Is DHEA Beneficial to Aging Skin?

Is DHEA Beneficial to Aging Skin?

Written by Michelle Violi, PharmD – Women’s International Pharmacy

Dehydroepiandrosterone (DHEA) is one of the most abundant circulating steroid hormones in humans, with concentrations typically peaking between the ages of 25 and 35 and then gradually declining with age. It is released mostly from the adrenal glands as a precursor to androgens and estrogens, but it may have its own effects on the body as well. A plethora of benefits has been associated with DHEA, from immune system support to improved sexual satisfaction. Some have called DHEA a “super hormone” and an “anti-aging panacea;” this article examines whether this bold reputation extends to the skin.

Skin Treatments with DHEA

The positive effects of DHEA on the skin have been supported by a number of studies, including both systemic (total body) and localized treatment methods. In 2000, Dr. Étienne-Émile Baulieu et al. conducted a study where 280 women and men, ages 60-79 years old, were given 50mg of DHEA by mouth daily for one year. A number of different outcomes were evaluated. With regard to skin, the results showed improvements in:

  • Sebum production
  • Skin surface hydration
  • Skin pigmentation
  • Epidermal thickness

The researchers concluded “a lack of harmful consequences” for the 50mg per day dose. However, like any other sex hormone, DHEA can have symptoms of excess if the dose is too high, such as:

  • Excessively oily skin
  • Acne
  • Increased facial or body hair
  • Breast tenderness

It is important to watch for these symptoms in order to adjust dosing levels.

Another study, conducted by Dr. Stephanie Nouveau et al., went the topical route, which allowed for a more directed approach and a lower dose of DHEA. Over the course of four months, 20 postmenopausal women applied a DHEA 1% (10mg/gm) cream to the skin on their face and hands. When compared to a group of 20 postmenopausal women who applied a cream with no active ingredient, Dr. Nouveau et al. found the topical DHEA tended to improve skin brightness and to counteract epidermal atrophy (a characteristic feature of hormone-related skin aging) as well as the papery appearance of aging skin.

DHEA and Vaginal Tissues

Vaginal atrophy is a common condition in postmenopausal women that often occurs with urinary symptoms and causes considerable discomfort. Typically, women with vaginal atrophy experience:

  • Dryness
  • Itching
  • Irritation
  • Burning of the vaginal and/or vulvar tissues
  • Painful sexual intercourse

Traditional treatments for these symptoms have included vaginal lubricants/moisturizers and vaginal estrogens. More recently, however, DHEA has also been shown to improve symptoms of atrophy. In a 12-week study by Dr. Fernand Labrie et al., involving almost 500 menopausal women, 6.5mg of DHEA was administered vaginally on a daily basis. The results of this study showed the following benefits:

  • Improvements in vaginal pH (which is important in preventing infections)
  • Improved skin thickness and color
  • Increased vaginal secretions
  • Reduced pain during sexual activity
  • Reduced vaginal dryness

DHEA blood levels remained well within the normal postmenopausal values. 

Conclusion

As with all hormones, the key to optimizing DHEA is balance. While supplementing DHEA deficiency can have manifold benefits, it’s equally important to watch for symptoms of excess and to adjust dosage levels to fit individual needs. The studies discussed in this article—along with many others—indicate that, with the guidance of a healthcare practitioner, DHEA may be used to optimize skin health, particularly in inhibiting or even reversing the effects of aging.

© 2019 Women’s International Pharmacy

Edited by Carol Petersen, RPh, CNP; Women’s International Pharmacy

Is DHEA Beneficial to Aging Skin?2019-07-19T09:31:15-05:00

Sarcopenia: Age-Related Muscle Loss

Sarcopenia: Age-Related Muscle Loss

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

woman lifting weightsSarcopenia, the muscle loss related to aging, may start slowly in your thirties and continue progressing with growing rapidity into your seventies. It is not identified with definite biomarkers as medical practitioners prefer to use today. Sarcopenia tends to get an “I know it when I see it” sort of diagnosis.

Although this difficulty in diagnosing sarcopenia is understandable considering the mental picture of the frailty associated with aging, loss of muscle mass is a major health issue.

  • With a loss of muscle comes a loss of strength
  • It is more difficult to get around, climb stairs, or walk long distances
  • It leads to falls and serious injuries including broken bones
  • When injuries occur, it takes longer to heal
  • Surgeries may be less successful and infections take hold more readily

Unless measures are taken to stop it, sarcopenia may lead to prolonged hospitalizations, nursing homes, and possibly even death.

Anabolism and Catabolism

Our bodies are in the constant process of remodeling. We build and rebuild molecules, break down old cells and tissues to make way for the new, and dispose of or reuse the molecules. When we are young the rate at which we rebuild (anabolism) exceeds the rate at which we break down (catabolism). There are multiple factors that trigger more catabolism than anabolism as we age, including:

  • Changes in neurochemistry
  • Hormone imbalances
  • Production of inflammatory cytokine (cells produced by the immune system that act on other cells)
  • Inadequate nutrition
  • Environmental hazards
  • Declining physical activity

Satellite Cells

Muscle is composed of many different cell types. Muscle stem cells are called satellite cells. Satellite cells are located on the outside membrane of the muscle cells and next to the blood vessels. These cells are not active unless there is some stimulus from injury to the muscle or from the environment carried in the blood stream. When activated, these satellite cells become new muscle cells.

Estradiol and Testosterone

Sarcopenia develops with the decline of sex hormones. Research in the last decade reveals that the satellite cells have receptors for–and respond to—estrogens (such as estradiol) and androgens (such as testosterone). Studies support that estradiol has beneficial effects on muscle strength.

Most muscle cell types have receptors for testosterone, but testosterone receptors predominate in satellite cells. Administration of testosterone increases the number of satellite cells, and also directly inhibits inflammatory cytokines. Higher testosterone levels contribute to increased strength and mass; since women generally have less testosterone than men, this might explain why women tend to develop sarcopenia at twice the rate as men. 

DHEA and Human Growth Hormone

Adrenal DHEA, another androgen, also declines with age, and may affect muscle strength via a number of mechanisms.  DHEA is converted to estrogens and testosterone in the body, which may have a direct effect on receptors. Also, DHEA increases sensitivity to insulin, another anabolic hormone, which may also increase levels of IGF-1 (the active metabolite of growth hormone). Increased IGF-1 may indicate increased levels of growth hormone. Growth hormone has been shown to increase muscle mass in many studies.

The Triad of Frailty

In their article Frailty and the Older Man, Drs. Jeremy Walston and Linda Fried proposed looking at the concept of frailty in the elderly as a triad:

  1. With aging the hypothalamic responses to stress change, cortisol levels increase, and the signals to produce sex hormones and growth hormone decline
  2. The immune system is affected, producing fewer antibodies and more inflammatory cytokines
  3. Both of these effects contribute to sarcopenia

All three systems are interdependent: the endocrine system, the immune system, and the muscular system participate together in a spiral of decline.

Conclusion

Maintaining the health of the body requires collaboration between various factors. Our awareness of these factors gives us the tools to optimize our aging with strong bodies. Such factors include:

  • Eating well and ensuring our digestive systems work
  • Bolstering our metabolic processes with vitamins and minerals
  • Avoiding environmental challenges to our biochemistry

In addition to these factors, our health is profoundly affected by hormones. Sarcopenia illustrates how hormone deficiencies hinder us from achieving optimal health. Fortunately, our ability to supplement the hormones that decline as we age may help stave off the effects of sarcopenia and other age-related conditions.

A validated questionnaire called FRAIL can be used as a simple screen for sarcopenia. Three or more “Yes” answers are considered “frail,” signalling the possibility of sarcopenia.

  1. F. Fatigue: Did you feel tired all or most of the time in the last 4 weeks?
  2. R. Resistance: Is it difficult to walk up 10 steps without resting?
  3. A. Ambulation: Is it difficult to walk several hundred yards?
  4. I. Illnesses: Do you have more than four illnesses?
  5. L. Loss of weight: Have you lost 5% of your normal weight in the last year?
  • La Colla A, et al. 17 Beta Estradiol and testosterone in sarcopenia: Role of satellite cells. Aging ResRev. 2015 Nov:24(Pt B): 166-177. doi: 10.1016/j.arr.2015.07.011. Epub 2015 Aug 3.
  • Health Sciences Institute. This hidden disease will land you in a nursing home. February 2016 (20) 6.
  • Walston J, Fried L. Frailty and the Older Man. Med Clin North Am. 1999 Sept;83(5):1173-1193.
  • Balagopal P, Proctor D, Nair KS. Sarcopenia and Hormonal Changes. Endocr. (1997) 7:57-60. https://doi.org/10.1007/BF02778064.
  • Morley JE, Malmstrom TK. Frailty, Sarcopenia, and Hormones. Endocrinol Metabl Clin N Am. (2013)42:391-405. https://doi.org/10.1016/j.ecl.2013.02.006.
  • Morley JE, Malstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012 Jul;16(7):601-8.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

Sarcopenia: Age-Related Muscle Loss2019-02-13T09:53:55-05:00

DHEA and Healing Skin Wounds

DHEA and Healing Skin Wounds

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

DHEA may improve skin's ability to healDehydroepiandrosterone (DHEA) is produced primarily by the adrenal glands and is the most abundant of all the steroidal hormones. The quantity of DHEA in the body drops significantly during the aging process. This is so predictable that DHEA levels could be regarded as an aging biomarker.

One of the problems of aging is that it impairs the rate of wound healing in the skin. Many people begin to notice that cuts take longer to heal as they age. Ulcerations may develop which become chronic.

In the UK, Stuart J. Mills and colleagues at Manchester University investigated the role of DHEA in aging skin. This group had already demonstrated that estrogens have a positive effect on skin healing whether used directly on the wound or throughout the body. They wondered if DHEA would have a similar effect, since it is an immediate precursor of both estrogen and testosterone. Understanding that DHEA has many positive effects on the immune system, the researchers also wanted to establish whether DHEA would work directly, or whether it had to be converted into estrogen or testosterone to be effective in healing skin wounds.

First, they compared two groups of human subjects. Those suffering from ulcerations or other signs of slow wound healing were compared with healthy individuals with normal healing. The researchers were able to demonstrate that those with slow skin healing had significantly lower DHEA levels in their blood than the healthy group.

Next, they procured estrogen-deficient mice. Unlike humans, mice do not produce DHEA but they do have the necessary enzymes in their skin to convert DHEA to estrogen or testosterone. After producing superficial wounds, the researchers gave these mice DHEA throughout their bodies. This did not produce any noticeable effect on healing. However, a marked increase in healing did occur when DHEA was applied directly to the damaged skin area.

Finally, in order to determine whether DHEA was working directly or whether the metabolites of estrogen or testosterone were the key to improved healing, the researchers used substances that blocked the conversion enzymes for estrogen and testosterone. Healing and inflammation relief did not occur when estrogen production was blocked. With only testosterone blocked, however, the benefits of the DHEA treatments remained. Mills et al. concluded that DHEA could be effective for targeted treatment of damaged skin, and that the effectiveness depended on the conversion to estrogen and its local action on estrogen receptors.

  • Mills SJ, et al. The Sex Steroid Precursor DHEA Accelerates Cutaneous Wound Healing Via the Estrogen Receptors. J Invest Dermatol. 125: 1053-1062 2005.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

DHEA and Healing Skin Wounds2018-11-05T13:27:54-05:00