https://www.womentowomen.

com/adrenal-health-2/dhea-and-adrenal-imbalance/
DHEA and Adrenal Imbalance by Marcelle Pick, OB/GYN NP
Two months ago, Lisa, a 28-year-old mom, came to see me. She was so worn out fro
m mothering two kids and working full-time she couldn t get out of bed. Just drivi
ng to our practice took everything she had. Her tests revealed severe adrenal im
balance and, as so often occurs in these cases, very low levels of an important
hormone called DHEA.
Many women are overwhelmed with lifeDHEA is a natural steroid and precursor horm
one produced by the adrenals. It s also available at health food stores and on-lin
e as an over-the-counter supplement. Manufacturers hype it as a magic cure-all f
or many things: muscle loss, weight loss, osteoporosis, and depression even meno
pause. Recently headlines have linked DHEA to athletes doping with steroids, leadi
ng to a lot of confusion about DHEA, it s role in the body, and how it should be u
sed. Now DHEA is being labeled everything from fountain of youth drug to fraud and
the very real benefits of DHEA, particularly for women, are getting lost in all
the controversy. The truth is that
for the women who need it
adrenal support wi
th DHEA supplementation can make a big difference. I ve seen it help patients get
going again when they feel like they ve hit rock bottom. But it s never as simple as
just popping a pill. When used appropriately
in a therapeutic setting under med
ical supervision DHEA is a critical component to jumpstarting hormonal balance.
Just ask Lisa. After two months of treatment that included lifestyle changes and
adrenal support with low daily doses of DHEA, she feels like herself again.
So let s give you more information about DHEA and it s role in hormonal balance. The
n you can talk to your healthcare professional and make the best choice for your
individual needs.
Adrenal Feeling Wired Nutritional Supplement System
What is DHEA?
Dehydroepiandrosterone, or DHEA, is a steroid hormone synthesized from cholester
ol and secreted by the adrenal glands. The adrenals are walnut-sized organs loca
ted right above your kidneys. The average adult makes about 25 mg of DHEA per da
y (some more, some less) with dwindling production as we get older. Men at all a
ges have more DHEA than women.
SS Woman Adrenal Glands Color FrontNatural DHEA production is at its highest in
your twenties: by the time we reach seventy we only make about 20% of the DHEA w
e had when we were young. A decline in DHEA with the passage of time is clearly
what nature intended and as far as we know, a healthy process. This is only one
of the major reasons we don t recommend self-prescribing DHEA through over-the-cou
nter products.
Another reason is that DHEA is a very powerful precursor to all of your major se
x hormones: estrogen, progesterone, and testosterone. (It s molecular structure is
closely related to testosterone). We call it the mother hormone
the source that f
uels the body s metabolic pathway:
Besides DHEA, your adrenals also make the stress hormones cortisol and adrenalin
e. Adrenal exhaustion from coping with chronic stress
from (among other things)
poor nutrition, yo-yo dieting, emotional turmoil, and job-related stress means y
our adrenals are bone-tired from pumping out cortisol and they simply can t manufa
cture enough DHEA to support a healthy hormonal balance. The end result? You fee
l tapped out, overwhelmed and, often, depressed.

It s likely that DHEA and adrenal function are related to neurotransmitter-release

rates, based on the mood elevation our patients report after just two weeks of
adrenal support. But more research is needed to isolate the individual effects o
f DHEA from the hormones it gets metabolized into before we can know for sure wh
at part it plays in all of this.
One thing we do know is that
ody can produce the hormones
your mood is stable and you
best feel-good hormone we
ith the right combination of

adequate levels of DHEA are needed to ensure your b

it needs when it needs them. In that balanced state
feel clear-headed, joyful and vigorous. DHEA is the
know. And it works quickly and effectively when taken w
support.

When DHEA levels are low, your body does not have enough working material for pr
oper endocrine function. This throws off your hormone production and you feel a
general sense of malaise, along with other symptoms of hormonal imbalance
how se
vere depends on how many other demands are being made on your body at the same t
ime.
There is a growing body of evidence that healthy levels of DHEA may help stave o
ff Alzheimer s disease, cancer, osteoporosis, depression, heart disease and obesit
y, but there is still no clearcut consensus. There may be some increased risks a
ssociated with DHEA for women with a history of breast cancer
all the more reaso
n to take DHEA under medical supervision.
At our practice we use DHEA where we ve seen reliable proof of efficacy
f adrenal imbalance.

in cases o

DHEA and Adrenal Imbalance

Your lifestyle, diet and stress levels all contribute to the amount of DHEA your
body can produce in a given period. At our practice we look first and foremost
at adrenal function, using DHEA levels as one of several diagnostic tools.
Think of our exhausted mother, Lisa. Like her, your adrenals work tirelessly to
meet the demands placed on them until they are utterly tapped. Without adequate
support, they spiral downward into adrenal imbalance and eventually adrenal exha
ustion.
Most of the women we see at our practice and I mean 99%
have some indication of
adrenal imbalance, including symptoms of low DHEA levels, such as:
depression, hormone, women, health, adrenalExtreme fatigue
Decrease in muscle mass
Decrease in bone density
Depression
Aching joints
Loss of libido
Lowered immunity
But simply adding more DHEA to the equation is not the answer
despite what some
of the popular products claim. DHEA alone can t fix adrenal imbalance (don t believe
any product that says it will!), but it can be an important factor in a combina
tion approach that includes hormonal and nutritional support, lifestyle changes,
and proper rest. For more information on adrenal function and adrenal exhaustio
n, see our extensive list of articles in our Adrenal Health section.
Remember that DHEA is just one stop along the metabolic pathway it doesn t work in
a vacuum. How it gets converted comes down to your individual biochemistry some
women may use it to make more estrogen, others may make more testosterone. Just
throwing a pill into the mix without understanding the bigger picture is never
a wise choice. Because having too much DHEA, or converting DHEA into too much of

one hormone and not enough of another, can be as upsetting to your body as not
having enough.
A delicate hormonal balance
So, you can t look to DHEA supplementation as a stand-alone solution. It just does
n t work that way. DHEA is one part of the whole concert of hormones at work every
moment in your body. Before you tinker with that balance it s a good idea to unde
rstand what is going on in your life on all levels physiologically and emotional
ly.
dhea, balance, hormones, women, imbalanceAfter menopause or a hysterectomy, when
your adrenals become the primary hormone factory, we see women in whom the rati
o of DHEA that is converted into testosterone outweighs what s converted into estr
ogen and progesterone. This can cause bouts of increased irritability and unusua
l body hair growth, especially when DHEA supplements are given without prior and
follow-up testing of total and free testosterone levels.
Free testosterone is the portion of the hormone that is biologically active in you
r bloodstream. After menopause, a woman may have volatile levels of free testost
erone at work, which accounts for some of the annoying male-pattern facial hair
that s common during the transition. Most doctors only test total testosterone lev
els, not the combined amount. Adding DHEA to this scenario can tip the scale dra
stically.
On the other hand, I ve also seen patients who convert most of their DHEA into est
rogen. In this case, DHEA supplements create a different kind of estrogen-proges
terone imbalance with symptoms similar to PMS, including breast tenderness and m
ood swings. For more information, see our article about estrogen dominance.
Even though we ve been trained in our culture to expect a one-size-fits-all drug c
ure for every health issue, ingesting a powerful hormone like DHEA can be unpred
ictable and in some cases, risky. That s why we advise our patients not to self-me
dicate.
The trouble with over-the-counter DHEA supplements
Nowadays you can buy DHEA over-the-counter as a matter of course in a confusing
variety of doses and combinations. Most of these DHEA products are geared toward
men, but I m seeing more and more aimed at women.
vitamins, supplements, women, health, dhea, hormonesThe labels claim DHEA will h
elp us lose weight, rev up our libido, lift depression and give us back the stre
ngth, immunity, and stamina we had when we were 20
the age at which our bodies n
aturally produced the most DHEA. While on the surface this is appealing (who wou
ldn t want to feel 20 again?), it s obviously not what nature intended. We also don t
know enough about DHEA to be conducting such a large, unregulated public experim
ent. DHEA is a potent steroid
that s why it s been in the headlines and why it shoul
d be approached with due diligence.
Without a comprehensive medical test it s impossible to know what your DHEA levels
are. Just because you re getting older doesn t automatically mean you re deficient. R
emember, this is a natural substance our bodies can produce more or less of it d
epending on our nutrient support, metabolism, hormonal balance, activity level a
nd emotional state.
In fact, there are many studies that show you can improve your DHEA levels natur
ally by maintaining a body mass index of 19-25, getting adequate rest and exposu
re to sunlight, exercising regularly (including sexual activity), and fostering
more downtime in your life but more on that in a moment.

Also remember that any time you buy a supplement at a health food store, you hav
e no guarantee that what you are buying is the real deal. There are few regulati
ons in place to police the manufacturing process or the product itself. This is
the reason we have formulated our own Women to Women supplements, made specific
ally for us by a manufacturer who tests every single batch.
Open Pill GreenMany of the DHEA supplements I see at my local store have very hi
gh dosages
way too high for most women (often as much as 20 times what I start m
y patients on!). While there s no way to tell how much of that you might actually
absorb, I think it s especially unwise to experiment with DHEA at these levels wit
hout medical supervision.
Furthermore, taking DHEA alone won t do any good if your adrenals are exhausted. T
here are too many other factors at work. You need to know the status of your adr
enal function and your other hormones before you can even begin to know what kin
d of combination of support your body needs.
That being said, if you ve been taking a DHEA enhanced product
don t worry! Just cal
l your doctor or medical practitioner and ask to get your hormones tested
then y
ou will know how to proceed.
How we test for DHEA at our practice
Saliva adrenal profiles can also be used to look at DHEA along with cortisol lev
els. If I suspect adrenal imbalance, hormonal imbalance or a DHEA irregularity i
n a patient, I often order is an adrenal panel. Using blood tests, I check estra
diol in the follicular phase (usually days 3 9 of a menstrual cycle); progesterone
in the luteal phase (days 14 28); DHEA-S; and both free and total testosterone le
vels. I like to see estrogen, progesterone, and DHEA in the upper quadrant of no
rmal.
What many traditional medical practitioners consider normal is a little low in m
y opinion. I think there are many women who fall just shy of the bell curve in e
ither direction, but still in the range of normal by current standards, who have l
egitimate health problems. And when such women go to a conventional practitione
r feeling awful they are told that there s nothing wrong.
But I don t just go by the numbers. I always look at how a woman is feeling; what
demands she s placing on her body
particularly her adrenals
and her emotional stat
e. Sometimes a woman can test normal by conventional standards and still need a
slight, temporary boost.
What if you need DHEA?
If tests indicate the need for DHEA supplementation, I start patients off
s little as 1-5 mg, under the tongue, two times per day. It s possible to
p the dosage if further tests warrant it, but I find I rarely need to use
han 10 12 mg sublingual per day
a physiological dose. We do not suggest
exceed 25 mg per day if capsule forms are used.

with a
slowly u
more t
any woman

SS Brunette Dr Okay SignI use only pharmaceutical-grade DHEA compounded by a rep

utable pharmacy. That way I can be confident that what I m prescribing is actually
what the patient will get. The kind I use comes in liquid sublingual drops
I pr
efer them to tablets. If your doctor is unaware of a reliable compounding pharma
cy in your area, log in to the International Academy of Compounding Pharmacists
website to access their referral service.
Once a patient is taking DHEA, I closely monitor how she is metabolizing the hor
mone through regular tests and face-to-face check-ups. Many women don t need to ta

ke DHEA for an extended period of time

once our bodies return to balance and we
make lifestyle changes, we re usually more than capable of making what we need.
Many of my patients in menopause who are taking bioidentical hormones also take
DHEA to promote a good overall balance and vice-versa. DHEA can be a great bridg
e through menopause. Again, once balance has been restored and symptoms even out
, most women produce enough DHEA on their own.
Which brings me to the point I most want to make about DHEA
.

it s connection to joy

The best way to make more DHEA: cultivate joy

As I said before, DHEA is just one small part of a much larger picture one that
you can exert considerable influence over. Our bodies produce DHEA all the time.
And it s possible to measurably boost your body s own production of DHEA naturally.
Some studies show that people with a positive outlook actually create a self-sus
taining cycle of DHEA production: they produce more DHEA, which may affect their
levels of serotonin (the happy neurotransmitter; for more about this, see our a
rticles about antidepressants), which in turn gives them a better outlook
which
ups DHEA and so on.
One proven way to boost levels of DHEA naturally is to find ways to cultivate jo
y in your life. This can mean different things to different people but overall t
here are some common threads when weaving this web of joy:
Connection: Human beings are social creatures
we like companionship. Connecting w
ith family and friends in a healthy, loving way is one of the best joy-makers ar
ound. Or think long and hard about what you like to do for pleasure and reach ou
t. Join a local class or group that shares your interest.
Exercise: Moving your body, even through deep breathing and mild stretching, re
duces stress, oxygenates your cells, and boosts mood-elevating substances in you
r bloodstream called endorphins. This process can actually change your body chem
istry for the better. Meditation is also useful in this way.
Spirituality: The ability to entertain the idea of some sort of
e it natural or divine, is a powerful component of joy. Rituals of
ontemplation, from a walk in the woods to yoga to prayer, helps us
our busy lives to focus on what is truly meaningful to us and who
.

larger power, b
worship and c
make space in
we really are

Play: Is it a coincidence that our levels of DHEA decline as we enter the grownup world of work and responsibility? Who knows? It would be interesting to find
out. But one thing is certain: playtime shouldn t be just for kids. Sometimes I ac
tually have to write out a prescription that reads PLAY so a patient can have fu
n without guilt. You too have my medical permission: go out and play. Kick up yo
ur heels it s good for your health!
I know none of this is easy to do in today s non-stop world. Everything around us
pushes us to have more, do more, be more is it any wonder our bodies eventually
throw up a huge stop sign? The best time to foster hormonal balance, adequate DH
EA levels, and healthy adrenals is before you hit that stop sign. So give yourse
lf a time-out and check-in. You may find, with a little help, your body and mind
are more than capable of taking care of themselves.
The evolving wheel
Feelings of health and well-being are never static. Like all things natural, the

y depend on a kaleidoscope of moving parts

always changing, always unique. DHEA
is just one part of this evolving pattern, one you can influence to create a bet
ter picture by changing your lifestyle and taking care of your adrenals. For mor
e on this, read our many articles in our Adrenal Health section.
As with all things concerning your body, your mind, and your health, I hope you ll
learn as much as you can about yourself and find a medical practitioner you can
talk openly with. DHEA should never be taken casually or unsupervised, but it s b
enefits are real for the women who need it as are the physiological benefits of
cultivating joy. I encourage you to embrace the possibilities inherent in both!