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 therapy, it is essential to monitor serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels to maintain them in the normal range when measured in the morning prior to DHEA ingestion.
- Key points to consider:
- DHEA replacement therapy should be used with caution due to the limited objective evidence of clinical benefit from large studies 1.
- A pragmatic approach is to offer female patients with PAI a 6-month trial of DHEA replacement, which can be continued if clinically effective 1.
- 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.
- Typical dosages of DHEA replacement therapy range from 10-50 mg daily, often 25 mg as a single daily dose 1.
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 Effects
- DHEA and its sulfated form DHEAS are the most abundant circulating steroid hormones in humans 3
- Low levels of DHEA have been associated with age-related involuntary changes, including reduced lifespan 3
- DHEA has been shown to exert an immunomodulatory action, increasing the number of monocytes, T cells, and natural killer cells in the elderly 3
DHEA Replacement Therapy
- DHEA replacement has been shown to be beneficial in patients with adrenal insufficiency, improving well-being, vitality, and sexuality 4, 5, 6
- DHEA restores low circulating androgens in women with adrenal insufficiency, increasing IGF-1 levels and improving health perception 4, 6
- The optimal dose and duration of DHEA replacement in adrenal failure are still unclear, with most studies using a single oral dose of 25-50 mg DHEA in the morning 4, 6
DHEA and Aging
- DHEA levels decline with age, with peak DHEAS concentrations at 70-80 years of age being only 10-20% of those in young adults 7
- DHEA replacement therapy has been proposed as a potential treatment for age-related disturbances, with some studies suggesting beneficial effects on mood, sexuality, and subjective health status 7, 3
- However, more defined and specific clinical trials are needed to fully understand the effects of DHEA replacement therapy in aging men and women 7
Controversies and Future Research
- The role of DHEA replacement in adrenal insufficiency remains unclear, with controversies surrounding the exact benefits and optimal dosing protocols 5, 6
- Large-scale randomized controlled trials are needed to fine-tune the indications and optimal dosing protocols for DHEA replacement therapy 3, 5, 6
- Further research is also needed to fully understand the immunomodulatory effects of DHEA and its potential benefits in patients with chronic adrenal failure 6