Testosterone with Dehydroepiandrosterone Interaction Details
Brand Names Associated with Testosterone
- Jatenzo®
- Testosterone
- testosterone undecanoate
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 27, 2023
Interaction Effect
Increased risk of adverse androgenic and hepatic effects
Interaction Summary
Patients electing to take both dehydroepiandrosterone (DHEA) and testosterone are at increased risk for androgenic side effects. Data are conflicting on the extent that DHEA increases the testosterone-epitestosterone (T/E) ratio. The effect appears to be dose-dependent, and at doses commonly used by body-builders (e.g. 1000 milligrams), androgenic effects are likely. Concomitant use is not advised.
Severity
Moderate
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Avoid concomitant use of dehydroepiandrosterone (DHEA) and testosterone. DHEA may increase testosterone levels, increasing the incidence of adverse androgenic adverse effects such as oligospermia (in men), gynecomastia, prostatic hypertrophy (especially in elderly males), and virilization in women (deepening voice, hirsutism, acne, clitoromegaly, and menstrual irregularities). Libido may increase or decrease. Adverse hepatic effects may also occur (peliosis hepatitis, hepatic neoplasms).
Mechanism Of Interaction
Additive androgenic effect, since dehydroepiandrosterone appears to act as a pro-drug for testosterone
Literature Reports
A) Dehydroepiandrosterone (DHEA) increased the testosterone-epitestosterone (T/E) ratio in an uncontrolled study of 4 human volunteers. Two over the counter DHEA preparations were used in this study. Nature's Pride "DHEA 50 mg+" (product A) contained DHEA 50 milligrams (mg), suma 25 mg, Korean ginseng 25 mg, muira pauma 25 mg, shitake mushroom concentration 15 mg, and green tea extract 5 mg. The second product, YourLife DHEA (product B), contained DHEA 25 mg as the only active ingredient listed on the label. Neither product contained testosterone as detected by gas chromatography-mass spectrometry (GC-MS) analyses. All subjects (except subject 4) took the product once daily for 4 days at breakfast. Subject 1 (age 47) took both preparations at 3 dosage levels at different times over a 6 month period: product A 50 mg/day, product A 100 mg/day, and product B 150 mg/day for 4 days. Subjects 2 (age 61) and 3 (age 28) took product B 50 mg/day and 100 mg/day, respectively. Subject 4 (age 27) took product A 100 mg/day for 2 days. A 24-hour urine was collected on day 3 and spot urine samples were taken in the morning and evening of day 4. Subject 1 at DHEA doses of 50 mg/day, 100 mg/day, and 150 mg/day had T/E ratios of 8.1, 11.4, and 14.4, respectively, compared to a pre-dose ratio of 2.4. Pre-dose T/E ratios for subjects 2 and 3 were 1.3 and 1.7, respectively, and T/E ratios were 1.6 and 3.9, respectively after DHEA. Subject 4 had a pre-dose T/E ratio of 0.8 and a T/E ratio of 1.1 following DHEA. Ratios exceeding 6:1 are used by several organizations including the United States Military and the International Olympic Committee (IOC) as an indication that additional tests are warranted to rule out use of exogenous physiological steroids. Manipulation of the steroid endocrine system to improve athletic performance has led some DHEA supplement providers on the internet to recommend up to 1000 mg/day .
B) Differences in baseline mean T/E ratios and dehydroepiandrosterone (DHEA) treatment mean ratios were not significant in 7 healthy subjects. Mean baseline T/E ratio was 0.67 (range: 0.1 to 1.2). DHEA 50 mg was taken each morning for 30 days with urinary samples collected before and two to three hours after ingestion with no voiding before collection. Individual variation was prevalent. The greatest individual variation from baseline to treatment mean T/E ratio was 1.20 to 2.11. The greatest difference from baseline mean to peak treatment mean T/E ratio was 1.2 to 3.7. A single dose of DHEA 250 mg resulted in a 40% increase in the T/E ratio relative to the pre-dose value (peak T/E ratio equal to 1.2). DHEA at this dose had a minimal effect on urine T/E ratios and would not be expected to result in a positive screen for testosterone abuse as the T/E ratio must exceed 6:1 .
C) Two female volunteers demonstrated three to four fold increases in plasma testosterone levels following dehydroepiandrosterone (DHEA) 100 mg administration. In subject 1, the pre-DHEA testosterone level was 0.07 mcg/100 mL compared to a maximum level of 0.28 mcg/100 mL ninety minutes after DHEA administration. In subject 2, the pre-DHEA testosterone level was 0.08 mcg/100 mL compared to a maximum level of 0.28 mcg/100 mL sixty minutes after DHEA administration. This demonstrates that in vivo conversion of DHEA to testosterone occurs in women as well as men .
Testosterone Overview
-
Testosterone is used to treat symptoms of low testosterone in men who have hypogonadism (a condition in which the body does not produce enough natural testosterone). Testosterone is used only for men with low testosterone levels caused by certain medical conditions, including disorders of the testicles, pituitary gland, (a small gland in the brain), or hypothalamus (a part of the brain) that cause hypogonadism. Your doctor will order certain lab tests to check your testosterone levels to see if they are low before you begin to take testosterone. Testosterone should not be used treat the symptoms of low testosterone in men who have low testosterone due to aging ('age-related hypogonadism'). Testosterone is a hormone produced by the body that contributes to the growth, development, and functioning of the male sexual organs and typical male characteristics. Testosterone works by replacing testosterone that is normally produced by the body.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.