Natural steroid is a safe and effective substitute for hormone replacement therapy
By Will Block
Everyone admires people who are able to adapt gracefully to the aging process, which for women holds special pitfalls. A major one is menopause, which can make a woman feel anything but graceful, what with the characteristic hot flashes, mood swings, insomnia, headaches, and fatigue. Menopause is a trying period (so to speak), and one can only sympathize with any woman who seeks to mitigate its symptoms through hormone replacement therapy (HRT).
For decades, women and their doctors have had to wrestle with the central question of HRT: Is it worth the risks? Underlying that question, of course, are other questions, such as: what are the risks, and how serious are they, and how would a given woman likely be affected by them? Much research has been devoted to these issues.
The Risks of Hormone Replacement Therapy
Learning what the risks are and assessing their severity and probable impact have proved to be difficult tasks, however. As more—but often confusing and contradictory—evidence has been obtained, and as scientific opinions have fluctuated accordingly, women and their doctors have felt as though they were on a roller-coaster ride. First the risks of HRT are low and the rewards seem to justify them; then the risks are up again and the whole idea looks less attractive; then they’re down again and the use of hormones increases . . .
Well, now the risks are up again, as anyone who has followed the news during the past year probably knows. The best current evidence suggests that hormone replacement therapy may not be worth the risk for many women—especially older women—because of the increased incidence of breast cancer, endometrial cancer, heart disease, stroke, pulmonary embolism, gallbladder disease, and even dementia. Furthermore, it seems that, in terms of such factors as mood, memory, sleep, or sex drive, HRT does not even improve the quality of life for most women for whom it’s prescribed
The Misery of Hot Flashes
On the other hand, HRT is effective in reducing the incidence of one of the curses of menopause: hot flashes. Although some women navigate the change of life without this notorious affliction, about 80% do suffer from it, sometimes with numerous sweat-soaked episodes per day, and several during the night. Between the damp sheets and the sleep deprivation, their general mood may become just that much more precarious. (Note to men: this is a time for limitless patience and understanding!)
Little wonder, then, that HRT has been so eagerly embraced by women who wished, if nothing else, to avoid the misery of hot flashes. But the recent news of HRT’s significant liabilities (which are greater in older women than in younger women) has cast cold water on that enthusiasm, and its use has fallen precipitously this past year—by about half, according to recent reports. As one woman put it, after contemplating the possibility that HRT might cause her to lose a breast or two some years down the line, “You can be hot and alive or cool and dead.”
Age-Related Nutritional Deficiencies
It’s well to remember, though, that HRT takes a number of different forms and is not necessarily bad for all women all the time. The trick lies in bringing expert medical judgment to bear on each case, because no two cases are exactly alike. For some women—depending on their age, general health, personal and family medical history, risk-aversion profile, etc.—some form of HRT, for some period of time, may be worth the risks. Every woman must make her own informed decision after careful consultation with her doctor—and perhaps with a good nutritionist as well.
Few would disagree that good nutrition is a key element for long-term health and happiness. What constitutes good nutrition for a young person, however, may not be good enough for an aging person, because aging entails two significant nutritional liabilities: (1) a declining production of certain vital compounds within the body, and (2) a declining ability of the digestive tract to assimilate certain vital nutrients found in foods. Both of these factors can, in many cases, be offset by the judicious use of nutritional supplements. Let’s look at one example of the first kind of deficiency—that of sex hormones.
Postmenopause Means Low Sex Hormones
After menopause, women enter the stage of life called postmenopause, which can be at once a liberating and oppressive state of being. Postmenopausal women are subject to special kinds of health problems that can affect many organs and functions, such as the skin and the urogenital, cardiovascular, skeletal, and nervous systems. Among the potential problems are those associated with a woman’s diminished desire for sex and her ability to enjoy it. Not surprisingly, such problems are often accompanied by a decline in a woman’s sense of well-being. That can lead to depression, which can impair the immune system, which can lead to an increased susceptibility to diseases, which can lead to a downward health spiral that can shorten life.
It is well known that women’s estrogen levels drop sharply during menopause and remain low thereafter, whereas men’s testosterone levels decline gradually throughout their lifetime, starting in their twenties. In both sexes, the decrease in hormone production after the age of about 40 becomes noticeable, and it entails a broad spectrum of age-related decline that slowly robs us of our youthful vitality. Many researchers believe, e.g., that some of the notable signs of aging, such as shrinking muscle mass and decreasing bone density (which can lead to osteoporosis), are related to the loss of sex hormones.
DHEA Is the Precursor Hormone
The primary reason for that loss is the decline, beginning in both sexes in the early to mid-twenties, of a precursor molecule called DHEA (dehydroepiandrosterone). DHEA is by far the most prevalent steroid hormone in the blood. Although it is a natural part of the biochemical makeup of both men and women, DHEA is considered to be an androgen (a male sex hormone); it is produced in our bodies from pregnenolone, the “mother” of all steroid hormones.
In both sexes, DHEA is produced mainly in the adrenal glands—but also, to some extent, in the brain—and it is initially converted to the male sex hormone androstenedione. In men androstenedione is converted primarily to testosterone (in the testes), and in women it is converted primarily to estrogen (in the ovaries).* Even the most masculine of men have some estrogen in their systems, however, just as the most feminine of women have some testosterone in theirs.
*Estrogen is not a single chemical compound, like testosterone, but a collective term for a class of female sex hormones consisting mainly of estrone, estradiol, and estriol. The other principal female sex hormone is progesterone, which in men is largely converted, via androstenedione, to testosterone.
Estrogen, Cancer, and I3C
One of nature’s cruel paradoxes is that estrogen, which so clearly defines a woman’s being (just as testosterone defines a man’s), can help hasten her demise by inducing cancer of the breast or the reproductive organs. Although a certain amount of estrogen is vital for women even with advancing years—particularly for its important role in reducing the risk of heart disease and osteoporosis—too much of it can be harmful. (It can be harmful to men too: increasing estrogenic activity in aging men is believed to promote prostate cancer and pancreatic cancer, as well as heart disease.)
It appears that the primary mechanism by which estrogen induces cancer is through its ability to increase the expression of certain genes that code for the synthesis of harmful proteins. The more estrogen there is, the more active the genes are, and the more of these proteins are produced. Wouldn’t it be great if there were a nutrient that could inhibit this process?
It turns out that Mother Nature has thoughtfully provided three such nutrients, all closely related and all found in the Brassica family of cruciferous vegetables, which includes broccoli, cabbage, cauliflower, bok choy, and Brussels sprouts, among others. These veggies contain indole-3-carbinol (I3C), diindolylmethane (DIM), and ascorbigen—chemical compounds that have been shown to inhibit abnormal cell proliferation, the hallmark of cancer.
Experimental and epidemiological studies have demonstrated the efficacy of these compounds—I3C in particular—in reducing the risk of estrogen-related cancers. A recent study discusses the evidence for believing that they interfere with the genetic mechanisms involved, by inhibiting the expression of certain harmful genes and stimulating the expression of a beneficial gene.1 (See “The Gene Connection in Preventing Estrogen-Related Cancers” in Life Enhancement, March 2001.)
These compounds also have a favorable effect on the ratio of a pair of naturally occurring, closely related estrogen metabolites (compounds resulting from metabolic processes involving estrogen), one of which has low estrogenic activity and the other of which has high activity. By shifting the ratio of these metabolites in the right direction, the Brassica compounds reduce their net estrogenic activity, and thus the risk for cancer.
Eating cruciferous vegetables regularly, even if you don’t like them, is a good idea (Mom was right, as usual). But the most convenient and reliable way to obtain the optimal amounts of the highly beneficial compounds these veggies contain is to take them every day in the form of dietary supplements. Even Mom would probably agree with that.
1.Auborn KJ, Fan S, Rosen EM, Goodwin L, Chandraskaren A, Williams DE, Chen D, Carter TH. Indole-3-carbinol is a negative regulator of estrogen. J Nutr 2003;133:2470S-2475S.
DHEA Is Prosexual, Especially in Older Women
Studies have shown that the lifelong decline in DHEA levels is due primarily, if not exclusively, to a decrease in output from the adrenal glands, not to a change in metabolism. In our forties, our DHEA levels are typically down to about 50% of their youthful peak values, and they hit about 20% in our seventies. Yikes! No wonder most of us are no longer the sexual dynamos we were in our teens and twenties. Although the effects are most readily evident in men (it’s not hard to see what the problem is), women too experience a gradual decline in libido and sexual gratification.
Many women, however, experience an increase in their sexuality when they take DHEA as a dietary supplement (alas, this effect is seldom seen in men). Oddly, this may be due to a significant increase in testosterone, which has a prosexual effect in women. A study carried out in France found that the effect is dramatically evident in older women, especially those over 70, who were reported to experience not only increased desire but also increased sexual activity and satisfaction.1 DHEA also improved the health of their skin and bones. For more on this study, see “DHEA Improves Sex and Helps Keep Women in Love” in Life Enhancement, June 2000.
DHEA Restores Hormonal Balance and Stops Bone Loss
Previously in this magazine (see “Stopping the Biological Clock in Postmenopausal Women,” December 2001), we reported on the results of research in Italy to assess the effects of DHEA on 12 different hormonal factors and on bone density in 31 healthy women, who were described as “early postmenopausal” (aged 50–55) and “late postmenopausal” (aged 60–65).2 The average age of onset of menopause—in the United States, anyway—is 51.
In women, according to the Italian researchers, DHEA appears to offer some of the same benefits as those of hormone replacement therapy, but without the risks. They found that oral administration of 50 mg of DHEA per day for 6 months restored the women’s plasma DHEA to youthful levels (i.e., those of their twenties) and had positive effects on numerous other aspects of hormonal balance as well. Furthermore, measurements of bone density in these women showed no changes over the 6-month period, indicating that the normal, age-related loss of bone mass was halted: DHEA apparently “stopped the clock” on bone loss, and thus on the risk for osteoporosis.
Significantly, the researchers found no change in the thickness of the endometrium (the glandular mucous lining of the uterus) in these women as a result of DHEA treatment. This is important because any such change could presage the development of endometrial cancer, which is one of the known risk factors in conventional HRT (the culprit there is believed to be estrogen). Although 6 months is a relatively short time in which to observe changes in the endometrium, the researchers were encouraged by the lack of any evidence of it.
DHEA Improves Symptoms of Menopause
Recently the same Italian research group published the results of a similar study on 20 healthy early-postmenopausal (50–55) and late-postmenopausal (60–65) women.3 In this study, they evaluated the effects of a lower dose of DHEA (25 mg per day) for 12 months. The substances targeted for measurement were 17 hormones (mostly steroids, and a few neuropeptides and proteins)—including, of course, DHEA itself.
The results showed that the 25-mg/day DHEA treatment had similarly positive (though not as strong) hormonal effects as did the 50-mg/day dose used in the previous study (and a number of other studies as well). There were 3- to 4-fold increases in the plasma levels of estrogen and testosterone, and progesterone levels more than doubled. The levels of beta-endorphin (the principal “feel-good” hormone) tripled, and the levels of cortisol (the principal stress hormone) fell by about 35%, suggesting, in the authors’ words, “a sort of neuroprotective (antistress) role for exogenous [from the outside] DHEA administration.”
As this magazine goes to press, the North American Menopause Society has just issued an evidence-based position statement on the treatment of hot flashes. The statement emphasizes lifestyle modifications and nonprescription medications (e.g., dietary supplements) before the use of estrogen or other prescription drugs is considered. Sounds like good advice.
A most encouraging finding was that of “progressive and significant improvement” in subjective symptoms of menopause, notably hot flashes and psychological effects. The authors also reported that throughout the study there were no significant changes in body weight, occurrence of uterine bleeding, abnormal events, or side effects. Importantly, their measurements of the women’s endometrial thickness showed no significant changes either.
The authors summarized by saying:
In conclusion, our data show that a daily dosage of 25 mg of DHEA restored the steroid milieu, both in early and late postmenopausal women . . . reducing postmenopausal and aging symptoms. In addition, according to our data, DHEA seems not to stimulate the endometrium. . . . these data support and confirm that DHEA must be considered a valid compound and drug for HT [hormone therapy] in postmenopausal women and not just a “dietary supplement.”
DHEA Is a Dietary Supplement
The fact is, of course, that DHEA is a no-quotation-marks dietary supplement and not a drug—and that’s something we can all be grateful for. It means that this remarkable substance, the precursor of our sex hormones, will remain open to all who want to avail themselves of the opportunity to improve their health and regain some of the lost vitality of their youth (see “DHEA—The Hormone of Youth?” in the December 2002 issue).
1.Baulieu ÉÉ, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy MP, Latour F, Leaud MC, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharrière O, Nouveau S, Rakoto-Arison B, Souberbielle JC, Raison J, Le Bouc Y, Raynaud A, Girerd X, Forette F. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci 2000 Apr 11;97(8):4279-84. 2.Genazzani AD, Stomati M, Strucchi C, Puccetti S, Luisi S, Genazzani AR. Oral dehydroepiandrosterone supplementation modulates spontaneous and growth hormone-releasing hormone-induced growth hormone and insulin-like growth factor-1 secretion in early and late postmenopausal women. Fertil Steril 2001;76(2):241-8. 3.Genazzani AD, Stomati M, Bernardi F, Pieri M, Rovati L, Genazzani AR. Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fertil Steril 2003;80(6):1495-1501.
DHEA in Different Formulations
A daily serving of 25 or 50 mg of DHEA is considered to be safe and effective in restoring this hormone to the youthful levels of our twenties. Some people may benefit just as much from smaller amounts, however—especially women, who typically need less DHEA than men for restoring youthful levels—and larger amounts may also be considered, but only on the advice of a physician. Life Enhancement also offers DHEA as an ingredient in FemRatio™, a supplement for women, whose principal ingredients are the estrogen-metabolite-balancing compounds indole-3-carbinol (I3C) and diindolylmethane (DIM), in optimal amounts. FemRatio also contains the botanical extract Vitex agnus-castus (the chaste tree), used traditionally to relieve the symptoms of PMS, which are caused by hormonal imbalances.