Why does DHEA decrease? Understanding the 'Adrenopause' Phenomenon

DHEA, the body's most abundant circulating steroid hormone, naturally decreases by up to 90% from its peak in early adulthood by the time we reach our 80s. But why does DHEA decrease and what drives this significant hormonal shift in older adults?

Quick Summary

DHEA levels fall primarily due to a natural, age-related decline known as 'adrenopause,' but chronic stress and inflammation also significantly suppress production. Lifestyle factors like poor diet, certain medications, and underlying health conditions contribute to this decrease.

Key Points

• Natural Decline: DHEA levels naturally peak in early adulthood and decline significantly with age, a process sometimes called 'adrenopause'.

• Stress is a Major Factor: Chronic stress increases cortisol production, which inversely affects DHEA levels and can accelerate their decline.

• Multiple Causes: Lifestyle factors like poor diet, inflammation, blood sugar issues, and certain medications also contribute to decreased DHEA.

• Health Impacts: Low DHEA is associated with symptoms such as fatigue, reduced libido, decreased muscle mass, and mood changes.

• Management is Possible: While the age-related decline is natural, managing stress, improving diet, and regular exercise can support adrenal health and hormonal balance.

The Natural Course of 'Adrenopause'

Produced primarily by the adrenal glands, DHEA (dehydroepiandrosterone) and its sulfated form, DHEA-S, are crucial precursor hormones for testosterone and estrogen. Production peaks in young adulthood, typically in our mid-20s, and then begins a gradual, progressive decline throughout our lives. This phenomenon is often referred to as 'adrenopause' and occurs in both men and women, independent of menopause. By the time individuals reach their 70s or 80s, DHEA levels may be only 10–20% of what they were in their prime.

The Adrenal Gland's Role

The adrenal glands' zona reticularis is the primary site of DHEA synthesis, a process regulated by the hypothalamic-pituitary-adrenal (HPA) axis and specifically the hormone ACTH. While the exact mechanism for the age-related decline isn't fully understood, it's believed to involve a reduction in the mass of the zona reticularis or decreased activity of the key enzymes responsible for DHEA synthesis. This age-dependent change is considered a normal physiological process, but its acceleration or exacerbation can have noticeable health impacts.

The Stress-Hormone Connection and Cortisol's Impact

One of the most significant external factors that influences DHEA levels is stress. The body's response to stress is governed by the HPA axis, which also controls DHEA production. During chronic stress, the body prioritizes the production of cortisol, often at the expense of DHEA. This is due to a phenomenon known as the 'cortisol-DHEA steal,' where the body diverts hormonal precursors to make more cortisol, an essential survival hormone, leading to a simultaneous drop in DHEA.

Chronic stress does not just suppress DHEA production; it also leads to an elevated cortisol-to-DHEA ratio, which can have detrimental health consequences. Studies have linked a high cortisol-to-DHEA ratio to immune dysfunction, metabolic syndrome, and cognitive decline. Effective stress management is therefore not only crucial for mental well-being but also for maintaining a healthier hormonal balance.

Other Key Factors Influencing DHEA Decline

Beyond age and stress, several other health and lifestyle factors can cause or accelerate a decrease in DHEA:

• Chronic Inflammation: Sustained, low-grade inflammation can disrupt adrenal function and shift the body into a catabolic state, causing DHEA levels to drop.
• Chronic Illness: Severe or long-term illnesses, including autoimmune conditions like lupus and Crohn's disease, as well as adrenal insufficiency, can significantly lower DHEA.
• Medications: Certain drugs, such as glucocorticoids (like prednisone), oral contraceptives, and opioids, are known to suppress adrenal function and reduce DHEA production.
• Nutritional Deficiencies: A diet lacking key micronutrients vital for adrenal health, such as zinc, magnesium, and vitamin C, can lead to decreased DHEA synthesis.
• Blood Sugar Imbalances: Both hyperglycemia (insulin resistance) and hypoglycemia can stress the body and negatively impact adrenal function, contributing to lower DHEA.
• Overtraining: Long-term, intense exercise without adequate recovery can place a significant strain on the body, which it perceives as stress, leading to a reduction in DHEA.

The Role of DHEA Decline in Aging

The fall in DHEA is more than just a number; it correlates with many age-related changes. A low DHEA level is associated with reduced physical vitality, diminished muscle and bone mass, decreased libido, and a weaker immune response. While DHEA supplementation has been explored, its use and safety should be discussed with a healthcare provider, as more research is needed on its long-term effects and risks.

Symptoms of Low DHEA

Decreased DHEA can manifest in various ways, with symptoms often being gradual and easy to mistake for other issues. Common signs include:

• Persistent fatigue and low energy levels
• Reduced libido and sexual function
• Decreased muscle mass and strength
• Increased body fat, particularly abdominal fat
• Reduced bone density
• Mood changes, including depression and anxiety
• Poor memory and concentration
• Dry skin and hair
• Weakened immune system

Normal DHEA-Sulfate Ranges by Age and Sex

Understanding the typical decline can help put individual levels into perspective. DHEA levels are typically measured via DHEA-sulfate (DHEA-S) tests. Here is a simplified comparison based on typical ranges reported, though these can vary by lab:

Age Group	Typical Female DHEA-S Range (µg/dL)	Typical Male DHEA-S Range (µg/dL)
18–29	45–320	110–510
30–39	40–325	110–370
40–49	25–220	45–345
50–59	15–170	25–240
60+	<145	<204

Lifestyle Strategies for Supporting Adrenal Health

While the age-related decline is inevitable, several lifestyle modifications can help support adrenal function and potentially slow the rate of decrease:

1. Manage Stress: Implement stress-reduction techniques like meditation, yoga, or deep breathing exercises. This can help lower cortisol levels and support a healthier DHEA-cortisol balance.
2. Maintain a Balanced Diet: Focus on whole, nutrient-dense foods. Ensure adequate intake of vitamins and minerals essential for adrenal health, such as vitamin C, magnesium, and B vitamins.
3. Prioritize Quality Sleep: Aim for 7–9 hours of quality sleep per night. Sleep is crucial for hormonal regulation and allows the body to recover from daily stress.
4. Engage in Regular, Moderate Exercise: Consistent physical activity, such as walking or strength training, can help support hormone levels. Avoid over-exercising, which can have a counter-effect on DHEA production.
5. Address Underlying Health Issues: Work with a healthcare provider to manage any chronic inflammatory conditions, blood sugar imbalances, or other underlying illnesses that may be impacting adrenal function.

Conclusion

The progressive decrease in DHEA is a complex process driven primarily by age, but heavily influenced by chronic stress and other health and lifestyle factors. Understanding why DHEA decreases is the first step toward proactive health management. By addressing controllable factors such as stress and diet and consulting a healthcare professional for a proper diagnosis, you can take meaningful steps to support your hormonal health and overall well-being as you age.

For more detailed information on hormonal health and aging, please visit the National Institutes of Health website.

Frequently Asked Questions

Does DHEA decrease in both men and women?

Yes, the natural decline in DHEA levels with age occurs in both men and women. The pattern and rate of decrease are similar across sexes, though men typically have higher baseline levels than women throughout adulthood.

Can stress cause DHEA to decrease?

Yes, chronic stress is a major contributor to decreased DHEA. The body prioritizes the stress hormone cortisol, often at the expense of DHEA production, creating an unfavorable hormonal balance.

Why does DHEA decrease as we get older?

The age-related decline is part of a normal physiological process called adrenopause. It is believed to be caused by a reduction in the adrenal glands' production capacity or changes in the enzymes involved in DHEA synthesis over time.

What are the common symptoms of low DHEA?

Common symptoms include fatigue, low energy, reduced libido, decreased muscle mass and bone density, increased body fat, mood swings, depression, and poor memory or concentration.

Do all people experience the same rate of DHEA decline?

No, there is significant individual variability in the rate of DHEA decline. While the general pattern is consistent, factors like genetics, lifestyle, and overall health influence the magnitude and timing of the decrease.

Can diet affect DHEA levels?

Yes, diet plays a role. Poor dietary habits, specifically deficiencies in key nutrients like zinc, magnesium, and vitamin C, can impair adrenal function and negatively impact DHEA synthesis.

Is DHEA supplementation a solution for decreasing levels?

While DHEA supplements are available and have been studied, it is crucial to consult with a healthcare provider before use. The long-term safety and efficacy are still under investigation, and DHEA can affect other hormone levels.