From the Guidelines
Treatment for high Dehydroepiandrosterone (DHEA) levels should focus on addressing the underlying cause, and adrenal steroidogenesis inhibitors such as ketoconazole, metyrapone, or osilodrostat may be used to decrease adrenal androgen production and secretion, as recommended in the most recent guideline update 1. The primary approach involves treating conditions that may cause elevated DHEA, such as congenital adrenal hyperplasia, adrenal tumors, or polycystic ovary syndrome (PCOS). For PCOS, treatments may include:
- Combined oral contraceptives like ethinyl estradiol with drospirenone (Yaz) or norgestimate (Ortho Tri-Cyclen) at standard dosing, which help regulate hormones and reduce androgen effects.
- Anti-androgen medications such as spironolactone (50-200 mg daily in divided doses) may also be prescribed to block the effects of excess androgens.
- Metformin (500-2000 mg daily) can improve insulin sensitivity, which may indirectly help lower DHEA levels in insulin-resistant patients. Lifestyle modifications including weight loss through regular exercise and a balanced diet are important complementary approaches, as excess body fat can contribute to hormonal imbalances. Regular monitoring of hormone levels is essential during treatment to assess effectiveness and adjust medications as needed, considering the potential risks of adrenal insufficiency or inappropriate glucocorticoid over-replacement 1. The goal of treatment is not only to normalize hormone levels but also to manage symptoms and prevent long-term complications associated with hormonal imbalances.
From the Research
Treatment for High Dehydroepiandrosterone (DHEA) Levels
- The treatment for high DHEA levels may involve addressing the underlying cause of the elevation, such as polycystic ovary syndrome (PCOS) or adrenal dysfunction 2, 3.
- In women with PCOS, GnRH agonist (GnRH-A) therapy has been shown to reduce DHEA sulfate levels in some cases 2.
- However, the etiology of adrenal dysfunction in PCOS may be heterogeneous, and treatment should be individualized 3.
- In some cases, DHEA levels may be elevated due to other factors, such as aging or menopause, and treatment with DHEA replacement therapy may be considered 4, 5.
- It is essential to note that DHEA replacement therapy should only be done under medical supervision, as high levels of DHEA can have potential risks and side effects.
Potential Risks and Side Effects
- High levels of DHEA have been linked to an increased risk of breast and uterine cancer, although the evidence is not conclusive 4.
- DHEA replacement therapy may also have potential benefits, such as improving bone density, reducing body fat, and enhancing sexual satisfaction 4, 5.
- However, more research is needed to fully understand the effects of DHEA replacement therapy and to determine the optimal dosing protocols 5.
Monitoring and Follow-up
- Regular monitoring of DHEA levels and other hormone levels is crucial to ensure that treatment is effective and to minimize potential risks and side effects 2, 3.
- Patients with high DHEA levels should be followed up regularly to assess their response to treatment and to adjust the treatment plan as needed 5, 6.