Hip Replacement Surgery Experiences

[Jerajera]

I can get all those things actually, as my trt is ugl diy anyhow. The bpc-157 i've used in the past, but wasn't overly impressed if i remember right (it was a few years ago - i think the bac water i had for is is still in the back of the fridge). The operation, combined with blood thinners i'm having to inject for a month is causing a fair amount of water retention in my legs - not sure if GH would make that worse?

I only started getting slight water retention when I bumped my dose to 3iu/day but it was minimal. I never tried higher, I run 1.8iu/day "permanently" and never had any issues with that.

Most likely though you'd need a higher dose to really make a difference in short term (~2-3 months) healing capacity. If you're using UGL GH the potency could be different even if it's legit; the only way to know would be to test IGF-1 levels.

Since you're not going to be doing a lot of cardio for a while I would make sure you really, really keep your diet super clean to minimize water retention.

 

[seppuku]

Another piece to manage. Have you run GH previously?

Hope you can find the right anabolic stimulus with least complications to manage.

Nope, never used it before.

 

[seppuku]

I only started getting slight water retention when I bumped my dose to 3iu/day but it was minimal. I never tried higher, I run 1.8iu/day "permanently" and never had any issues with that.

Most likely though you'd need a higher dose to really make a difference in short term (~2-3 months) healing capacity. If you're using UGL GH the potency could be different even if it's legit; the only way to know would be to test IGF-1 levels.

Since you're not going to be doing a lot of cardio for a while I would make sure you really, really keep your diet super clean to minimize water retention.

I'll keep that in mind if i do end up trying the GH, thanks. As to the diet, yeah i appreciate i'll have to be careful not to pile the weight back on. I had to get my BMI down for the NHS to let me have this op - i was 122kg last June, got down to 96.5kg this June when i got weighed and measured again at the hospital. Poor way of assessing things in my opinion, especially if you lift weights. At 5'8", 96.5kg i'm not ripped, but my abs are at least visible. A BMI calculator still puts me at 'obese' though. I saw a guy on my ward with stick thin arms and legs, but with a huge gut. We were probably a similar BMI, but very different composition.

 

[seppuku]

15 days post op. I'm quite impressed with the surgeon's handywork!

 

[John Scher]

View attachment 4711315 days post op. I'm quite impressed with the surgeon's handywork!

I had Hip resurfacing and have a similar scar. I was back on the squash court after 10 months

 

[seppuku]

I had Hip resurfacing and have a similar scar. I was back on the squash court after 10 months

Great stuff! And would you say you're back to normal now, or has the procedure caused any limitations or niggles?

 

[John Scher]

Great stuff! And would you say you're back to normal now, or has the procedure caused any limitations or niggles?

Best thing I've ever done! The surgery was in Birmingham by the actual doctor who pioneered resurfacing rather than replacement and this has been discussed above. Several years later I have no issues whatsoever, feels like new. In summary, fantastic!

 

[seppuku]

Best thing I've ever done! The surgery was in Birmingham by the actual doctor who pioneered resurfacing rather than replacement and this has been discussed above. Several years later I have no issues whatsoever, feels like new. In summary, fantastic!

Oh wow, how bizarre - looks like we were at the same hospital then (Royal Orthopaedic Hospital, B'ham)?!

 

[John Scher]

After reporting to the McMinn Center in March 2018, the surgery was conducted at BMI Edgbaston Hospital in Birmingham by Professor Derek McMinn himself. As mentioned above I am extremely pleased with the outcome. Also I might add that whilst I was under their care the service and staff were excellent.

Now having said all this I've come to learn that McMinn ran into problems of one type or another a few years ago and I'm not sure if he's still taking patients.

 

[seppuku]

After reporting to the McMinn Center in March 2018, the surgery was conducted at BMI Edgbaston Hospital in Birmingham by Professor Derek McMinn himself. As mentioned above I am extremely pleased with the outcome. Also I might add that whilst I was under their care the service and staff were excellent.

Now having said all this I've come to learn that McMinn ran into problems of one type or another a few years ago and I'm not sure if he's still taking patients.

Very interesting! Just had a quick google, Derek McMinn seems to still have a website running, no idea if he's still practicing. According to the R.O. Hospital site, the procedure was a joint partnership between McMinn and Mr Ronan Treacy, at the Royal Orthopaedic (i'm guessing the BMI you had yours done was the Priory hospital down the road in Edgbaston). Either way, Ronan Treacy is still performing the op at the ROH. I wasn't a suitable candidate for resurfacing, as my arthritis was end stage and too much damage had been done. It sounds like yours has lasted better than Andy Murray's.

 

[John Scher]

 

[John Scher]

As I didn't know they might not be functioning, just last week I sent an email of thanks to Ms Hena, recovery nurse in the McMinn center and she responded saying she would pass on the message to Derek which tends to imply they are operating in some capacity

 

[seppuku]

Had a letter arrive in the post late yesterday - got the date for my other hip to be done. That means it'll be 10 weeks between surgeries, and not the 6 months i was originally told by the surgeon that i'd need to recover. I'm not sure if this is because he thinks i've recovered quickly like Wolverine, or more to do with the new government here telling the NHS to clear the backlog.

 

[Nelson Vergel]

Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient

Severe injuries are the major cause of death in those aged under 40, mainly due to road traffic collisions. Endocrine, metabolic and immune pathways respond to limit the tissue damage sustained and initiate wound healing, repair and regeneration mechanisms. ...

www.ncbi.nlm.nih.gov

@Nelson Vergel @Cataceous @madman

I thought this study was very interesting, especially now i'm one week on from my surgery. Thought you guys might be interested too. I have several bottles of 25mg DHEA pills, i reckon now would be a good time to start taking them daily.

Sorry for the late reply. I have been on vacation.

@seppuku Very interesting paper!

I created a document using Notebook LM

Briefing Doc: DHEA as a Potential Therapeutic Agent in Trauma Patients​

Main Themes:

• This review article explores the potential of Dehydroepiandrosterone (DHEA) and its sulfated form, DHEAS, as a therapeutic agent for trauma patients.
• The authors highlight the role of these hormones in modulating the endocrine, immune, and metabolic responses to trauma, particularly in light of the well-documented decline of DHEA/DHEAS with age and its impact on recovery.
• While no human studies have yet been conducted on DHEA supplementation in trauma patients, the authors draw upon evidence from animal models and other human studies to build a case for its potential benefits across various aspects of recovery.

Most Important Ideas/Facts:

• Trauma and Hormonal Imbalance: Severe injury triggers a stress response leading to elevated cortisol levels. DHEA/DHEAS levels are also declining along with this, which leads to an imbalance that is associated with higher morbidity and mortality. "The DHEAS: cortisol ratio is proposed to represent a balance between the catabolic effects of cortisol and the regenerative effects of DHEAS [54, 55] and its modulation may benefit the trauma patient."
• DHEA/DHEAS Deficiency Post-Trauma: Studies reveal a significant drop in DHEA/DHEAS levels after trauma, persisting for extended periods. This deficiency is implicated in prolonged recovery, increased infection risk, and muscle loss.
• Potential Benefits of DHEA Supplementation:Immune Function: DHEA/DHEAS supplementation may enhance immune response by bolstering neutrophil function, potentially mitigating the risk of infections. "DHEAS has been shown to directly stimulate the action of NADPH oxidase and reactive oxygen species production and thus improve neutrophil function [42]."
• Wound Healing: Animal studies indicate that DHEA can accelerate wound healing, possibly by dampening excessive inflammation. "Topical administration of DHEA has also acted as a mediator of tissue repair to ultra violet (UV) light damaged skin [98]."
• Psychological & Neurological Effects: DHEA shows promise in animal models for improving cognitive function, reducing depressive symptoms, and promoting neurogenesis following traumatic brain injury.
• Body Composition: DHEA supplementation may help maintain bone mineral density and counteract muscle loss (sarcopenia) – common challenges in trauma recovery, particularly in older patients.
• Advantages over Downstream Sex Hormone Supplementation:DHEA offers a more comprehensive approach by acting as a precursor to both androgens and estrogens, benefiting both male and female patients.
• DHEA's potential conversion to DHEAS, with its specific immune-boosting effects on neutrophils, makes it potentially superior to androgen-only therapies.
• Dosing, Delivery, and Safety:The review acknowledges the lack of human studies to guide optimal dosing and delivery methods for DHEA in trauma patients.
• It suggests that different delivery routes, including oral, buccal/sublingual, and transdermal, should be investigated to bypass first-pass metabolism and ensure efficacy.
• While short-term DHEA supplementation appears safe, potential side effects and long-term consequences need careful monitoring in future clinical trials.

Short Podcast:

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DHEA Supplementation for Trauma Patients: Potential Benefits and Research Gaps

While no human studies have specifically investigated DHEA supplementation in trauma patients, the sources point to several potential therapeutic benefits based on animal studies and research in other populations:
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Immune Function: Traumatically injured patients often experience low DHEA and DHEAS levels, which can suppress immune response and increase infection risk.
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DHEA supplementation in animals has been shown to improve survival rates in sepsis, a common complication after trauma.
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DHEAS may directly enhance neutrophil function, potentially offering protection against infection.
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Inflammation: DHEA supplementation has shown potential to modulate the inflammatory response after trauma.
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In a mouse model of bilateral femoral fracture, DHEA reduced serum levels of inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-10, MCP-1).
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DHEA may also inhibit NF-κB DNA binding activity, dampening the transcription of pro-inflammatory genes.
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Wound Healing: Animal studies indicate DHEA could benefit wound healing, especially in older patients.
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Rats pre-treated with DHEA showed improved muscle flap microcirculation and protection against ischemia and reperfusion injury.
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Topical DHEA accelerated wound healing in a mouse model of age-related delayed healing.
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Neurological Effects: DHEA and DHEAS may offer neuroprotective effects after traumatic brain injury (TBI).
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DHEA supplementation in rats promoted neurogenesis in the hippocampus and improved cognitive and motor skills after TBI.
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Psychological Well-being: DHEA and DHEAS could play a role in mitigating psychological distress after trauma.
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The DHEAS:cortisol ratio has been linked to stress resilience and lower PTSD symptoms in military personnel .
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DHEA levels are inversely correlated with depressive symptoms in adults under 64 years old .
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Body Composition: DHEA supplementation might help maintain bone and muscle mass in recovering trauma patients.
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Studies suggest DHEA can improve bone mineral density, potentially benefiting patients with fractures .
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DHEA has shown potential to reduce fat mass and increase muscle strength in older adults .
Important Considerations:
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The sources highlight the lack of human studies on DHEA supplementation in trauma patients, emphasizing the need for research to determine optimal dosing, delivery methods, and long-term effects.
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DHEA supplementation may pose risks for certain patients, including those with liver issues, thromboembolic events, hormone-sensitive malignancies, or certain medications.
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Further research is crucial to establish the safety and efficacy of DHEA supplementation as a therapeutic intervention for traumatically injured patients.
○
Factors such as dosing, delivery route, and patient-specific considerations need to be carefully evaluated.
Overall, while promising, the potential therapeutic benefits of DHEA supplementation for traumatically injured patients require further investigation through well-designed human studies.



What are the biological functions of DHEA and its relationship to cortisol?

The Interplay of DHEA, DHEAS, and Cortisol
DHEA (dehydroepiandrosterone), primarily found in its sulfated form DHEAS (dehydroepiandrosterone sulfate), plays various roles in the body, often acting as a counterbalance to the catabolic hormone cortisol.
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DHEA Synthesis and Levels: Primarily produced in the adrenal glands, DHEA and DHEAS levels fluctuate throughout life.
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After peaking in the second decade, levels decline with age, a phenomenon known as adrenopause.
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DHEA and Cortisol: A Balancing Act: The sources describe a dynamic relationship between DHEA/DHEAS and cortisol, particularly after traumatic injury:
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Trauma typically triggers a surge in cortisol, a crucial hormone for immediate response, while simultaneously suppressing DHEA/DHEAS production.
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This shift towards higher cortisol levels relative to DHEA/DHEAS, reflected in the cortisolHEAS ratio, is associated with negative outcomes in trauma patients.
Biological Functions of DHEA/DHEAS: The sources describe DHEA/DHEAS as having a range of effects, often opposing those of cortisol:
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Immune Modulation: DHEA/DHEAS may enhance immune function, a role that could be critical in the context of trauma where immune suppression is a concern.
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DHEAS can directly stimulate neutrophil activity, potentially bolstering the body's defense against infection.
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Anti-Inflammatory Action: DHEA/DHEAS can dampen inflammatory responses, potentially mitigating the excessive inflammation often seen after trauma.
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Wound Healing Support: Animal studies suggest DHEA may promote wound healing, a crucial aspect of trauma recovery.
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Neurological Effects: DHEA and DHEAS might offer neuroprotection following traumatic brain injury, with animal studies showing potential for improved cognitive and motor function.
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Psychological Well-being: The DHEAS:cortisol ratio has been linked to stress resilience and a lower risk of developing PTSD and depression.
●
Body Composition: DHEA/DHEAS may help preserve bone and muscle mass, important factors in trauma recovery where muscle wasting and bone loss can occur.
The sources suggest that the balance between DHEA/DHEAS and cortisol is essential for recovery from trauma. Disruptions to this balance, often seen as elevated cortisolHEAS ratios, can contribute to negative outcomes. More research is needed to understand the full potential of DHEA supplementation in trauma patients, but the existing evidence points to its multi-faceted role in the body's response to injury and healing processes.



What is the potential therapeutic benefit of DHEA supplementation in trauma patients?

Potential Therapeutic Benefits of DHEA Supplementation in Trauma Patients: A Synthesis of Existing Evidence
While there is not much research that specifically looks at DHEA supplementation in trauma patients right now, what is available gives us a lot of compelling information about its possible therapeutic benefits, mostly based on studies in animals and other populations. Here's a comprehensive look at these potential benefits:
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Mitigation of Trauma-Induced Immune Suppression:
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Trauma often leads to a decline in DHEA and DHEAS levels, potentially contributing to the immune suppression commonly observed in these patients. This suppression increases susceptibility to infections, a major cause of morbidity and mortality after trauma.
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DHEA supplementation in animal models of sepsis, a frequent complication in recovering trauma patients, has demonstrated improved survival rates. This suggests a potential role for DHEA in restoring immune competence and reducing infection risk in trauma patients.
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Specifically, DHEAS, the sulfated form of DHEA, has shown the ability to directly enhance neutrophil function, a critical component of the innate immune response. Neutrophils play a crucial role in fighting infection, and their impaired function after trauma can have detrimental consequences. DHEA supplementation could offer a way to support neutrophil activity and mitigate this risk.
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Modulation of the Inflammatory Response:
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The body's inflammatory response, while crucial for initial healing, can become detrimental if excessive or prolonged. Trauma often triggers a dysregulated inflammatory response, contributing to tissue damage and organ dysfunction.
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The sources highlight DHEA's potential to modulate this inflammatory cascade after trauma. Studies in mice with bilateral femoral fractures, a common traumatic injury, revealed that DHEA administration reduced systemic levels of key inflammatory cytokines, including TNF-α, IL-1β, IL-6, IL-10, and MCP-1. These cytokines play a central role in amplifying and perpetuating inflammation.
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Furthermore, DHEA might exert its anti-inflammatory effects by inhibiting NF-κB, a transcription factor that regulates the expression of various pro-inflammatory genes. By suppressing NF-κB activity, DHEA could potentially dampen the inflammatory cascade at its source.
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Enhancement of Wound Healing:
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Effective wound healing is paramount for successful recovery from trauma. Delayed or impaired healing not only prolongs recovery but also increases the risk of complications.
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Animal studies suggest a role for DHEA in promoting wound healing, particularly in older individuals who often experience age-related delays in tissue repair.
○
In rats, pre-treatment with DHEA significantly improved muscle flap microcirculation and offered protection against ischemia-reperfusion injury. This suggests a potential for DHEA to improve blood flow and oxygen delivery to injured tissues, facilitating healing.
○
Topical DHEA application has also demonstrated accelerated wound healing in mouse models of age-related delayed healing. This finding is particularly relevant to older trauma patients who might benefit from targeted DHEA application to enhance wound closure.
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Neuroprotection and Improved Neurological Outcomes After Traumatic Brain Injury (TBI):
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TBI represents a significant public health concern, often leading to long-term disability and cognitive impairment. The sources indicate a possible neuroprotective role for DHEA and DHEAS in this context.
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Animal studies have shown that DHEA supplementation can stimulate neurogenesis, the formation of new neurons, in the hippocampus, a brain region crucial for learning and memory. This finding suggests a potential for DHEA to aid in brain repair and functional recovery after TBI.
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Moreover, DHEA administration in rats has demonstrated improvements in cognitive and motor skills following TBI, as assessed by behavioral tests . These improvements might be attributed to DHEA's ability to promote neuronal survival and potentially reduce glial scar formation, a process that can impede recovery.
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Psychological Support and Stress Resilience:
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Psychological distress, including PTSD and depression, is common after trauma, significantly impacting recovery and long-term well-being . The interplay between DHEA, DHEAS, and cortisol appears to be relevant in this domain.
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The DHEAS:cortisol ratio has emerged as a potential biomarker for stress resilience. Studies in military personnel, a population exposed to high stress, revealed that a higher DHEAS:cortisol ratio correlated with fewer PTSD and depressive symptoms and improved psychological well-being over time . This suggests that maintaining a favorable balance between these hormones might be protective against psychological distress.
○
Furthermore, research has found an inverse correlation between DHEA levels and depressive symptoms in adults under 64 years old . This link implies that DHEA might play a role in mood regulation, and its supplementation could potentially offer psychological benefits in trauma patients.
In summary, the sources suggest that DHEA supplementation holds promise as a potential therapeutic strategy for trauma patients, with benefits extending across various domains crucial for recovery:
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Immune function
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Inflammation modulation
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Wound healing
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Neurological outcomes
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Psychological well-being
However, it is crucial to emphasize that these potential benefits are primarily based on preclinical studies and research in populations other than trauma patients. Rigorous, well-designed human studies are essential to confirm these benefits and determine the safety, efficacy, optimal dosing, and delivery methods for DHEA supplementation in the context of trauma.



What are some practical considerations and challenges for conducting a clinical trial investigating the effects of DHEA supplementation in trauma patients?

Practical Considerations and Challenges for DHEA Supplementation Trials in Trauma Patients
Conducting a clinical trial to investigate DHEA supplementation in trauma patients presents various practical considerations and challenges:
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Patient Population and Ethical Considerations:
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Trauma patients often present with complex injuries, comorbidities, and varied demographics, making it essential to carefully define inclusion and exclusion criteria to ensure a homogenous study population.
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Ethical considerations are paramount, given the vulnerable nature of critically ill trauma patients. Obtaining informed consent might be difficult, especially if patients are unconscious or cognitively impaired.
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The potential impact of DHEA supplementation on various physiological systems necessitates careful monitoring for adverse effects and the establishment of clear safety protocols.
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Polypharmacy and Drug Interactions:
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Trauma patients frequently receive multiple medications, raising concerns about potential drug interactions with DHEA.
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Concurrent use of medications that influence steroid metabolism should be assessed as potential exclusion criteria.
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For instance, concurrent DHEA and testosterone therapy have not been adequately studied, and available data suggest avoiding this combination.
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Meticulous medication reconciliation and monitoring are essential throughout the trial to mitigate interaction risks.
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DHEA Metabolism and Individual Variability:
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DHEA undergoes extensive first-pass metabolism in the liver, converting to DHEAS and other metabolites.
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Pre-existing liver dysfunction could alter DHEA metabolism and impact trial outcomes, warranting exclusion of patients with liver failure.
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Inter-individual variability in DHEA metabolism, influenced by factors like age, sex, and genetics, poses challenges for determining optimal dosing and interpreting treatment effects.
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Dosing, Route of Administration, and Formulation:
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The optimal dose, route of administration, and formulation of DHEA for trauma patients remain to be established.
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Factors such as the severity of injury, patient characteristics, and practical considerations (e.g., ability to swallow) might necessitate flexible dosing regimens and alternative delivery routes (e.g., sublingual, transdermal).
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The chosen route should be not only effective but also feasible, considering potential injuries and patient tolerance.
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Establishing standardized protocols for DHEA administration, considering potential variations in absorption and bioavailability, is crucial for data reliability.
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Monitoring and Outcome Measures:
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Selecting appropriate outcome measures to capture the multifaceted effects of DHEA is essential.
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Beyond clinical outcomes like mortality and infection rates, assessments should encompass immune function (e.g., neutrophil activity), inflammatory markers, wound healing progress, neurocognitive function, and psychological well-being.
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Regular monitoring of DHEA and DHEAS levels, along with other relevant hormones like cortisol, is necessary to assess treatment adherence and understand the dynamic hormonal changes.
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Duration of Supplementation and Long-Term Effects:
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Determining the optimal duration of DHEA supplementation in trauma patients is crucial.
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While short-term use might be beneficial during acute recovery, longer-term supplementation might be necessary to support long-term rehabilitation and mitigate potential long-term consequences of trauma.
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Long-term follow-up is essential to assess the durability of any observed benefits and monitor for potential late-onset side effects.
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Confounding Factors and Bias:
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Trauma recovery is influenced by numerous factors, including injury severity, comorbidities, age, sex, and treatment received.
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Controlling for these confounders is essential to isolate the specific effects of DHEA supplementation.
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Blinding both patients and investigators to treatment allocation is crucial to minimize bias in outcome assessments.
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Pilot Studies and Feasibility:
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Given the complexities and unknowns surrounding DHEA supplementation in trauma, conducting pilot studies is crucial before embarking on large-scale clinical trials.
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Pilot studies can help optimize trial design, refine dosing and delivery methods, identify appropriate outcome measures, and assess the feasibility and acceptability of the intervention in this specific patient population.
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These initial studies can provide valuable insights and inform the development of more robust and definitive clinical trials.
In essence, while the potential therapeutic benefits of DHEA supplementation in trauma patients are promising, translating these benefits to clinical practice demands rigorous research that addresses the practical and methodological challenges inherent in studying this complex patient population.



What are the known physiological effects of DHEA supplementation in humans?

Physiological Effects of DHEA Supplementation in Humans
The sources focus primarily on the potential therapeutic uses of DHEA, but they also highlight several known physiological effects of DHEA supplementation in humans:
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Bone Health: DHEA supplementation, specifically in postmenopausal women, has been shown to increase bone mineral density in the lumbar spine and femoral neck. This effect may be due to the conversion of DHEA to both estrogens and androgens, which play a role in bone metabolism . Some research suggests that DHEA may also exert direct effects on bone cells, independent of its conversion to sex hormones, promoting the proliferation and inhibiting the death of osteoblasts, cells responsible for bone formation .
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Body Composition: DHEA supplementation, particularly in older men, has demonstrated potential benefits for body composition, including reduced body fat and increased muscle strength . A study in healthy men aged 50–65 years old found that 6 months of DHEA supplementation led to a 6.1% reduction in fat mass and significant improvements in knee and lumbar strength . These effects might be mediated by DHEA's influence on insulin sensitivity and its potential to increase levels of IGF-1, an anabolic hormone involved in muscle growth .
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Psychological Well-being: The relationship between DHEA and psychological well-being is complex, but some studies suggest that DHEA may play a role in mood regulation. The sources note an inverse correlation between DHEA levels and depressive symptoms in adults under 64 years old . Additionally, there is evidence that higher serum DHEAS levels in older adults might be protective against the onset of depression . However, the sources also acknowledge that DHEA supplementation in healthy older adults has not consistently demonstrated benefits for well-being or depressive symptoms . This discrepancy highlights the need for further research to clarify the potential mood-related effects of DHEA in different populations.
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Immune Function: The sources emphasize the role of DHEA, particularly its sulfated form DHEAS, in immune function. DHEA supplementation has been shown to enhance neutrophil function, potentially by directly activating protein kinase C-beta, a key enzyme involved in neutrophil activation and the production of reactive oxygen species. Neutrophils are essential immune cells that fight off infections, and their function can be impaired after trauma or during aging.
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Hormonal Changes: As a precursor hormone, DHEA supplementation can lead to increases in downstream hormones, including testosterone and estrogen. However, the extent of these hormonal changes can vary depending on factors such as age, sex, and individual metabolism. The sources highlight the importance of monitoring these hormonal effects during DHEA supplementation, especially in the context of a clinical trial involving trauma patients.
It is important to acknowledge that the majority of research on the physiological effects of DHEA supplementation stems from studies in specific populations, such as postmenopausal women, older adults, or individuals with certain health conditions. The sources emphasize the need for further research to determine the optimal dosing, delivery methods, and long-term effects of DHEA supplementation in various contexts, particularly in the setting of trauma recovery.



How does DHEA supplementation affect wound healing in animal models?

DHEA and Wound Healing in Animal Models
The sources describe several animal studies that have investigated the effects of DHEA supplementation on wound healing, particularly in the context of trauma or injury:
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Improved Muscle Flap Survival: One study in rats examined the impact of DHEA on muscle flap surgery, a procedure often used to repair large wounds. Rats pretreated with DHEA showed significantly improved blood flow and reduced tissue damage in the muscle flap compared to control rats . This finding suggests that DHEA might help protect against ischemia-reperfusion injury, a type of tissue damage that can occur when blood flow is interrupted and then restored. Another study, also in rats, found that intravenous DHEA administration reduced the activation of white blood cells (leukocytes) and improved blood circulation in muscle flaps, potentially by delaying the expression of adhesion molecules on leukocytes . These molecules play a role in the inflammatory response and can contribute to tissue damage during ischemia-reperfusion injury.
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Enhanced Skin Wound Healing: Research has also explored the effects of DHEA on skin wound healing. A study by Mills et al. focused on age-related delays in wound healing using a mouse model. The researchers observed that topical application of DHEA accelerated wound closure and reduced inflammation at the wound site . They proposed that this beneficial effect might be attributed to the conversion of DHEA to estrogen, which has known anti-inflammatory properties. Interestingly, the study found that DHEA did not significantly affect wound healing in young mice, suggesting that its effects might be more pronounced in the context of age-related decline in healing capacity . This difference might stem from sufficient estrogen levels in young animals, making the additional contribution from DHEA conversion less impactful.
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Potential Mechanisms: While the precise mechanisms by which DHEA influences wound healing remain to be fully elucidated, the sources highlight several possibilities:
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Modulation of Inflammation: Excessive inflammation can hinder wound healing, and DHEA has demonstrated anti-inflammatory effects. For instance, DHEA has been shown to inhibit NF-κB, a protein complex involved in regulating the expression of genes involved in inflammation. By suppressing NF-κB activity, DHEA could potentially dampen the production of inflammatory molecules like IL-6 and TNF-α, contributing to a more favorable healing environment .
○
Conversion to Sex Hormones: DHEA serves as a precursor to both androgens and estrogens, and these sex hormones have been implicated in wound healing processes. As mentioned earlier, the conversion of DHEA to estrogen might underlie its beneficial effects on skin wound healing in the mouse model . Androgens, such as testosterone, have also been shown to influence wound healing, although their specific roles and the potential contribution of DHEA conversion to these effects in the context of these studies require further investigation.
It's important to note that these findings stem from animal models, and further research is needed to determine whether similar effects translate to human wound healing. The sources emphasize the lack of human studies investigating DHEA supplementation specifically for wound healing in trauma patients, highlighting a critical area for future research.



What effect does DHEA supplementation have on the cortisolHEAS ratio in trauma patients?

DHEA Supplementation and CortisolHEAS Ratio in Trauma Patients
The sources primarily focus on the potential benefits of DHEA supplementation and the implications of low DHEA and DHEAS levels after trauma. However, they do not directly address the effect of DHEA supplementation on the cortisolHEAS ratio in trauma patients. While the sources suggest that DHEA supplementation might be beneficial in this population, there is a clear need for clinical trials to investigate this relationship directly.
Here's what the sources do say about DHEA, DHEAS, cortisol, and trauma:
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Trauma leads to a decrease in DHEAS levels and an increase in cortisol levels. This shift results in an elevated cortisolHEAS ratio, which is associated with negative outcomes in trauma patients, including increased mortality, infections, and slower recovery.
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DHEA is a precursor to DHEAS. Oral DHEA supplementation undergoes first-pass metabolism in the liver, leading to an increase in DHEAS levels.
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The cortisolHEAS ratio is considered a balance between catabolism (breakdown) and regeneration. High cortisol is associated with catabolic processes, while DHEAS is thought to promote regeneration and anabolic processes.
Based on this information, it is reasonable to hypothesize that DHEA supplementation in trauma patients could:
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Increase DHEAS levels.
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Potentially reduce the cortisolHEAS ratio.
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Shift the balance toward a more anabolic state, potentially improving recovery outcomes.
However, it's crucial to emphasize that this is currently speculation based on the available information. Direct research on DHEA supplementation in trauma patients is necessary to determine:
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The actual effect of DHEA supplementation on the cortisolHEAS ratio in this population.
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The optimal dosage and delivery method of DHEA for potential therapeutic benefit.
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The long-term safety and efficacy of DHEA supplementation in this context.



What are some potential side effects of DHEA supplementation?

Potential Side Effects of DHEA Supplementation
While the sources predominantly focus on the potential therapeutic benefits of DHEA, they also acknowledge some potential side effects, particularly with long-term use:
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Mild Androgenic Effects: The sources mention that longer-term studies have reported mild cases of hirsutism (excessive hair growth) and acne as potential side effects of DHEA supplementation. These effects are likely related to the androgenic properties of DHEA, as it can be converted into androgens like testosterone in the body.
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Potential for Drug Interactions: The sources highlight the importance of considering potential drug interactions when studying DHEA supplementation, particularly in a trauma cohort likely to be on multiple medications. For instance, concurrent DHEA and testosterone therapy have not been extensively studied and might lead to unforeseen interactions . Additionally, DHEA's metabolism could be affected by drugs that influence steroid metabolism, making it important to consider a patient's medication history . Certain medications, like progesterone, might also interfere with DHEA assays, potentially confounding results .
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Lack of Long-Term Safety Data in Trauma Patients: A critical point emphasized throughout the sources is the need for more research on DHEA supplementation in trauma patients. While some studies suggest that short-term DHEA supplementation is relatively safe, there is limited data on the long-term safety and ideal dosing strategies for this specific population. The sources call for feasibility and pilot studies to establish appropriate dosing and administration routes before conducting larger clinical trials.
Important Considerations:
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The sources primarily focus on reviewing existing literature on DHEA and advocating for further research in the context of trauma recovery. They do not provide a comprehensive analysis of all potential side effects of DHEA supplementation.
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The safety and potential side effects of any supplement can vary depending on factors such as dosage, individual health status, and interactions with other medications or supplements.
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It's crucial to consult with a qualified healthcare professional before starting any new supplement regimen, including DHEA.



How does DHEA affect the inflammatory response in animal models of trauma?

DHEA and the Inflammatory Response in Animal Models of Trauma
The sources describe several studies that investigated how DHEA supplementation affects the inflammatory response in animal models of trauma. They highlight that DHEA consistently demonstrates anti-inflammatory effects across various injury types.
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Bilateral Femoral Fracture: In a mouse model replicating the musculoskeletal damage seen in bilateral femoral fractures, subcutaneous DHEA administration (25 mg/kg/day) led to a significant reduction in several inflammatory markers:
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TNF-α
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IL-1β
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IL-6
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IL-10
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MCP-1 However, DHEA did not affect markers of pulmonary inflammation in this study.
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Traumatic Hemorrhage: Rodent models of traumatic hemorrhage showed that a single subcutaneous injection of DHEA could reverse the immunosuppressive effects of trauma by:
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Restoring splenocyte proliferation
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Normalizing splenocyte apoptosis and lymphocyte migration
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Reducing the production of pro-inflammatory cytokines (TNF-α, IL-1, and IL-6) by macrophages
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Enhancing the secretion of cytokines (IL-2, IL-3, and IFN-γ) from splenic T cells
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Preventing an increase in serum corticosterone levels These immunomodulatory effects of DHEA translated to improved survival rates in these models.
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Sepsis: DHEA administration also improved survival rates in mouse models of sepsis, a frequent and dangerous complication in trauma patients.
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Thermal Injury: Mice subjected to thermal injury and supplemented with subcutaneous DHEA exhibited increased resistance to pathogenic challenges and experienced reduced inflammation and tissue necrosis compared to controls. However, DHEAS and other steroid types did not show similar protective effects in this context.
Potential Mechanisms:
The sources suggest that DHEA might mitigate the inflammatory response after trauma through various mechanisms:
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Direct Modulation of Immune Cell Function: DHEA can directly influence the activity of immune cells. For example, it has been shown to restore the balance of cytokine production by macrophages and T cells, key players in the inflammatory response.
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Inhibition of NF-κB: DHEA has demonstrated the ability to inhibit NF-κB, a protein complex that regulates the expression of inflammatory genes. By suppressing NF-κB activity, DHEA can dampen the production of inflammatory molecules like IL-6 and TNF-α, creating a less inflammatory environment conducive to healing.
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Conversion to Sex Hormones: DHEA serves as a precursor to androgens and estrogens, which have their own anti-inflammatory properties. While the sources focus on the effects of direct DHEA administration, they acknowledge that its conversion to sex hormones could play a role in its overall impact on the inflammatory response.
The sources highlight the need for more research to understand the complex interplay between DHEA, inflammation, and various types of trauma fully.