Dr James Schaller
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Should DHEA be a First Line Natural Hormone Replacement?

Let me mention some basics of aging to make you aware of two types of medical trends with aging. Some sincere people focus on prevention of illness and the effects of increased aging, and others focus on the repair of age related disease once it has caused a problem.

A common example might be the chiropractor who recommends joint protective nutrients and the orthopedic surgeon who replaces the knee when you develop bone on bone pain with no cartilage.

I believe in both types of medicine. Meaning, I believe in very aggressive prevention and also treatment and removal of pain. I believe in a full-integrated model of healing with broad solid treatments.

So what does this have to do with DHEA?

First, some physicians believe that since it is "natural" for hormone levels to decline as we age, we should do the "natural" thing and just let them decline. This approach sounds too close to the thinking of the sadist, the dark Marquise de Sade, who said, "What is, should be."

It is natural for teeth to rot and fall out. It is natural to die when your appendices ruptures. So I am a very strong believer in bio-identical hormone replacement using hormones that are absolutely the same as the ones in your body. These should be replaced as early as the thirties in some people. And we have had great success treating PMS and PDD in adolescent girls with a special form of bio-identical progesterone (See this free article). And I feel we have had better success, 99% are satisfied, than any synthetic birth control pill or serotonin anti-depressant for treating it.

My concern with DHEA replacement is that I am finding many practitioners replacing it alone and replacing it first.

Specifically, as we age we do not merely have decreases in DHEA, but also other hormones. Researcher Dr. David Zava, in his new Breast Cancer book, has made a convincing case that progesterone should be replaced as a priority to prevent cancer, PMS, Perimenopause symptoms, bone loss, etc.

My concern is that routine hormone care that starts with over the counter DHEA makes some problems worse. DHEA often becomes estrogen and testosterone. The problem is that DHEA may add to the estrogen dominance already present in a woman's body. After about 32-35 years of age, progesterone starts to decrease and estrogen, which retains fluid, does not decrease as much until full menopause. The point?

Many women get increased bloating when put on DHEA first because of the extra estrogen that results from DHEA use. And then they feel even more uncomfortable.

Also, while most women lose half their testosterone from the 20's to the 40's, if the DHEA is added first and casually, the DHEA can become testosterone, and then DHT, which can increase acne.

So what is the take home message? Many people have a very low DHEA blood or 24-hour urine level, and would benefit from receiving some at gentle and low starting doses. If you have a very low DHEA test result, the slower you should start, since the body is not used to it.

Ideally, after other critical hormones are normalizing, the DHEA could be added to your prescription cream so you do not have to take another pill. I typically will add small amounts to a successful prescription transdermal cream.

I Wish You a Long and Healthy Life!

Best Regards,

James Schaller, MD, MAR

Bank Towers, Tamiami Trail, Naples, FL
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