreted as a 3-sulfoconjugate dehydroepiandrosterone sulfate (DHEAS). Both hormones are albumin bound, but DHEAS binding is much tighter. As a result, circulating concentrations of DHEAS are much higher (>100-fold) compared to DHEA. In most clinical situations, DHEA and DHEAS results can be used interchangeably. In gonads and several other tissues, most notably skin, steroid sulfatases can convert DHEAS back to DHEA, which can then be metabolized to stronger androgens and to estrogens.

Within weeks after birth, DHEA/DHEAS levels fall by 80% or more and remain low until the onset of adrenarche at age 7 or 8 in girls and age 8 or 9 in boys. Adrenarche is a poorly understood phenomenon, peculiar to higher primates, that is characterized by a gradual rise in adrenal androgen production. It precedes puberty but is not casually linked to it. Early adrenarche is not associated with early puberty or with any reduction in final height or overt androgenization. However, girls with early adrenarche may be at increased risk of polycystic ovarian syndrome as adults.

Following adrenarche, DHEA/DHEAS levels increase until the age of 20 to a maximum roughly comparable to that observed at birth. Levels then decline over the next 40 to 60 years to around 20% of peak levels.

Elevated DHEA/DHEAS levels can cause signs or symptoms of hyperandrogenism in women. High levels may be due to PCOS, congenital adrenal hyperplasia, insulin, stress, elevated prolactin, alcohol and certain medications like ADD medications, Xanax and Wellbutrin.

Most mild-to-moderate elevations in DHEAS levels are of unknown origin. However, pronounced elevations of DHEA/DHEAS may be indicative of androgen-producing adrenal tumors. In small children, congenital adrenal hyperplasia (CAH) due to 3 beta-hydroxysteroid dehydrogenase deficiency is associated with excessive DHEA/DHEAS production. Lesser elevations may be observed in 21-hydroxylase deficiency (the most common form of CAH) and 11 beta-hydroxylase deficiency.

Origins of lower elevations of DHEA and DHEA-s include:

  • Chronic daily stress

  • PTSD

  • PCOS

  • Elevated prolactin

  • Non-classical adrenal hyperplasia

Symptoms of elevated DHEA include:

  • High DHEA can cause symptoms of androgen excess including oily skin, acne, sleep problems, headaches and mood disturbances.

  • In some cases, highly androgenic people may show high levels of both DHEA or testosterone without negative clinical consequence.

  • Symptoms include:

    • Difficulty in controlling weight

    • Acne or oily skin

    • Excess hair growth all over the body (hirsutism).

    • Male patterned baldness

    • Generalized fatigue or low energy

    • Irritability, anger or depression (and other changes in mood)

    • Infertility

    • Changes to your voice (a deeper voice in women)

    • Changes to muscle structure (increase in muscle mass)

    • Aggressive behavior

    • Reduction in breast size

    • Known history of PCOS

    • Recent history of stress

Management of elevated DHEA:

  • High DHEA can be managed with blood sugar balancing lifestyle, stress reduction and in appropriate cases Ashwagandha and other supplements.

  • If possible find and eliminate the source of stress

  • Manage stress

  • Consider supplementing with the adrenal adaptogen Ashwagandha  has been shown to reduce enzyme production in individuals with adrenal hyperplasia.

  • Ashwagandha has also been shown to help balance cortisol levels which is also helpful if stress is worsening your DHEA. Dosing500mg per day but note that some people may need up to 2,000mg per day. 

  • Consider further supplementation to improve adrenal function such as:

    • Alpha Lipoic Acid

    • Phosphatidyl Serine A dose of 200 mg of phosphatidylserine/phosphatidic acid complex per day may help to normalize ACTH and serum cortisol secretion in chronically-stressed individuals. 800 mg of phosphatidylserine per day blunted the stress-induced activation of the HPA axis.

    • L-Theanine: Found in green tea, L-theanine has been found in mice to protect normal ACTH secretion in the presence of stress via modulation of the HPA axis.

    • Hypericum perforatum: In patients with PCOS who also display symptoms of depression or anxiety related to stressors, St John’s wort has been found to attenuate the plasma increases of ACTH.20 As women with PCOS are at increased risk for depression and anxiety,

    • Melatonin When administered at bedtime in patients who are deficient in this hormone or who have sleep disorders, melatonin may help reduce ACTH stimulation of the adrenal gland.

    • Rhodiola rosea: The active ingredient in rhodiola, salidroside, has been found in animals to attenuate CRH expression in the hypothalamus and significantly reduce the levels of cortisol, thereby improving depressive symptoms and regulating the HPA axis.

    • Schizandra chinensis: This herb is often used in Traditional Chinese Medicine for the treatment of stress. A 2007 study found that schizandra was an effective protector against stress-related increases in cortisol, protein kinase, and nitric oxide in rabbits.

    • Lavandula officinalis: Inhalation of the vapor of lavender oil has been found to decrease plasma ACTH levels25 and reduce self-reported anxiety.

    • Some adaptogenic herbs may increase serum androgens, it is important to consider contraindications before prescribing commonly used adaptogen formulas.

  • Lifestyle

    • It’s important to not overlook the benefits of stress reduction via lifestyle modifications, including meditation, deep breathing, visualization and other mindfulness activities.

    • Quality sleep

    • Reduce refines carbohydrates and sugars

    • Restorative exercise

  • Gut Repair

    • There exists an important connection between the gut and the HPA axis. Probiotics that improve intestinal permeability have been found to attenuate the response of the HPA axis to stress. It’s also known that cortisol increases intestinal permeability through mast cell-dependent mechanisms; as such, women with PCOS who make excessive adrenal steroids may be at increased risk.

  • Anti-androgen Therapeutics

    • Many significant clinical problems related to excess adrenal androgens occur due to their conversion to testosterone or DHT. Anti-androgen therapies may be particularly beneficial for women with androgen-related hirsutism, acne, androgenetic alopecia, and androgen-related menstrual irregularities, who wish to avoid the side effects of conventional approaches such as spironolactone or finasteride.

    • Spearmint Tea: At a dosage of 1 cup BID, spearmint tea has been shown in 2 studies to have anti-androgenic properties. Over a 30-day period, spearmint tea brought about a significant reduction in free and total testosterone levels in a group of 42 women with confirmed PCOS and hirsutism.30

    • Glycerrhiza glabra: Licorice was found in a 2004 trial to significantly decrease testosterone levels in healthy female patients after 1 month of treatment. The study concluded that licorice may exert its anti-androgenic action through blocking 17-hydroxysteroid dehydrogenase and 17-20 lyase. The glycyrrhizin and glycyrrhetic acid constituents of licorice have significant anti-androgen effects, which may be helpful in reducing androgenic symptoms in women with PCOS.

    • Paeonia lactiflora: Peony is another popular anti-androgenic herb. It is often combined with Glycyrrhiza glabra in a ratio of 1:1 in Traditional Chinese Medicine for the treatment of PCOS. Studies have found that this combination is able to decrease the production of testosterone without altering the production of androstenedione and estradiol.

    • Camellia sinensis: For patients with androgenetic alopecia, hirsutism, or acne, Camellia sinensis (green tea) may be of benefit. Epigallocatechins in green tea are 5α-reductase inhibitors, which decrease the production of DHT. As green tea can also increase sex hormone-binding globulin, it can be helpful in patients with elevated free androgens.

    • Serenoa repens: Saw palmetto is a well-known plant-derived anti-androgen. By moderately inhibiting the enzyme 5α-reductase, saw palmetto shows promise in the treatment of androgenetic alopecia.

    • Ganoderma lucidum: Among its many health benefits, reishi mushroom exerts a significant anti-androgenic action.38 Research suggests that its triterpenoid fraction in an ethanol extract is able to inhibit both type 1 and type 2 5α-reductase.39 In addition, it appears to suppress the growth of cells that are stimulated by testosterone itself, suggesting that it may also have a role to play as an androgen receptor blocker.

    • Rosmarinus officinalis: As a topical therapy for androgenetic alopecia, rosemary leaf extract was found in a 2013 study to improve hair regrowth in mice with androgen-induced hair-growth interruption. The extract showed inhibitor activity upwards of 82.4% in inhibiting 5α-reductase, and also decreased the binding of DHT to androgen receptors.

High DHEA levels can be a very serious indicator of deeper problems, thus it is necessary to assure that possible origins of elevated levels are properly evaluated.

  • High DHEA levels in females are often associated with PCOS.

  • High levels of DHEA are associated with a higher risk of breast cancer.

  • High DHEA levels in females also may indicate an adrenal gland tumor or overactive adrenal glands

  • High DHEA levels in females also seem to be associated with Cushing’s syndrome