DHEA, androstenedione and pregnenolone are examples of readily available OTC hormones. Claims abound that these substances are the long sought after "fountain of youth." People take these supplements to feel younger, build muscle mass and to improve their energy, concentration, libido, athletic performance and so on. While some of these responses may be noted in patients with hormonal deficiencies benefits would not be expected and the possibility of numerous side effects exists in patients who take these supplements in the absence of a hormonal deficiency. For this reason some of the health food stores have responsibly refused to sell these supplements even though they could make money hand over fist doing so. 

DHEA (dehydroepiandrosterone) is produced in the zona reticularis of the adrenal glands and can serve as a precursor to androstenedione, testosterone, estrone and estradiol. While DHEA levels demonstrate significant diurnal variations the sulfated form, DHEA-S, remains relatively constant. DHEA-S levels are therefore more useful to see if a patient might be more likely to benefit from or be hurt by DHEA supplementation. Consider checking a DHEA-S level in patients with chronic fatigue, fibromyalgia, or chronic glucocorticoid use (which predictably causes adrenal suppression). There are age and gender specific laboratory norms for DHEA-S. A male patient in his mid 40s presented to me with a diagnosis of CFS and fibromyalgia of many years duration which had not been helped by conventional medications. His DHEA-S level was typical of someone far older. Since taking 25 mg of DHEA daily his energy and myalgias have both improved significantly and he is now able to exercise regularly. We are monitoring his DHEA-S level periodically to ensure that the level doesn't rise into the "supraphysiologic" range and I am also doing routine prostate exams and PSA levels to monitor for unwanted prostatic stimulation. 

Clearly patients should not be taking OTC hormones "willy nilly" because of the latest hype they've heard. On the other hand there may be situations where the use of these supplements proves beneficial. OTC hormones, such as DHEA, should only be taken under medical supervision which includes monitoring of blood levels as well as prostate exams and PSA levels in men and breast exams and mammograms in women. Warn your patients that inappropriate, unsupervised use of these supplements could cause acne, aggressive behavioral changes, hepatitis, hirsutism, prostatic hypertrophy and stimulation of hormone-dependent tumors. Encourage them to trust the abundant information in the medical literature rather than what they find in the popular press. 

If the FDA regulates these OTC hormones they will undoubtedly be accused of Gestapo tactics. If they don't they will be accused of being ineffectual. Until the FDA resolves this dilemma and takes the appropriate course of action it is up to us to ensure that if our patients are using these supplements it is being done safely and rationally.