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DHEA good for improving sexual life, but women should understand 2 points

Dr Jennifer Landa MD's picture
Dr. Jennifer Landa, MD

With the recent results of the Italian study published in Climacteric, the Journal of the International Menopause Society regarding DHEA and its ability to improve sexual well-being, women may be tempted to jump on the over-the-counter "supplement" to improve their sex drive and avoid hormone replacement therapy. First, it should be understood that DHEA is a hormone. Second, understandings abound regarding hormone replacement therapy and women need to know more about their choices for hormone replacement therapy.

In 2002, one of the arms of a study called the Women’s Health Initiative was stopped early because of reports that hormone replacement therapy increased the risk of breast cancer and cardiovascular disease. Women were taken off hormone replacement in record numbers. The news reports about hormone replacement therapy were bad – really bad. They reported over and over that hormone replacement therapy will give you breast cancer or heart disease. This was surprising news to the medical community because doctors had been advocating for hormone replacement therapy, until this time, as a way to decrease heart disease and many other diseases including osteoporosis and others.

Well, there is bad news and good news here. The good news is that we now know that the combination of Premarin and Provera (Prempro) increases the risk of breast cancer and heart disease. These results have been verified in other studies as well, including the Million Women Study in the UK. It is very important to point out that in both of these studies the combination of estrogen with a progestin (an artificial form of progesterone) increased the risk of breast cancer and heart disease.

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Now for the good news: the extremely important distinction that has been missed over and over by researchers, physicians and the media. When estrogens, such as estradiol (a naturally occurring estrogen) are combined with progesterone (also a naturally occurring compound) the risks of breast cancer and heart disease are not increased at all and in some studies, the risks are even decreased. This data has been shown very well in the E3N Cohort Study in France that includes over 100,000 women and has been going on for over 10 years. In the E3N Cohort study they compared the risks of breast cancer in women on estrogen alone, estrogen plus progestins and estrogen plus progesterone. In the women on estrogen alone there was a small increased risk of breast cancer. With the combination of estrogen and progestins, the risk was further increased. When estrogens were combined with progesterone, there was no increased risk of breast cancer at all.

Additionally, the WHI study showed an increased risk of cardiovascular disease, particularly in older women who started the combination of estrogens and progestins after age 59. The women who started the combination between ages 50-59 were found to have a decreased risk of cardiovascular disease. Since 2002 and the early termination of the Prempro arm of the WHI study we have learned several things about the risks of cardiovascular disease and hormone replacement therapy. One of the most important things we have learned, in multiple studies, is that transdermal estrogen therapy (estrogen through the skin) yields a much lower risk of cardiovascular disease, especially stroke, than does taking estrogen by the oral route. Further, multiple studies have shown improvements in cardiovascular health with estrogen and progesterone use including positive effects on the thickness of blood vessels, lipid levels and incidence of atherosclerosis.

There are many studies that also show that DHEA has various health benefits. An interesting aspect of DHEA that must be understood though is that DHEA is a foundation hormone that the body uses to make estrogen and testosterone. When one takes DHEA, there is no way of knowing how much of each of the other hormones might be made. This could expose one to increased risks that may be incurred due to hormone imbalance. With the results of the recent study, women might be tempted to take DHEA as the “safer” choice since it is over the counter, but in my opinion DHEA should not be taken without medical supervision, as it is a hormone and hormones can have both beneficial and deleterious effects which must be understood fully by the prescriber.

In sum, hormone replacement therapy does offer the benefits we always thought were true but the weight of the evidence points to the need for very careful choice when it comes to which hormones we choose. While DHEA does offer promise and can be used therapeutically, more study would be welcome to better understand its use as a hormone replacement therapy choice.

Bioidentical Hormone Replacement Therapy trailerblazer Dr. Jennifer Landa, MD, Chief Medical Officer of BodyLogicMD, and author of the forthcoming Sex Drive Solution for Women: Dr. Jen’s Power Plan to Fire Up Your Libido (Atlantic Publishing Group; February, 2012).