To Your Health

Q. I want to try a supplement of DHEA. Is it worth paying extra for 7-keto DHEA, since I've heard it has less chance of side effects?

A. Before you try either DHEA (or DeHydroEpiAndrosterone) or 7-keto-DHEA (also known as 7-oxo-DHEA) you should be very sure you don't have one of the hormone-sensitive cancers. In men, these cancers are usually prostate cancer or less often testicular cancer. In women, breast, ovarian, or endometrial cancers are most responsive to hormones, but in practice estrogen can promote cancer at other sites as well.

DHEA and 7-keto-DHEA are hormones. The Food and Drug Administration (FDA) banned sales of nonprescription DHEA in 1985, but the ban was lifted with the passage of the Dietary Supplement Health and Education Act of 1994. This law allows certain substances to be sold for human consumption without FDA approval, as long as they are marketed as "dietary supplements" and not labeled for a particular use like prescription drugs. 7-keto-DHEA came on the market much more recently and research is still insufficient in many ways. Theoretically, 7-keto-DHEA is superior to DHEA in most applications because it will not convert to estrogen in women or testosterone in men, yet retains many of the benefits of DHEA. The price tag for 7-keto-DHEA is about three times that of plain DHEA.

Once you and your physician are satisfied that either DHEA or 7-keto-DHEA is safe to try, you need to decide on a dose. Dosage is highly individual, and a blood or saliva DHEA test prior to supplementation would help decide not only the dose but also whether or not you really need a supplement. Our bodies produce most DHEA during the morning hours, so that is the time to test, and also supplementation is best done at this time. Ordinarily, men or women under 35 years of age produce sufficient DHEA, 1-2 mg per day on average, and rarely benefit from supplements.

The dosage you use depends on your reason for using DHEA. When it is used to slow the aging process or to improve memory, which means you would probably be using it for many months or years, as little as 1 to 5 mg per day may be sufficient. Women should use about 20% less than men, both because they are generally smaller than men are and because many women already tend toward estrogen excess, which might be aggravated by DHEA supplements.

There may be circumstances in which larger amounts are worth a try. In a recent study with 11 postmenopausal women, 50 mg DHEA daily resulted in dramatic enhancement in natural killer cell activity in all 11 women. Natural killer cells are a key part of the immune system, constantly on the lookout for viruses and cancer cells to destroy. In another study of 14 women with mild to moderate systemic lupus, a serious autoimmune disease, those receiving 200 mg of DHEA daily for three months showed marked improvement compared to the women receiving a placebo. DHEA supplements above 25 mg per day for women are seldom recommended; but since it does not increase estrogen, doses of 7-keto-DHEA as high as 200 mg/day for short periods of time do not appear to cause ill effects. However, lower amounts (5-25 mg/day) may be just as effective because the body rapidly converts high doses into less active forms.

Bear in mind that although neither DHEA nor 7-keto-DHEA requires a prescription, they are steroid hormones. Both show promise of being beneficial when used prudently, but both are powerful substances and their long-term use deserves considerable forethought.