I posed this same question to Dr. Dinoiii a few weeks ago. Below is his response:
I see patients in office with DHEA serum levels low as they progress in their years which brings up a very valid discussion on whether or not to entertain DHEA replacement - oral or otherwise - when confronted with documented low levels (we will leave out whether or not you actually measured them...this can be done at your cost if sincerely concerned through privatemdlabs.com). I think the effects are interesting and if we are trying to generalize (which is not always easy to do), we can probably consider the following data (collected from literature and my own clinical data combined).
< 65 years:
LH + FSH
Physically Active – no overt suppression upwards of 150 mg; minimally suppression thereafter
Sedentary – minimal suppression after surpassing 50 mg
Testosterone
Physically Active – no change
Sedentary – no change
Estrogen
Physically Active – minimal change, but usually requiring over 100 mg (haven’t seen changes in supplemental replacement doses of 25 or 50 mg; if using 50 mg bid tallying 100 mg, this may stave off estrogen changes as well)
Sedentary – as above for physically active
> 65 years:
LH + FSH
No overt suppression in sedentary individuals matching age-matched physically-active controls
Testosterone
Modest INCREASE in both groups
Estrogen
Modest INCREASE in both groups (within acceptable range)
Why do the physically active get better results in the young groups? I personally think it is due to the cortisol-lowering effect of DHEA, which is almost unanimous across the board. DHEA supplementation WILL lower cortisol! At the same time, how do we respect the testosterone/estrogen changes as cited above? Observe doses at minimum or avoid supplementation altogether due to our limited knowledge (I mean, if you supplement high enough, it should come as no surprise that the higher you go…the more likely you are to suppress natural levels. Hell, the same can be said for supplemental testosterone; if you use enough, it’s suppressive – we all know that…BUT at the same time, low-dose hormonal replacement does not always impact the HPGA in the same way.).
It has been suggested that there is currently no scientific reason to ever prescribe DHEA, but I would suggest some contrary evidence from literature and practice….
Caveats
1. DHEA has NO USE in supplemental regimen of post-cycler with concurrent use of SERM; in fact, DHEA may negate any benefits seen with a SERM (only study that exists is with Nolva, BUT it was interesting enough to dissuade my use with any patients on SERMs); outside of this, there are likely some cases where supplemental DHEA is of positive or equivocal benefit
2. DHEA likely of NO USE in supplemental regimens of men less than 35 years of age; of QUESTIONABLE USE at low dose in supplemental regimens of men between age 35-65 years; and of MODEST BENEFIT to those over the age of 65
3. Even groups younger than 35 years of age still may see acute cognition and memory benefits through stimulation of the Anterior Cingulate Cortex (ACC) as suggested by literature though I have NOT cared to test this theory in practice…for sheer pontification, it would probably be seen best with high-dose (why I wouldn’t suggest it) at say a week or less in more of a pulsatile fashion if you try and translate the literature, BUT I would stay away from it myself.
4. Mixed review on cardiovascular data; Overly positive data on insulin resistance (probably mostly an anti-cortisol effect coupled with anti-oxidative effect through lowering of pentosidine)
5. Longevity – boy, if patients are followed long enough (> 15 years); there is a mortality benefit. In other words, if followed less than that timeframe, studies have come out negative…BUT the lowest levels of DHEA-S in men were associated with a shorter life span (which is why I am even open to guys between the ages of 35-65 years taking it with an equivocal offering on hormonal changes you may not enjoy – androgenic/estrogenic), BUT I would hope if this was being employed … people would consider verifying this with serum levels as opposed to blindly supplementing.
Keep in mind, the above is for DHEA alone (not necessarily all metabolites or byproducts - some of which we know to be "safe" in this regard...7-keto --> 7-OH --> bAET)
You may or may not see what I have done here. I have tried to offer up the most objective set of conditions to time periods where people can make the best informed decision on taking DHEA or not as long as it remains an OTC supplemental option. I will NOT suggest anyone take it without full understanding of your case and/or an in-person physical exam and evaluation; so this is the best I can provide you in this setting.
D_