Dehydroepiandrosterone and its sulfate
- George P Chrousos, MD
George P Chrousos, MD
- Professor and Chairman
- First Department of Pediatrics
- Director, Division of Endocrinology, Metabolism, and Diabetes
- University of Athens Medical School, Greece
Adrenal production of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA sulfate or DHEA-S) is substantial in both men and women. The production of both is greatest among young adults, and it declines progressively with age. At their peak at age 25 years, serum DHEA concentrations range from 0.2 to 0.9 mcg/dL (7 to 31 nmol/L), 10-fold lower than those of cortisol, and serum DHEA-S concentrations range from 75 to 370 mcg/dL (2 to 10 µmol/L), 20-fold higher than those of cortisol. By age 80 years, the concentrations are only about 20 percent of those at age 25 years [1-3].
DHEA is converted to DHEA-S in the adrenal and liver, both of which contain a sulfotransferase. The former is produced from the latter in peripheral tissues that contain a sulfatase. In the adrenal glands and peripheral tissues such as hair follicles, prostate, external genitalia, and adipose tissue, small amounts of DHEA and DHEA-S are converted to more active androgens such as androstenedione, androstenediol, testosterone, and 5-dihydrotestosterone, and estrogens such as estradiol and estrone. These hormones then exert their usual androgenic and estrogenic effects via the androgen and estrogen receptors, respectively. In women, adrenal production of DHEA and DHEA-S contributes substantially to overall androgen production and effects; in men the adrenal contribution is very small.
DHEA has been proposed to have many actions, including vasodilatory, anti-aging, anti-inflammatory, anti-atherosclerotic actions and anti-depressant, and it is widely available in stores that sell health foods and nutritional supplements. However, quality control of these products has been shown to be quite poor [4,5].
The possible sites of action and clinical uses of DHEA are reviewed here. Measurements of adrenal androgens and the causes and effects of excess endogenous production of DHEA and DHEA-S are discussed separately. (See "Adrenal hyperandrogenism".)
POSSIBLE SITES OF ACTION
Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) act, after conversion to androgens and estrogens, by activating androgen and estrogen receptors, respectively, as noted above.
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