Guidelines for DHEA Supplementation
DHEA supplementation should be used selectively in specific clinical scenarios, with caution regarding safety in hormone-dependent conditions and limited evidence for most general uses.
Primary Clinical Applications
1. Primary Adrenal Insufficiency (PAI)
- Recommended dosing: 10-50 mg daily (often 25 mg) as a single morning dose 1
- Target population: Female patients with PAI experiencing persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement
- Treatment approach:
- Offer a 6-month trial of DHEA replacement
- Continue if clinically effective
- Monitor serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels to maintain in normal range
- Measure levels in the morning prior to DHEA ingestion 1
2. Sexual Dysfunction in Cancer Survivors
- Vaginal DHEA (prasterone) can be considered for vaginal dryness or pain with sexual activity in postmenopausal women 1
- Special considerations:
- Use with caution in survivors receiving aromatase inhibitor (AI) therapy
- Vaginal DHEA increases levels of circulating androgens which may impact AI activity
- Safety data for androgen-based therapy in survivors of hormonally mediated cancers are limited 1
Evidence Quality and Limitations
- Limited objective evidence of clinical benefit from large studies 1
- Long-term effects of DHEA replacement therapy in patients with PAI are not well established 1
- Safety not firmly established in survivors of estrogen-dependent cancers 1
- A randomized controlled trial of 464 cancer survivors showed vaginal DHEA led to significant improvements in sexual desire, arousal, pain, and overall sexual function, but plain moisturizer also improved symptoms 1
Monitoring and Safety
Contraindications/Cautions:
- Use with caution in patients with hormone-dependent cancers
- Not recommended for routine use in general population
- Uncertain risk/benefit profile in women on endocrine therapy for breast cancer 1
Monitoring:
- For PAI patients: Monitor DHEAS, androstenedione, and testosterone levels
- Watch for signs of excess androgen effects in women (acne, hirsutism)
- Regular follow-up to assess clinical benefit versus side effects
Common Pitfalls
Inappropriate use for anti-aging: Despite being marketed as an "anti-aging hormone," evidence is insufficient to recommend DHEA for this purpose 2
Inconsistent product quality: As a dietary supplement in the US (not regulated as a drug), different brands may contain varying amounts of active ingredient 2
Unrealistic expectations: DHEA supplementation normalizes some effects of aging but does not create "supermen/women" 3
Overlooking contraindications: Particular caution needed in patients with hormone-sensitive conditions
Conclusion
While DHEA shows promise in specific clinical scenarios like primary adrenal insufficiency and certain cases of sexual dysfunction, current evidence does not support its widespread use for general health, anti-aging, or most medical conditions. The strongest evidence supports its targeted use in women with PAI experiencing persistent symptoms despite optimized conventional hormone replacement.