DHEA revisited..

DHEA revisited..

Joined: January 22nd, 2017, 9:43 am

March 18th, 2018, 3:19 am #1

Joy, on this topic sometimes i wonder if Dr Sher is WRONG about his opinions, even though he blogs about it with confidence.

Apparently, Dr Braverman started with Dr Sher as a medical director. Since Dr Sher only scratches the surface on immune treatment, when Dr Braverman brought up the possibility that there are more pieces to the immunity puzzle in the context of infertility, they had a falling out.

Dr Sher waxes lyrical about DHEA being bad for you, but I'm starting to wonder if he's right.. he posted that he was working on a study re the effects of testosterone on egg quality and it hasn't been and won't be published and he refuses to make it an article.. I wonder if he's wrong and it wasn't accepted because his methodology was wrong?

I had my male androgens tested recently and they were low as follows:

Testosterone: 11.5 ng/dL
Free testosterone: 0.6 pg/ml
SHBG: 1.8 mg/dL or 17.9 ug/ml
Free androgen index: 0.3%
DHEAS: 4.7 umol/L or 173 µg/dL

These seem to be at the lower end of the range of normal..

According to what i've found, androgens are needed to increase the sensitivity of the follicles to FSH.. I understand Dr Sher is worried about those with already elevated levels of LH, because he says LH converts DHEA to testosterone, but I'm not sure I see a problem with this because while DHEA converts to testosterone, it is then aromatised to oestrogen.. This is the process and it's the correct process.. Dr Sher seems to think elevated LH overtaxes the follicle, but where is his proof??!?!

From what i've read, our DHEA-S levels need to be in the upper third or above of the range which is normal for 25-year old women.. mine are clearly low and i'm thinking they need to be above 250..?

Typical normal ranges for females are:
Ages 18 to 19: 145 to 395 µg/dL or 3.92 to 10.66 µmol/L
Ages 20 to 29: 65 to 380 µg/dL or 1.75 to 10.26 µmol/L
Ages 30 to 39: 45 to 270 µg/dL; and
Ages 40+: 32 to 240 µg/dL

So maybe I need DHEA supplementation is warranted in certain situations? If our androgen levels are low, doesn't it make sense to supplement them? Androgens are needed for fertility and egg quality.. I think Dr Sher's theory is WRONG.

Anyone here have normal levels and found their IVF response was a bit better than when they were low?!?!
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Joined: January 27th, 2015, 5:04 pm

March 18th, 2018, 7:55 pm #2

Thanks so much for writing to me Penny! I appreciate you sharing your thoughts with me!

I still have no clue what to do with DHEA. Some days i take it, some days i don't. I really don't know what to do.

When I had a phone consult with Dr Gleicher a few years back he told me that the DHEA-s levels are relatively unimportant. He said they check both free and total testosterone but total testosterone is more important. I remember asking him whether my fibroids would get bigger if i were to take DHEA given that the testosterone gets converted to estrogen but he said that estrogen levels wouldn't go high and that most of the DHEA gets converted to testosterone.

I asked whether taking DHEA would lower fsh and he said no unless the reason for the high DHEA is adrenal then it will help. Apparently it helps lower fsh if a woman suffers from adrenal insufficiency. He had asked me at the time to do some tests to check my adrenals.

Most of the REs i talked to told me it won't help and it won't hurt. One RE i talked to said the American society of gynecologists doesn't say to take it so he doesn't recommend it for his patients. I don't know though if all these REs are relaxed about taking it cause they haven't seen any damage in more normal women-under 40, lower LH etc. But I am not in that category-i am over 40 with super high LH so maybe it would hurt my eggs?? I don't know.

One woman told me that Dr KK told her to take it. However she did not have high LH.

In my case without the help of DHEA my testosterone is almost zero and my DHEA-s levels are very very low.
Taking 75mg of it pushed my testosterone in the upper third of the normal range but my DHEA-s levels would get very very high and out of range. Once my reserve got extremely low the 75mg wouldn't push my testosterone in the upper third of the normal range. I started to take 50mg at one point. With that testosterone was lower than the upper third but at least not zero. My DHEA-s levels were still high and out of range. Then i tried 25mg. Again testosterone was not zero but my DHEA-s levels were still out of range but not very high, just a bit out of range. If i stop it testosterone goes to zero and my DHEA-s levels very very low.

Lately i have stopped taking it completely but I still have no clue if i am doing right.

It would be good if someone on here talking to Dr Check or Dr KK would ask specifically about Dr Sher's theory-i mean how about DHEA in high LH women with low testosterone who are over 40? Women whose testostone levels are zero without it..and what if DHEA-s get out of range when taking it..

I am sorry I not being much help..I am so confused about it myself. What does Dr Braverman think specifically about Dr Sher's theory?

Thanks for sharing your thoughts on it Penny! If you find something more on it please let me know!

Wishing you all the best as always!
xx
Joy



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Joined: January 22nd, 2017, 9:43 am

March 24th, 2018, 7:15 am #3

Hey Joy!

Sorry for the delay in replying.. so Dr Braverman believes that it's ok to take DHEAS supplementation if your total testosterone is low, but when you take DHEA supplementation, as you said, it's ok for DHEAS levels to go up, but FREE testosterone must NOT go up.

Dr Check doesn't recommend DHEA, but that's probably because he doesn't have much experience with it. I think Dr Braverman's view is the same as Dr Gleicher's view ,but Dr Braverman seems to say that with DHEA supplementation, total testosterone can go up, but free testosterone shouldn't go up.

If your testosterone is virtually zero, then I would take DHEA supplementation. You need testosterone for follicle growth. It's ok and totally normal for DHEAS levels to be high while on supplementation, but free testosterone must not go over range.

Dr Braverman said "it's ok for the DHEAS levels to go up, but free testosterone should not be above range when supplementing with DHEAS".

Still not sure what to do for me.. I took DHEAS for 4 weeks before starting an IVF cycle. So after 4 weeks my DHEAS and total testosterone levels were elevated, but my free testosterone was within range. However, my RE told me that the labs struggle to test testosterone as accurately as they would like and they keep changing the assay. In one lab, the reference range is different because they're using a different assay and in another the reference range is the complete opposite, so I don't know which assay is better and which is not. However, when I take DHEAS, the only level that is not elevated is the FREE testosterone level.

So free testosterone is the amount of testosterone that is not bound to carriers and is available to stimulate tissues. The higher this is, the more androgenic effect on the tissues. The reason why Dr Braverman does not want FREE testosterone to be elevated is because PCOS women tend to have elevated levels of free testosterone which we know results in poor quality eggs and abnormal embryos.

Have you had your free testosterone level checked while on DHEAS? If it's elevated while supplementing, then you need to stop taking it. But if it's not elevated and within range, keep taking it. We need free testosterone to stimulate tissues and therefore, help follicles grow.

Given my free testosterone is within range with or without supplementation, I am not sure if the higher the level the better or whether as long as it's range that's all that matters.. This is a question I have written down to ask Dr Braverman during my followup consultation. Do you want me to ask him anything else? If so, please let me know.

xx
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Joined: January 27th, 2015, 5:04 pm

March 30th, 2018, 5:46 pm #4

Hello Penny!!! Thank you so very much for trying to help me with my DHEA dilemma! I appreciate this so much!

It is very interesting to hear what Dr Braverman thinks. But let me get this straight-

He believes that it is ok for DHEA-s levels to get out of range, it's ok for total testosterone to get out of range but it is not ok for free testosterone to get out of range.

Did i get this right?( when you say DHEA-s and total testosterone are ok to be elevated do you mean out of range?)

And does he believe the above about high LH women like me? ( I would be forever grateful if you can ask him this when you next talk with him)

I have no idea what to advise you as to whether to take DHEA or not. I remember when i was studying about DHEA there were good videos on the CHR site explaining things. Can you check to see if they want both free and total testosterone to be in the upper third of the normal range? Maybe that would give you an indication as to whether you should continue it or not.

However the fact that both Dr Check and both Dr Yelian seem against it...makes me pause. We all know the successes of both these doctors with high fsh women.

Anyways..i hope i am not too late when you see this message. If you can please ask Dr Braverman the above for me..thank you a million times!
xx
Joy

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Joined: January 22nd, 2017, 9:43 am

April 8th, 2018, 4:11 am #5

Joy, on this topic sometimes i wonder if Dr Sher is WRONG about his opinions, even though he blogs about it with confidence.

Apparently, Dr Braverman started with Dr Sher as a medical director. Since Dr Sher only scratches the surface on immune treatment, when Dr Braverman brought up the possibility that there are more pieces to the immunity puzzle in the context of infertility, they had a falling out.

Dr Sher waxes lyrical about DHEA being bad for you, but I'm starting to wonder if he's right.. he posted that he was working on a study re the effects of testosterone on egg quality and it hasn't been and won't be published and he refuses to make it an article.. I wonder if he's wrong and it wasn't accepted because his methodology was wrong?

I had my male androgens tested recently and they were low as follows:

Testosterone: 11.5 ng/dL
Free testosterone: 0.6 pg/ml
SHBG: 1.8 mg/dL or 17.9 ug/ml
Free androgen index: 0.3%
DHEAS: 4.7 umol/L or 173 µg/dL

These seem to be at the lower end of the range of normal..

According to what i've found, androgens are needed to increase the sensitivity of the follicles to FSH.. I understand Dr Sher is worried about those with already elevated levels of LH, because he says LH converts DHEA to testosterone, but I'm not sure I see a problem with this because while DHEA converts to testosterone, it is then aromatised to oestrogen.. This is the process and it's the correct process.. Dr Sher seems to think elevated LH overtaxes the follicle, but where is his proof??!?!

From what i've read, our DHEA-S levels need to be in the upper third or above of the range which is normal for 25-year old women.. mine are clearly low and i'm thinking they need to be above 250..?

Typical normal ranges for females are:
Ages 18 to 19: 145 to 395 µg/dL or 3.92 to 10.66 µmol/L
Ages 20 to 29: 65 to 380 µg/dL or 1.75 to 10.26 µmol/L
Ages 30 to 39: 45 to 270 µg/dL; and
Ages 40+: 32 to 240 µg/dL

So maybe I need DHEA supplementation is warranted in certain situations? If our androgen levels are low, doesn't it make sense to supplement them? Androgens are needed for fertility and egg quality.. I think Dr Sher's theory is WRONG.

Anyone here have normal levels and found their IVF response was a bit better than when they were low?!?!
Hi hun, your understanding of what I said is correct. They can all go above range but free testosterone must be in range. If it goes above you have to stop taking dhea.

I'll ask Dr B about high LH... High LH tends to suggest PCOS.. Could you have DOR causes by underlying endometriosis and PCOS? It is suggested endo causes low AMH and PCOS causes high LH.. Yours is an interesting case because testosterone is low and LH is high..

Dr B just posted an article about treating endo and high success rates (he uses the words "outstanding success rates") for women in the 40-45 age bracket. Up to 40% is seriously amazing..

Have a look:http://www.preventmiscarriage.com/Immun ... ook%20Post

Or this is the shortened link:https://goo.gl/V5QYjf
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Joined: January 27th, 2015, 5:04 pm

April 8th, 2018, 6:15 pm #6

Penny wow thank you so much!!!
This is more than kind asking Dr Braverman for me!!!
Thanks a million!!!

I am certain I don't have PCOS. And as far as I know I have no endo( it was never seen on scans but maybe there is silent endo going on in there, I know for sure I have adenomyosis which is mild and focal though)

Basically people with severe DOR can get high LH as well as FSH( even without PCOS). So yeah i am unlucky to have both hormones working against me.

Basically for some of us with minimal endogenous testosterone is it ok to take DHEA given that we have super high LH and are over 40? I am really hoping he will solve this dilemma and thank you greatly for asking Penny!

Do you plan on having the testing done with Dr Braverman? Maybe visit him in the States? He sounds really good! But I heard from somewhere else that he is super expensive. I don't know how true that is though.

Again thank you wholeheartedly Penny! As always my best wishes to you!!!

xx
Joy
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Joined: January 22nd, 2017, 9:43 am

April 9th, 2018, 8:55 pm #7

Hi Joy, I asked Dr B for you. He said the theory that LH converts DHEA to testosterone in the ovary is not correct. He says if free testosterone levels are out of range (i.e. outside the low end range), then you need to get them into range and the way to do this is to supplement with DHEA. He says often when he sees men with high LH but low testosterone, then there is a problem with the LH communicating with the brain to produce testosterone as this is LH's primary function. He would prescribe them androgens to get their testosterone within range. He says for women, he does the same. He says DHEA supplementation is required to get free testosterone within range. The other male androgens will be outside the high range, but that's nothing to worry about. His view is that if you have virtually zero levels of male androgens, you need DHEA, but you need to be monitored on it every 2 or so weeks and if free testosterone starts to go too high and therefore, outside the high end range, then you adjust the dose.

I'm going to be starting 50mg of DHEA supplementation because my free testosterone is low. It's 2.0 when it has to be above 2.1 (Australian reference range).

Does this help? Any other questions, let me know and i'll email him!!

Joy, have you had your male androgens tested recently while on DHEA? You should do another blood test and share your levels and I can share it with him with any questions you might have.
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Joined: September 23rd, 2017, 2:12 am

April 10th, 2018, 3:06 am #8

Joy, on this topic sometimes i wonder if Dr Sher is WRONG about his opinions, even though he blogs about it with confidence.

Apparently, Dr Braverman started with Dr Sher as a medical director. Since Dr Sher only scratches the surface on immune treatment, when Dr Braverman brought up the possibility that there are more pieces to the immunity puzzle in the context of infertility, they had a falling out.

Dr Sher waxes lyrical about DHEA being bad for you, but I'm starting to wonder if he's right.. he posted that he was working on a study re the effects of testosterone on egg quality and it hasn't been and won't be published and he refuses to make it an article.. I wonder if he's wrong and it wasn't accepted because his methodology was wrong?

I had my male androgens tested recently and they were low as follows:

Testosterone: 11.5 ng/dL
Free testosterone: 0.6 pg/ml
SHBG: 1.8 mg/dL or 17.9 ug/ml
Free androgen index: 0.3%
DHEAS: 4.7 umol/L or 173 µg/dL

These seem to be at the lower end of the range of normal..

According to what i've found, androgens are needed to increase the sensitivity of the follicles to FSH.. I understand Dr Sher is worried about those with already elevated levels of LH, because he says LH converts DHEA to testosterone, but I'm not sure I see a problem with this because while DHEA converts to testosterone, it is then aromatised to oestrogen.. This is the process and it's the correct process.. Dr Sher seems to think elevated LH overtaxes the follicle, but where is his proof??!?!

From what i've read, our DHEA-S levels need to be in the upper third or above of the range which is normal for 25-year old women.. mine are clearly low and i'm thinking they need to be above 250..?

Typical normal ranges for females are:
Ages 18 to 19: 145 to 395 µg/dL or 3.92 to 10.66 µmol/L
Ages 20 to 29: 65 to 380 µg/dL or 1.75 to 10.26 µmol/L
Ages 30 to 39: 45 to 270 µg/dL; and
Ages 40+: 32 to 240 µg/dL

So maybe I need DHEA supplementation is warranted in certain situations? If our androgen levels are low, doesn't it make sense to supplement them? Androgens are needed for fertility and egg quality.. I think Dr Sher's theory is WRONG.

Anyone here have normal levels and found their IVF response was a bit better than when they were low?!?!
Penny,

This is not to discourage you from trying it, but just be careful with DHEA. It can mess up your cycles. (Both times I tried, my cycles were messed up). If you try it, be sure to have your T levels monitored. Having said that, I should share that I did find info that T at the beginning of the cycle (CD1-7) can be helpful. So, may be worth trying it, to see how your body reacts.
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Joined: January 27th, 2015, 5:04 pm

April 10th, 2018, 1:07 pm #9

Hi Joy, I asked Dr B for you. He said the theory that LH converts DHEA to testosterone in the ovary is not correct. He says if free testosterone levels are out of range (i.e. outside the low end range), then you need to get them into range and the way to do this is to supplement with DHEA. He says often when he sees men with high LH but low testosterone, then there is a problem with the LH communicating with the brain to produce testosterone as this is LH's primary function. He would prescribe them androgens to get their testosterone within range. He says for women, he does the same. He says DHEA supplementation is required to get free testosterone within range. The other male androgens will be outside the high range, but that's nothing to worry about. His view is that if you have virtually zero levels of male androgens, you need DHEA, but you need to be monitored on it every 2 or so weeks and if free testosterone starts to go too high and therefore, outside the high end range, then you adjust the dose.

I'm going to be starting 50mg of DHEA supplementation because my free testosterone is low. It's 2.0 when it has to be above 2.1 (Australian reference range).

Does this help? Any other questions, let me know and i'll email him!!

Joy, have you had your male androgens tested recently while on DHEA? You should do another blood test and share your levels and I can share it with him with any questions you might have.
Penny hello!!! How are you?
Thank you so very much for asking Dr Braverman for me!!!! Huge thanks!!!

Let's see. I have a few questions for you and a few for Dr Braverman but I don't want to be giving you a hard time. If you have the chance to ask him good otherwise don't feel pressured.

Questions for you:
1) In my country we can't measure DHEA in blood. Just DHEA-s. Is he ok with that?
2) Why did he decide 50mg for you rather than 75 or 25mg of DHEA?
3) You wrote "the other male adrogens will be outside the high range but that's nothing to worry about"-i take it you mean total testosterone and the DHEA-s levels right?

Questions for Dr Braverman:
1) Given that my adrogens are NOT totally zero( but still very low) and I am a super high LH woman( 30-50 at baseline) is it still ok to take DHEA supplementation?
2) Does he want free testosterone to be just within range or does he want it to be in the upper third of the normal range like dr Gleicther wants?
3) Does he believe that high LH in the follicular phase( above 15) damages the egg in a natural ivf cycle?


For me total testosterone is usually 0.08ng/ml without supplementation( lab range 0.06-0.82ng/ml)
DHEA-s levels without supplementation are around 100μg/dl( lab range 60.9-337μg/dl).
I have no idea what my free testosterone is.
I can get tested for all of them again including free testosterone and send them to you Penny but I feel so bad you asking him for me......

He must be one amazing person answering so many questions though. And of course I read of him being an amazing dr. Will you visit him in the States? How much does he charge for a consult? And will you do the blood panel he suggests for immune problems?( how does one send blood overseas to the US ??)

Ok i should stop now. I am sorry for asking more..just don't feel pressured that you need to ask him anyways.
Only if you can...whatever you can.
I so so appreciate all your help on this. This dilemma on DHEA has been eating my soul away for 4 years!

THANK YOU!!!!!!!!!!!!!!!!!!!
xx
Joy



Last edited by joy39 on April 10th, 2018, 1:29 pm, edited 1 time in total.
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