From the Guidelines
Measuring Dehydroepiandrosterone (DHEA) levels is not routinely recommended for everyone, but it can be useful in specific clinical situations, such as evaluating adrenal insufficiency, congenital adrenal hyperplasia, or certain cases of infertility, as supported by the study 1.
Clinical Utility of DHEA Measurement
The clinical utility of measuring DHEA levels lies in its role as a precursor to testosterone and estrogen, making it important in the body's hormonal cascade. DHEA testing may be beneficial when investigating symptoms of hormonal imbalance, particularly in women with signs of excess androgens like hirsutism or acne.
Specific Clinical Situations
Some specific clinical situations where DHEA measurement may be useful include:
- Evaluating adrenal insufficiency
- Congenital adrenal hyperplasia
- Certain cases of infertility
- Investigating symptoms of hormonal imbalance, such as hirsutism or acne ### Test Procedure and Interpretation The test typically involves a simple blood draw, preferably in the morning when levels are highest. Normal DHEA-S (sulfated form) ranges vary by age and sex, generally between 10-619 μg/dL for adult women and 24-537 μg/dL for adult men, with levels naturally declining with age.
Considerations for DHEA Supplementation
If considering DHEA supplementation (typically 25-50mg daily), testing beforehand establishes a baseline and helps determine if supplementation is warranted. However, DHEA supplements should only be taken under medical supervision as they can cause side effects including acne, hair loss, and mood changes, as noted in the context of hormonal therapy 2.
Comprehensive Evaluation
Many symptoms attributed to "low DHEA" are often multifactorial and require comprehensive evaluation, taking into account the patient's overall health, medical history, and other potential underlying conditions.
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 clinical utility of measuring DHEA levels is to identify potential imbalance in Adrenal and DHEA output, which may be associated with symptoms such as:
- Low energy
- Depression
- Anxiety
- Dry eyes, skin, and hair
- Loss of head hair However, the label does not provide direct information on the clinical utility of measuring DHEA levels, only the symptoms that may be associated with imbalanced Adrenal and DHEA output 3.
From the Research
Clinical Utility of Measuring DHEA Levels
The clinical utility of measuring Dehydroepiandrosterone (DHEA) levels is supported by several studies, which suggest that DHEA has various benefits in different medical conditions. Some of the key points include:
- DHEA exerts an immunomodulatory action, increasing the number of monocytes, T cells, and natural killer cells, and improves physical and psychological well-being, muscle strength, and bone density 4
- DHEA is steroid-sparing in systemic lupus erythematosus and induces remission in patients with inflammatory bowel disease 4
- DHEA modulates cardiovascular signaling pathways and exerts an anti-inflammatory, vasorelaxant, and anti-remodeling effect, with low levels correlating with increased cardiovascular disease and all-cause mortality 4
- DHEA/DHEAS appear protective in asthma and allergy, attenuating T helper 2 allergic inflammation and reducing eosinophilia and airway hyperreactivity 4
Diagnostic Value of DHEA Measurements
Measurements of serum DHEA and DHEA sulfate (DHEA-S) levels have diagnostic value in certain conditions, such as:
- Adrenal insufficiency: baseline measurements of serum DHEA-S levels are valuable in patients suspected of having adrenal insufficiency, and a normal age- and sex-adjusted serum DHEA-S level practically rules out the diagnosis 5
- Central adrenal insufficiency: measurements of serum DHEA levels during low-dose cosyntropin stimulation provide additional valuable information that improves the diagnostic accuracy of the test 6
Therapeutic Use of DHEA
DHEA supplementation has been studied in various conditions, including:
- Hypoadrenalism: oral DHEA administration may improve well-being and hormonal/metabolic parameters in patients with hypoadrenalism, particularly in women 7
- However, the evidence is not yet sufficient to recommend routine treatment with DHEA, and large-scale human studies are needed to answer key questions 8
- DHEA may be beneficial for female patients with hypoadrenalism, mainly in restoring androgen levels, but more sensitive and specific instruments to measure the effects of DHEA treatment could be necessary 7