DHEA, the commonly used abbreviation for the hormonal precursor dehydroepiandrosterone, is a popular, if controversial, supplement in the pharmacopeia of alternative medicine. While androstenodione has been removed from the market by the United States Food and Drug Administration, as of 2011 DHEA remains available in North America over the counter. No longitudinal studies have been published that could be used to determine a safe or effective DHEA dosage level in any population, and the expert opinions vary widely on the topic, with DHEA dosage recommendations varying from the irregular, episodic use of 5 mg of the supplement per day to daily oral doses of greater than 1000 mg. In the absence of sufficient clinical or experimental evidence to make an informed judgment, the factors most likely to determine DHEA dosage recommendations are the philosophical orientation of the medical practitioner recommending the pre-hormone and his or her beliefs about its safety.
Ray Sahelian, M.D. is among the most conservative of alternative medical practitioners in his approach to the use of DHEA. Due to concerns over the long-term safety of any pre-hormone, Dr. Sahelian advocates strongly against the use of DHEA unless alternative approaches to treatment have already failed. He recommends that patients with demonstrably low levels of DHEA who have not responded to other treatments and who wish to try the supplement start with a single 5 mg dose of DHEA, taken on alternate days or no more than five days a week in order to prevent the sensitization of the glands in the body responsible for its production. Very few commercially available DHEA supplements are available in 5 mg dosages.
A physician at the Baylor College of Medicine recommends that an initial DHEA dosage of no more than 25 mg be used in geriatric patients, a dose much lower than that of the most commonly available DHEA supplements. Serum DHEA levels should then be monitored to determine whether optimum DHEA levels have been achieved. These recommendations are based on the fact that prior to age-related declines in DHEA production, a healthy male produces 25 mg of the pre-hormone and a healthy female produces 17 mg per day. Considering that geriatric patients still produce non-negligible amounts of DHEA, even these doses may be considered high.
While many of the concerns over DHEA dosage have been based on anecdotal reports of side effects, it is important to consider that several placebo-controlled clinical trials at doses as high as 100 mg administered daily for a period of six months to a year have not found a statistically significant incidence of any side effects. Concerns over the use of any drug that may increase serum levels of sex hormones, however, may be valid. Ample evidence suggests that elevated levels of certain sex hormones can be correlated with the growth of a number of different cancers.In an attempt to reduce the potential for elevating cancer risk in users, the DHEA alternative 7-KETO® was released on the market. Unfortunately, insufficient evidence exists to suggest that 7-KETO® has any less of an affect on the body's production of sex hormones than DHEA.