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Dr Lowe Q&A – DHEA

June 7, 2003

Question: I read your June 6, 2003 answer to another patient who takes DHEA. You wrote that you cant conclude that DHEA will lower a patients cortisol level. But Ive been reading Dr. Barry Durrant-Peatfields book The Great Thyroid Scandal and How to Survive It.[1] On page 99, he explains how DHEA lowers the cortisol level. How do you reconcile that your opinion is different from his?

Dr. Lowe: Youve misunderstood the statement by Dr. Durrant-Peatfield on page 99 of his book. Dr. Durrant-Peatfield, of course, is extremely knowledgeable about cortisol and DHEA, and his statement on that pagelike the content of his entire book – is clear, which this is one of many reasons that I strongly recommend the book to patients. Despite its clarity, however, I can see how you might misinterpret the statement.

Inside the cells of the adrenal cortex is an enzyme thats dependent on the vitamin panthothenic acid. When cholesterol enters the adrenal cells, this enzyme converts it to pregnenolone. Dr. Peatfield explains quite correctly that pregnenolone is the “pro-hormone” of the adrenal cortex. This means that its the hormone from which all the other hormones of the adrenal cortex are derive.

Some of the pregnenolone is converted to cortisol. But some patients adrenal cortex cells dont convert pregnenolone to cortisol at a normal rate. As a result, the patients cortisol levels may decrease. As Dr. Durrant-Peatfield writes, in these patients, the pregnenolone that would have been converted to cortisol may insteadbe converted to DHEA. This may raise the patients DHEA levels, and it may increase the ratio of DHEA to cortisol. Researchers have found this pattern – an increased ratio of DHEA to cortisolin patients with panic disorder.[2]

In summary, cells of the adrenal cortex may use less pregnenolone to produce cortisol, and this may divert more pregnenolone into the pathway that leads to DHEA. If so, lab tests may show a low ratio of cortisol to DHEA. This does not mean, however, that DHEA has suppressed the cortisol level. As Dr. Durrant-Peatfield suggests, it simply means that the cells of the adrenal cortex have increased their production of DHEA at the expense of cortisol.

References:

[1] Durrant-Peatfield, B.: The Great Thyroid Scandal and How to Survive It. London, Barons Down Publishing, 2002.

[2] Fava, M., Rosenbaum, J.F., MacLaughlin, R.A., et al.: Dehydroepiandrosterone-sulfate/cortisol ratio in panic disorder. Psychiatry Res., 28(3):345-350, 1989.

June 6, 2003

Question: Ive read that taking DHEA lowers patients cortisol levels. My doctor measured my level and said it is borderline low. For several years, Ive taken 10 mg of DHEA. This is supposed to be a small dose, but do you think the 10 mg of DHEA is the cause of my borderline low cortisol level?

Dr. Lowe: The question of whether DHEA will lower a patients cortisol level is interesting. Unfortunately, its one for which we dont have a definite answer. The reason is that study results are contradictory.

In one study, the cortisol level of healthy older men and women was lower after they took 200 mg of DHEA each day.[1] In another study, though, the secretion of cortisol at night in healthy men didnt decrease after they took a single dose of 500 mg of DHEA.[2] In another study, perimenopausal women took 50 mg of DHEA for three months. Their blood cortisol level was 13% lower at the end of the study.

[3] But in still another study, the cortisol level of schizophrenic patients taking 100 mg of DHEA each day didnt decrease.[4] Also, researchers gave 12 health rhesus monkeys huge amounts of DHEA for eight weeks. The equivalent dose of DHEA for a 150-pound human being would be 4090 mg for the first four weeks and 5114 mg for the second. During the eight weeks, the monkeys’ cortisol levels decrease.[5]

With such mixed study results, we simply cant conclude that DHEA will or wont lower a particular patients cortisol level. To learn whether it will or wont, we must test the patients cortisol response to DHEA on an individual basis.

References:

[1] Kroboth, P.D., Amico, J.A., Stone, R.A., et al.: Influence of DHEA administration on 24-hour cortisol concentrations. J.Clin. Psychopharmacol., 23(1):96-99, 2003.

[2] Friess, E., Trachsel, L., Guldner, J., et al.: DHEA administration increases rapid eye movement sleep and EEG power in the sigma frequency range. Am. J. Physiol., 268(1 Pt 1):E107-E113, 1995.

[3] Barnhart, K.T., Freeman, E., Grisso, J.A., et al.: The effect of dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life. J. Clin. Endocrinol. Metab., 84(11):3896-3902, 1999.

[4] Strous, R.D., Maayan, R., Lapidus, R., et al.: Dehydroepiandrosterone augmentation in the management of negative, depressive, and anxiety symptoms in schizophrenia. Arch. Gen. Psychiatry, 60(2):133-141, 2003.

[5] Haffa, A.L., MacEwen, E.G., Kurzman, I.D., et al.: Hypocholesterolemic effect of exogenous dehydroepiandrosterone administration in the rhesus monkey. In Vivo., 8(6):993-997, 1994.

 

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