What are the Dehydroepiandrosterone (DHEA) levels?

From the Guidelines

DHEA levels should be managed with caution, and replacement therapy should only be considered in female patients with primary adrenal insufficiency (PAI) who have a persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement, with a typical dosage of 25 mg daily guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 1. When considering DHEA replacement, it's essential to note that patients with PAI are deficient in adrenal androgen secretion, including dehydroepiandrosterone (DHEA), which can result in severe androgen deficiency in female patients.

• The diagnosis and treatment of PAI should be guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels, which should be maintained in the normal range when measured in the morning prior to DHEA ingestion 1.
• A pragmatic approach is to offer female patients with a persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement a 6-month trial of DHEA replacement, which can be continued if clinically effective 1.
• However, the long-term effects of DHEA or testosterone replacement therapy in patients with PAI are not known, and such a regimen should be used with caution 1.
• Regular monitoring every 3-6 months is recommended to assess hormone levels and adjust dosage, as DHEA is a hormone precursor that can convert to testosterone and estrogen.
• Side effects may include acne, hair loss, and mood changes, particularly in women, and supplementation should only be initiated after blood testing confirms low levels and under medical supervision.

From the FDA Drug Label

INDICATIONS: Temporarily supports the body to rebalance Adrenal and DHEA output. Symptoms of imbalanced Adrenal and DHEA may include: low energy, depression, anxiety, dry eyes, skin, and hair, loss of head hair. The answer to Dhea levels is not directly addressed in the provided drug label. Key points:

• The label mentions supporting the body to rebalance Adrenal and DHEA output.
• It lists symptoms of imbalanced Adrenal and DHEA, but does not provide information on DHEA levels. 2

From the Research

DHEA Levels and Their Implications

• DHEA (Dehydroepiandrosterone) is an androgen produced by the zona reticularis of the adrenal gland, and its deficiency is associated with morbidity, including adverse impacts on metabolic function, quality of life, and sexuality 3.
• Patients with adrenal insufficiency will have a deficiency of DHEA, and DHEA supplementation has been shown to have beneficial impacts on quality of life, body composition, bone health, and metabolic markers in these patients 3, 4.
• The benefits of DHEA supplementation have been demonstrated in historical studies, but published data are inconsistent, and controversies persist around the exact role of DHEA replacement and which patient cohorts are most likely to benefit 3, 4.

DHEA Replacement Therapy

• DHEA replacement therapy is not considered essential for life and is therefore not routinely replaced in adrenal failure, but it may be beneficial for patients with impaired well-being 4.
• The optimal dose and duration of DHEA replacement in adrenal failure are unclear, and large randomized controlled trials are needed to inform on this topic 3, 4.
• A single oral dose of 25-50 mg DHEA in the morning has been suggested as a replacement therapy, but side effects such as increased sebum production, facial acne, and changes in hair status have been reported 4.

DHEA and Health Outcomes

• DHEA has been shown to have immunomodulatory effects, improving physical and psychological well-being, muscle strength, and bone density, and reducing body fat and age-related skin atrophy 5.
• Low levels of DHEA have been associated with increased cardiovascular disease and all-cause mortality, and DHEA may have a protective effect in asthma and allergy 5, 6.
• DHEA may also have a role in the treatment of systemic lupus erythematosus and inflammatory bowel disease, and may be beneficial for women with sexual dysfunction and age-related vaginal atrophy 5, 7.

Measurement of DHEA Levels

• Measurement of circulating androgens, including DHEA-S, is helpful in patients presenting with adult-onset acne and hirsutism, and patients with elevated levels may benefit from hormonal therapy 7.
• Low levels of DHEA-S have been associated with adrenal suppression, and may be used to screen for the side effects of steroids 5, 7.