Cortisol & DHEA
Cortisol and DHEA are two of the
most important hormones produced by the adrenal gland. They are
considered “stress hormones.” When you are under stress (whether
emotional, physical, or psychological), the adrenal glands start
producing cortisol and DHEA. Therefore levels of these two hormones
will increase. This helps our bodies cope with the stress. However, if
the stress become prolonged or chronic, the adrenal glands start to get
fatigued, and eventually the hormone levels will start to fall, and we
may begin to show physical, emotional, and psychological signs of
or hydrocortisone, is a natural hormone produced by the adrenal gland,
a small gland that sits on top of each kidney. It is the main hormone
among a whole family of hormones known as steroid hormones. Some people
do not produce enough cortisol to provide for their body’s needs.
adrenal glands are a major component of the body’s natural defense
against stress, including any type of injury (including surgery),
infection, or emotional, physical or psychological stress. Repeated
stress, infections, or chronic illness can deplete the body’s adrenal
reserves, and the ability to produce adequate amounts of cortisol is
Furthermore, adrenal hormone is necessary to
maintain adequate blood sugar. People with low adrenal reserve
experience rapid drops in blood sugar (hypoglycemia) during stress
because there is not enough cortisol to maintain sugar levels. In
response, the body starts producing and secreting adrenaline, which
raises blood sugar but also causes anxiety. Therefore, people with low
adrenal cortisol are more prone to flare-ups of temper, nervousness or
shaking, palpitations, irritability, difficulty concentrating, salt
cravings, sleep disturbances, fear of situations that are even
moderately stressful, and can have panic attacks, fatigue, feel cold,
and may have depression.
The adrenal glands also play a key
role in reproductive function. Women with low adrenal output can have
skipped or irregular menstrual periods, unusual menstrual bleeding, and
are at greater risk for miscarriage or infertility. Because of changes
in the functions of the ovaries, women can also have increased facial
hair or acne.
During infections, the adrenal glands normally
increase their output to double or triple the amount of cortisol in the
blood to help fight the infection. During a viral infection, adrenal
hormone is necessary to suppress inflammation—people with low reserves
are more prone to higher fever and body aches. Therefore, people with
low adrenal reserve may have increased susceptibility to colds and
infections, more prolonged infections, and are more prone to allergies
Like persons with low thyroid function,
people with low adrenal reserve benefit from taking cortisol pills to
make up for what the body is not producing. The normal average daily
production of cortisol is 30-40 mg (milligrams). If you have adrenal
insufficiency you may be producing only 15-20 mg per day. Taking an
additional 5-20 mg of cortisol a day can support the adrenals and
improve health and well-being.
The big misunderstanding is
that cortisol is the same as Prednisone (or similar high-strength
steroids, such as Medrol). Such medications, while useful in select
medical conditions, provide cortisone far in excess of the normal
physiologic needs of the body, and long-term use is associated with
serious side effects and medical complications, including: high blood
pressure, weight gain and bloating, immune suppression, osteoporosis,
fungal infections, and a tendency towards diabetes and stomach ulcers.
Furthermore, within a short period of time, medications like Prednisone
actually can shut down the body’s normal hormone production. These
potential side effects have no relationship to low-dose cortisol
Low-dose treatment with cortisol replaces only
what your body is not producing. In fact, even if your cortisol
production is normal, an additional 5-20 mg of cortisol will not cause
any appreciable side effects. Cortisol is actually 5 times weaker than
Prednisone, so 40 mg of Prednisone would be like taking 200 mg of
cortisol! Furthermore, unlike Prednisone, cortisol has very short life
span in the body. In other words, it gets cleared out of the body
before it has a chance to do any harm.
Many patients respond
to proposed cortisone treatment by expressing fears about how dangerous
it is-- “My mother took it and it gave her ulcers, puffed out her face,
and put a hump on her back!“ Be reassured that cortisol is completely
different from Prednisone and used very differently.
cortisol levels be tested? Yes, but the “normal” laboratory values are
so broad that the test often misses people with subtle or moderate
adrenal insufficiency. For example, the standard laboratory range for
cortisol is 8-22. However, anything under 14 would be considered
adrenal insuffiency, in spite of it being in the “normal” range.
Because cortisol is so safe, sometimes the best “test” is simply
beginning a trial of taking cortisol (based on your symptoms and
physical exam, of course).
comes in 5 mg tablets, as a prescription medication known as Cortef. It
may also be compounded in a cream by a compounding pharmacy.
Cortisol generally should not be taken in the evening or at bedtime.
should improve within 3-4 weeks. If there are no changes in how you
feel, then it is unlikely that adrenal insufficiency is the root cause
of your symptoms, and the search continues to find the cause.
you feel a little “too good,“ or if you begin to have trouble falling
asleep or feel a little bloated, either the dose of cortisol needs to
be decreased to a level that does not produce any side effects, or you
do not need the cortisol. Your doctor will determine what the correct
course of action to take is. Remember, there are essentially no risks
to such a cortisol trial!
Avoid caffeine, or at most have
minimal amounts, when taking cortisol. Caffeine raises adrenaline
levels, which can overstimulate your body and cause anxiety reactions.
Also avoid excess sugar or heavy carbohydrate diets. Both of these
raise blood sugar levels rapidly, releasing a surge of the hormone
insulin, which subsequently quickly lowers blood sugar and stresses the
It may take several weeks to notice the
benefits of cortisol treatment. It is essential to get 8 hours of
sleep, because the adrenals generally need that much time to replenish
their reserves and “recharge their batteries.“ As you continue eating a
proper diet, take the appropriate vitamin and nutritional supplements,
get enough sleep, and exercising, you will begin to notice more energy,
less fatigue, less anxiety, and a greater ability to tolerate stress.
(DHEA) is the most abundant androgen (male steroid hormone) secreted by
the adrenal glands (small hormone producing glands that sit on top of
the kidneys), and to a lesser extent, by the ovaries and testes. DHEA
can also be converted into other steroid hormones, including
testosterone and estrogen. Considerable interest in DHEA has developed
in recent years with reports that it may play a role in the aging
process. Circulating levels of DHEA peak at age 25 and then steadily
decline with age. DHEA levels in 70-year-old individuals tend to be
roughly 80 percent lower than those in young adults.
researchers consider DHEA a possible anti-aging hormone because DHEA
deficiencies in older individuals have been associated with a number of
medical conditions including breast cancer, cardiovascular disease,
impaired memory and mental function, and osteoporosis. In addition,
population-based studies have suggested that people with higher DHEA
levels tend to live longer, healthier lives than those with lower
levels of DHEA. However, low levels of DHEA being linked to certain
diseases does not necessarily mean that DHEA supplements will reduce
the risk or improve the outcome of these conditions.
United States Food and Drug Administration (FDA) removed DHEA
supplements from the market in 1985 due to false claims about health
benefits. However, since the passing of the US Dietary Supplement
Health and Education Act of 1994, DHEA has made its way back on the
market and its popularity continues to grow. Despite this growth and
attention, support for the health claims, particularly as tested on
people, is lacking. Plus, given that DHEA products are sold as dietary
supplements, there is no control over their contents or the
manufacturing practices of the companies that make the supplements. One
independent evaluation found that the amount of DHEA in over the
counter products ranged from 0% to 150% of what the content stated on
Uses / Indications
that DHEA levels decline with advancing age, some researchers have
investigated whether DHEA supplementation may slow or prevent
age-related declines in mental and physical function. Preliminary
results from the DHEAge study in France suggest that the hormone may
slow bone loss, improve skin health, and enhance sexual drive in aging
adults, particularly women older than 70 years of age. Animal studies
that have shown a boost in memory for older rats taking DHEA
supplements. Results from human studies, however, have been
conflicting. Some studies have shown that DHEA improves learning and
memory in those with low DHEA levels, but other studies have failed to
detect any significant cognitive effects from DHEA supplementation.
Further studies are needed to determine whether DHEA supplementation
helps prevent or slow medical conditions associated with the aging
earlier, DHEA is one of the hormones made in the adrenal glands. When
the adrenal glands do not make enough hormones, this is called adrenal
insufficiency. Women with this condition who were given DHEA
supplements reported improved sexuality and sense of well-being
(including decreased feelings of depression and anxiety). Only a doctor
can determine if you have adrenal insufficiency and if DHEA, along with
other hormones, is needed. Adrenal insufficiency can be a medical
emergency, particularly when first diagnosed. This is especially the
case if your blood pressure is low, which can cause you to experience
dizziness or lightheadedness. Another reason to seek medical attention
right away in the case of adrenal insufficiency is swelling of the
ankles or legs.
Studies suggest that DHEA supplementation may help impotent men have and sustain an erection.
Studies have shown that DHEA cream applied to the inner thigh may boost bone density in older women.
with anorexia nervosa are at increased risk for bone fractures and can
develop osteoporosis at a younger age than women without eating
disorders. It has been observed that adolescents and young adults with
anorexia nervosa tend to have low levels of DHEA. Some studies suggest
that DHEA may help protect against bone loss in people who are anorexic.
DHEA supplements are widely used by athletes and body builders to boost
muscle mass and burn fat, there is little evidence to support these
claims. There are no published studies of the long-term effects of
taking DHEA, particularly in the large doses used by athletes. Plus,
the building blocks of testosterone, including DHEA, may adversely
affect cholesterol in male athletes by lowering HDL ("good")
Lupus is an autoimmune
disorder. Autoimmune diseases are a group of conditions in which a
person's antibodies attack a part of their own body because the immune
system believes the body part is foreign. Studies have shown that DHEA
helps regulate the immune system and may play a role in the prevention
and/or treatment of certain autoimmune diseases.
review of scientific literature found that DHEA supplementation may
reduce the need for medications and the frequency of flare-ups, enhance
mental function, and boost bone mass in women with lupus. Further
studies are needed to determine whether DHEA is safe and effective for
both men and women with this condition, however.
levels tend to be low in individuals infected with the human
immunodeficiency virus (HIV), and these levels decline even further as
the disease progresses. In one small study, DHEA supplementation
improved mental function in men and women infected with HIV. However,
studies have yet to demonstrate whether DHEA supplementation can
improve immune function in people with this condition.
a preliminary study of individuals with major depression, DHEA
significantly improved symptoms of depression compared to placebo.
However, results of this study and others conducted to date on DHEA and
depression are not conclusive. The potential value of using DHEA for
depression, therefore, remains unclear, and the long-term effects of
taking this supplement are unknown.
results of studies using DHEA to treat overweight people have been
conflicting. While animal studies have found DHEA to be effective in
reducing body weight, studies of men and women showed that DHEA
produced no change in total body weight, although total body fat and
LDL ("bad") cholesterol did improve. These differences may be due to
the fact that higher dosages were used in the animal studies than in
the human studies (such high doses would cause intolerable side effects
in people). Further studies are needed to determine whether DHEA is an
effective way to reduce body weight in obese people. Until the safety
and effectiveness of DHEA is fully tested, it is best not to use this
supplement for weight loss.
has gained some popularity among peri-menopausal women. They often used
the supplement to alleviate symptoms of menopause including decreased
sex drive, diminished skin tone, and vaginal dryness. In one recent
study, DHEA supplements did raise levels of certain hormones in
post-menopausal women. However, clinical studies regarding the value of
DHEA for improving menopause symptoms have had conflicting results.
who believe in the use of DHEA claim that it relieves the menopausal
symptoms described above without increasing the risk of breast cancer
or cancer of the endometrium (lining to the uterus). The risk of each
of these cancers may be increased with regular, prescription hormone
replacement therapy. There is no proof, however, that DHEA does not
stimulate these cancers as well. Women with breast cancer tend to have
low levels of this hormone in their bodies. But replacement may lead to
either inhibition or stimulation of growth of breast cancer cells.
Inflammatory Bowel Disease (IBD)
levels appear to be low in people with ulcerative colitis and Crohn's
disease. It is premature to say whether DHEA supplements have any
impact, positive or negative, on these two bowel diseases.
DHEA supplements are produced in laboratories from diosgenin, a plant
sterol extracted from Mexican wild yams. Some extracts from wild yams
are marketed as "natural DHEA." Advertisers claim that these "natural"
extracts of diosgenin are converted into DHEA by the body. However, it
takes several chemical reactions to convert diosgenin into DHEA, and
there is no evidence that the body can make this conversion. For this
reason, it is best to look for labels that list DHEA rather than
diosgenin or wild yam extract. Also, it is important to select products
that state it is "pharmaceutical grade."
One way to avoid
purchasing a product with contaminated DHEA is to purchase it through a
professional healthcare provider or in a custom compounded prescription
cream from a pharmacy.
DHEA is available in capsules, chewing gum, drops that are placed under the tongue, and topical creams.
DHEA is a hormone produced in the body and is not obtained through the diet.
is not recommended for people under the age of 40, unless DHEA levels
are known to be low (<130 mg/dL in women and <180 mg/dL in men).
DHEA supplements should not be used in children.
for men and women differ. Men can safely take up to 50 mg/day, but
women should generally not take more than 25 mg/day, although up to 50
mg has been used for women with anorexia, adrenal insufficiency, and
other medical conditions under medical supervision. DHEA is produced by
the body primarily in the morning hours. Taking DHEA in the morning
will mimic the natural rhythm of DHEA production. Positive effects have
been noted at dosages as low as 5 mg/day and the lower the dose the
Because of the potential
for side effects and interactions with medications, dietary supplements
should be taken only under the supervision of a knowledgeable
DHEA generally is not recommended for
people under 40 years of age, unless DHEA levels are known to be low
(less than 130 mg/dL in women and less than 180 mg/dL in men). People
taking DHEA should have their blood levels monitored every 6 months.
No studies have been conducted on the long-term safety of DHEA.
DHEA is a precursor of estrogen and testosterone, patients with cancers
affected by hormones (such as breast, prostate, ovarian, and testicular
cancer) should talk to their physician before taking DHEA.
doses of DHEA may inhibit the body's natural ability to make the
hormone and also may be toxic to liver cells. At least one case of
hepatitis has been reported.
In women (but apparently only
negligibly in men) DHEA gets metabolized in small amounts to estrogen
and testosterone. Women should be aware of the risk of developing signs
of masculinization, such as loss of hair on the head, deepening of the
voice, hair growth on the face, weight gain around the waist, or acne.
Notify your health care provider if any of these symptoms occur. Other
adverse effects that have been reported include high blood pressure and
reduced HDL ("good") cholesterol.
The International Olympic
Committee and National Football League recently banned the use of DHEA
by athletes because its effects are very similar to those of anabolic
Possible Drug Interactions
are currently being treated with any of the following medications, you
should not use DHEA without first talking to your healthcare provider.
a laboratory study, DHEA enhanced the effectiveness of an HIV
medication known as AZT. However, scientific studies in humans are
needed before DHEA can be used for this purpose in people.
studies suggest that DHEA may increase the effects of barbiturates, a
class of medications often used to treat sleep disorders including
butabarbital, mephobarbital, pentobarbital, and phenobarbital. However,
scientific studies in humans are needed before it is known whether this
same effect occurs in people and whether it is safe for DHEA and
barbiturates to be used together.
animal study indicates that DHEA may increase the effectiveness of an
anti-cancer medication known as cisplatin; further studies are needed
to know if this effect applies to people.
studies suggest that DHEA may increase the effects of prednisolone, a
steroid medication used to treat inflammation and other disorders.
Additional research is needed to determine if this effect applies to
It is possible that DHEA may
influence the level of estrogen in the body. For this reason, some
women on estrogen replacement therapy may need to adjust their dosage.
This should be discussed with your healthcare provider.
Source: Adapted from University of Maryland Medical Center, 2004.