After interviewing more than 40 researchers and clinicians familiar with DHEA, I have realized that there is a wide range of opinions concerning testing and dosing. This is because the studies on DHEA in humans are still in their infancy; consequently, the practice of DHEA supplementation is still an art rather than a science. (The practice of medicine is also an art. For instance, if a patient goes to a few different doctors complaining of a particular symptom, there's no guarantee that the diagnosis, lab tests ordered, and method of therapy will be consistent between all the physicians.)
The following are some general approaches the doctors I interviewed use to evaluate a patient before starting therapy with DHEA.
• A few physicians will not do any testing before initiating DHEA because they claim the blood tests are expensive and inconvenient, and the results inconsistent. These doctors assume that almost all older individuals are low in DHEA(S) anyway, and will prescribe 5, 10, 25, or 50 mg to see if there are benefits. If so, they will continue the therapy. If side effects occur, they will lower the dose.
• The majority of clinicians will check DHEA levels on almost every patient after a certain age, such as forty or fifty, and then recommend DHEA if levels are low. Some are very conservative in their dosages and will start with 5 or 10 mg initially and titrate up if these doses, after a month or so, do not elevate the blood DHEA(S) levels back to youthful levels, or do not provide any noticeable benefits. It seems that experienced physicians are first opting for this conservative low dose approach before moving on to higher doses.
• A few physicians think that 25 or 50 mg of DHEA will not lead to anti-aging outcomes and perhaps higher dosages, such as 200 mg, or more, are more appropriate. At least one scientist believes that the DHEA molecule has to be altered, such as being fluorinated, to have a significant influence on longevity.
As you have probably already gathered having read thus far into this book, Medicine does not always speak with one voice. Rational, intelligent physicians, looking at the same data, may come to different conclusions. Even after studying the simple vitamins and nutrients such as C, E, and beta-carotene for two or three decades, there is still no consensus among physicians how they influence health and longevity and if so, what dosages are best. It will take us many more decades to sort everything out.
In the meantime, I have chosen in this book to present to you, the intelligent reader, all the options; and let you, in consultation with your personal physician, decide whether DHEA is appropriate for your unique circumstance, and if so, how much.
There are at least two types of individuals and physicians. The conservatives who want to patiently wait until all the studies are in before starting a course of action, and the optimists who will take a particular supplement based on an educated guess on its purported benefits from the available, limited studies. These optimists claim they don't have the patience, or life expectancy, to wait a few decades for the definitive results. Where do you fit in?
Here are some answers to questions I was asked while writing this book.
What forms and in what dosages does DHEA come in?
Capsules are the most common form. Compounding pharmacies can make it in any dosage that a doctor recommends, from 5 mg to 200 mg. They can also make it in creams, ointments, and even lozenges.