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1	DHEA an Androgen Catalyst for Female Sexuality Richard F. Spark, MD, FACE Beth Israel Deaconess Medical Center Boston, MA
2	DHEA and the DSHEA 1984-DHEA ignored by FDA 1986-Rancho Bernardo-Low DHEA and CV deaths 1994-DSHEA -DHEA an OTC “supplement” 1999-DHEA-improves well-being + sexuality in women with adrenal insufficiency 2000-DHEA heightens sexuality in older women, not men
3	Adrenal Steroids and their Function
4	Adrenal Steroid Hormone Secretion
5	Steroidogenesis in Pregnancy
6	DHEA - In Utero
7	What is DHEA & Who needs it?
8	DHEA-S Levels and Age
9	Plasma DHEA-S & 12 Year Mortality- Men 50-79
10	DHEA 50 mg/d vs.Placebo
11	DHEA vs.Placebo DHEAS levels Men
12	DHEAS vs. Placebo Testosterone - Men
13	DHEA 50 mg/d vs. Placebo DHEAS- Women
14	DHEAS 50mg/d vs. Placebo- Testosterone- Women
15	Androgens and Women Advocates E +T better than E a. bone density, b. GH and IGF c. Libido DHEA improves a. Well-being b. QOL c. Libido Skeptics Baseline T low ? Inc.T to young female range- no High normal T + resp AE’s DHEA Variable to no benefit Unreliable DHEA preps. AE’s
16	Content of DHEA as a Percentage of the Label Claim in 16 Dietary Supplement Products
17	Lessons from Rheumatology-- DHEA & SLE NZB mice a.Prevents autoimmune disease b. prolongs life Patients a. Pre- Rx. DS levels suppressed b.DHEA improves SLEDAI scores c. Reduces Prednisone requirement d.Up-regulates IL-2 production
18	Cytokines + DHEA IL-6 levels increase as DHEA/DHEA-s levels decline in aging, RA, PMR, osteopenia, atherosclerosis. Il-6 receptors in adrenal cortex Il-6 increases cortisol, DHEA/DHEAS while blunting ACTH. DHEA reverses endotoxin-mediated IL-6 production Are immunosenescence and adreno-senescence co-dependent ?
19	Summary-DHEA 50 mg bid
20	DHEA- Issues for the Future