Staying forever young

Reluctant to take HRT, Julia Pascal discovered DHEA, a little-known natural treatment for menopausal symptoms. She's thriving on it - so why aren't more women taking it?

Can a hormone you've been producing naturally for years protect you against the effects of the menopause? DHEA (dehydroepiandrosterone) is the most common hormone in our bodies. It is a steroid which comes from cholesterol and is a natural substance. In women, DHEA is produced in the ovaries and the adrenals: in men it is manufactured in the testes. It peaks in our twenties and thirties, and then starts plummeting fast.

Can a hormone you've been producing naturally for years protect you against the effects of the menopause? DHEA (dehydroepiandrosterone) is the most common hormone in our bodies. It is a steroid which comes from cholesterol and is a natural substance. In women, DHEA is produced in the ovaries and the adrenals: in men it is manufactured in the testes. It peaks in our twenties and thirties, and then starts plummeting fast.

It appears that by replacing this lost DHEA, women like me who are going through the menopause but don't wish to take Hormone Replacement Therapy (HRT) can avoid or alleviate some of the unpleasant symptoms of the "change", such as depression, fatigue, hot flushes and loss of libido. Yet few women in this country have even heard of it.

I came across DHEA by chance in a New York vitamin shop. It is routinely sold over the counter in the US as a "food supplement". In fact it is chemically synthesised in a laboratory. Previously, I had been to my NHS GP who, without taking my blood pressure or suggesting any blood tests, informed me that I was menopausal and that I should instantly take HRT to guard against osteoporosis, which is predominant in small white women. I took HRT for a month (with certain reservations), and then like thousands of other women, ditched it after learning of research that linked its use with a possible increased risk of breast cancer. Recent reports have upped the ante on the cancer risks and a mass flight from HRT has hit the country. We still don't really know whether the benefits of HRT - it protects against calcium loss from the bones - outweigh the risks, but I certainly feel it's best to be wary and consider other options.

I have, therefore, been taking DHEA for four years (I am now 54) and have managed to avoid all the common symptoms of the menopause. I have had no hot flushes, weight gain, depression, fatigue or any diminution of libido. As an experiment, I withdrew the DHEA for one month and began to experience the occasional hot flush. I went straight back to a 25mg dosage. I take yearly blood tests to determine cholesterol levels, liver function and fluctations in hormone and DHEA levels. All this is supervised by Dr Daniel Sister, a French doctor based in London. If you want to have these tests you will usually have to pay. I get mine done in France, where they are cheaper and I have health insurance via my French husband.

In Britain, and most of mainland Europe, DHEA cannot be bought over the counter, although research over the past 30 years has shown that menopausal women can benefit significantly from it. Bearing that in mind, why wasn't it promoted in the same way as HRT? And, now that HRT is under serious scrutiny, why is DHEA not being offered as a safer alternative?

The answer is that few drug companies stand to make a huge profit from its sale, since it has never been patented. Consequently, few NHS GPs have time to explore this hormone and no medical rep is going to approach them with samples. In this way, few people are aware of DHEA as a possible safer alternative to HRT.

According to Italian researchers at the Universities of Pisa and Modena, DHEA can be a viable replacement for HRT and their conclusion that, "DHEA treatment acts similarly to oestrogen-progestin replacement therapy," suggests that DHEA is more than a "food supplement" and should be seriously explored here.

The Italians tested 31 healthy post-menopausal women with DHEA. They were split into two groups: "early menopausal" (50-55) or "late menopausal" (60-65). These selected women were of normal body size or slightly overweight. At the beginning of the study, the older ones were seen to have lower levels of DHEA than their younger counterparts. Over the research period, DHEA levels in the older group caught up with that of the younger ones. Bone mass density tests were also conducted on the lumbar spine and the thigh bone and while no bone density increase was revealed, neither was there any loss, even though some might well have been expected over the six-month period of the study. The doctors concluded that those taking DHEA were able to "stop the clock".

Before the recent Italian research, there have been nearly 100 studies on DHEA since its official "discovery" in the early 1970s. A 1999 German paper, published in the New England Journal of Medicine, found that DHEA supplements lessened depression and anxiety in women as well as improving their libidos. Research at the University of California showed that 84 per cent of those taking DHEA felt better physically and mentally. The dramatically increased libido associated with DHEA was recently illustrated in a French study where older women, particularly those over 70, were reported to experience increased desire, sexual activity and satisfaction. And the Belgian doctor Thierry Hertoghe and the French doctor Jules-Jacques Nabet (in their book DHEA - L'hormone du Mieux-Vivre) promote DHEA as a hormone which, "helps sleep, improves skin quality, guards against memory loss, alleviates depression and controls obesity."

In a double blind study, 50mg was given daily to post-menopausal men and women over six months. Of the women, 84 per cent reported increased energy levels and libido while 67 per cent of men observed a drop in stress levels and an increased sense of well-being. DHEA also seems to have an effect on heart disease in men and very low levels of DHEA have been found in men suffering heart failure.

Are there dangers from DHEA? Well, clearly it hasn't been tested as much as HRT, which has been taken by millions of women, but the signs are good. In a small proportion of people it provokes headaches. In this case it should be stopped. Nobody under 35 needs DHEA unless specifically prescribed. Pregnant and nursing mothers must not take it, or those who may become pregnant. Overdosing can cause acne or facial hair growth. It is important to take it only after a blood test so that levels can be personalised and tests should be at least once a year.

Dr Sister - who has been studying and working with hormones for nearly 30 years and, in 1974, was the first doctor to publish a paper in French on DHEA - is against self-medication. Many of his patients complain of diminished libido. He finds that DHEA produces remarkable results in improving sex drive. "It's not the elixir of youth. It will never make an old person young," he says, "but it does have a strong effect on improving energy levels and sleeping problems. It also works on the skin and hair."

Dr Sister is a private doctor, so what is the NHS medical reaction to the hormone? Dr Karim Meeran, Senior Lecturer and Consultant in Endocrinology at Charing Cross Hospital says: "DHEA is a very interesting area but my opinion is that there isn't a good reason to administer it. I don't think it's dangerous but I don't know if it is safe. I am keeping an open mind."

There has been conjecture about breast or prostate cancer risks, but these have not been substantiated. In fact, an English study of 5,000 women in Guernsey, reported in the The Lancet in l971, showed that those who developed breast cancer had lower than average amounts of DHEA in their urine nine years before the cancer's onset. All who had less than 10 per cent of the average DHEA levels for their age group, died of breast cancer, while those with higher than average levels were cancer-free. Furthermore, a research study presented by the Sixth International Conference on AIDS, showed an increase in immune system functions in 13 patients taking DHEA supplements.

There is medical controversy about whether DHEA, when taken by men, improves or worsens prostate cancer. Dr G Debled, a European urologist uses DHEA to treat this cancer and reports that in over 20 years of administering it, no case of prostate cancer has developed, despite evidence that approximately 50 cases should have occurred according to national averages, while Dr Michael Schachter's book, The Natural Way to a Healthy Prostate, suggests DHEA should seriously be considered for the therapy of prostate disease.

Dr Alan Gaby, writing in the Alternative Medicine Review, confirms the studies showing DHEA as an immune booster and backs up research showing that women with low DHEA are, "40 times more likely to have osteoporosis than with normal DHEA levels." However, he cautions that it must be used with care to maximise advantages and minimise risks. Dr Sister maintains that, "not everybody needs it and those who do, don't all require the same dosage." I believe the NHS should explore prescribing DHEA for all who have abandoned HRT. There is too much overwhelming evidence of the benefits of DHEA to ignore this alternative any longer.

Dr Sister, Radical Beauty, 118 Harley Street, London W1 (020-7487 3220; e-mail: drsister@onetel.com)

MENOPAUSE - WHAT ELSE HELPS?

* Many women decide not to go the route of HRT. As an alternative, a regime of herbs, diet and exercise can help reduce menopausal effects.

* Black Cohosh has been effective in treating hot flushes, memory loss, mood swings and depression. Sage, traditionally used for excessive perspiration, is a common remedy for hot flushes and night sweats. Valerian is the herb of choice for interrupted sleep patterns. Hawthorn can help alleviate heart palpitations, but a doctor should confirm there is not a more serious cause.

* A diet of oily fish, grains, seaweed, soy and citrus fruits can soothe bloating, water retention, and tiredness. Limiting alcohol intake and smoking is advised.

* Exercises like weightlifting, yoga and t'ai chi fight bone loss and will promote a sense of well-being.

Liz Choppin