By: Dr. Adam McLeod, BSc, ND
DHEA (Dehydroepiandrosterone) is often described as a wonder drug that is used by patients interested in its anti-aging effects. As we age the levels of DHEA in the blood start to decrease so the logic was that if patients were given this hormone then they would be able to partially reverse the aging process. There is evidence to suggest that indeed it improves many of the characteristics that we associate with aging.
Supplementation with DHEA is not safe for everyone as it is strongly associated with an increased risk of developing breast cancer1,2. In response to this risk, supplement companies began to produce a molecule called 7-keto DHEA, which is a metabolite of DHEA. This was considered a safer alternative to DHEA because it does not break down into estrogen or testosterone4. It is true that when patients take 7-keto DHEA there is no statistically significant increase in hormone levels but this does not make it safe to use with breast cancer.
I have personally seen several patients with active estrogen positive breast cancer who were prescribed 7-keto DHEA by a medical doctor. This is a dangerous combination and it is reckless to prescribe this medication in this clinical situation. 7-keto DHEA is not safe for any patient with estrogen positive breast cancer. There are a number of obvious biochemical reasons for this contraindication. First of all there are absolutely no studies which indicate that this is safe with estrogen positive breast cancer. Secondly, just because the estrogen levels are not elevated does not mean that the estrogen receptor is not being stimulated.
Normally the receptors on the surface of a cell are only stimulated by a few specific molecules. The estrogen receptors are notoriously promiscuous. What this means is that they are stimulated by many different molecules as well as estrogen. One of those molecules is 7-keto DHEA. In other words, even though patients do not have elevations in estrogen levels the estrogen receptors are being directly stimulated by the 7-keto DHEA3. As far as the cancer cells are concerned, they will act as if they are being stimulated by estrogen even though the actual levels of estrogen remain unchanged.
In one study it was conclusively shown that 7-keto DHEA (aka 7-oxo DHEA) is a low affinity ligand activator of estrogen receptors. The estrogen activity in these cancer cell lines were significantly elevated compared to the controls. In this same study, the cancer cells (MCF-7 breast cancer cells) that were treated with 7-keto DHEA grew much faster than the controls. This simple study certainly raises concern about the use of this supplement in cancer patients. It is clearly misleading to state that 7-keto DHEA has all the positive effects of DHEA without any of the negative effects. This is simply not how our cells operate on the biochemical level.
Another obvious concern is that 7-keto DHEA is essentially structurally identical to DHEA. This means that its overall shape is so similar that it will stimulate estrogen receptors the same as if it was DHEA. The estrogen receptors on cancer cells cannot tell the difference between 7-keto DHEA and DHEA. As far as the cancer is concerned it is the same thing. Of course the DHEA will not stimulate these receptors as strongly as estrogen but they still increase the activity which is the complete opposite of what you want to do with estrogen positive breast cancer. Conventional cancer therapies work very hard to reduce estrogen activity as much as possible because this activity acts as a signal for these cancer cells to grow5.
It is important that more patients become aware of this serious concern because it is difficult to sift through the mountains of information on the web. Unfortunately, there are still doctors that are prescribing this medication to estrogen positive breast cancer patients. The simple explanation that estrogen levels are unaffected does not mean that it is safe. Biology is much more complex than simply monitoring the level of a few arbitrary hormones in the blood. There is significant cross talk between these different pathways in cells and this well understood biological concept also applies to the clinical setting.
Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, First Nations Healer, Motivational Speaker and International Best Selling Author http://www.dreamhealer.com
He currently practices at his clinic, Yaletown Naturopathic Clinic, in Vancouver, BC where he focuses on integrative oncology. http://www.yaletownnaturopathic.com
1) Tworoger, S. S.; Missmer, S. A.; Eliassen, A. H. et al. (2006). “The association of plasma DHEA and DHEA sulfate with breast cancer risk in predominantly premenopausal women”. Cancer Epidemiol. Biomarkers Prev. 15 (5): 967–71.
2) Key, T.; Appleby, P.; Barnes, I.; Reeves, G. (2002). “Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies”. J. Natl. Cancer Inst. 94 (8): 606–16.
3) Michael Miller, Kristy K., et al. “DHEA metabolites activate estrogen receptors alpha and beta.” Steroids 78.1 (2013): 15-25.
4) Lardy, H; Kneer N, Wei Y, Partridge B, Marwah P (1998). “Ergosteroids II: Biologically Active Metabolites and Synthetic Derivatives of Dehydroepiandrosterone”. Steroids 63 (3): 158–165.
5) Janni W, Hepp P. Adjuvant aromatase inhibitor therapy: Outcomes and safety. Cancer Treat Rev. 2010; 36:249–261.