From the Guidelines
Stress does not directly cause elevated Dehydroepiandrosterone (DHEA) levels in females, as the current evidence suggests that DHEA levels are more closely related to adrenal insufficiency and replacement therapy rather than stress response. When considering the relationship between stress and DHEA levels, it's essential to understand the role of the hypothalamic-pituitary-adrenal (HPA) axis in responding to stress. However, the provided evidence 1 focuses more on the management of adrenal insufficiency and the replacement of DHEA in patients with primary adrenal insufficiency (PAI) rather than the direct impact of stress on DHEA levels.
Key Points to Consider
- The management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy, as outlined in the ASCO guideline update 1, does not directly address the effect of stress on DHEA levels.
- The consensus statement on the diagnosis, treatment, and follow-up of patients with primary adrenal insufficiency 1 suggests that patients with PAI are deficient in adrenal androgen secretion, including DHEA, and may benefit from DHEA replacement therapy, particularly females with persistent lack of libido and/or low energy levels.
- The evidence provided does not support a direct causal relationship between stress and elevated DHEA levels in females, emphasizing the importance of proper diagnosis and treatment of underlying conditions such as adrenal insufficiency.
Clinical Implications
- In clinical practice, it's crucial to differentiate between the effects of stress and underlying adrenal insufficiency when evaluating DHEA levels in females.
- Managing stress through lifestyle modifications and mindfulness practices can help mitigate its impact on overall health, but it may not directly influence DHEA levels.
- Healthcare providers should consider DHEA replacement therapy in female patients with PAI, guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels, as suggested by the consensus statement 1.
From the Research
DHEA Levels and Stress
- There is limited research directly linking stress to elevated Dehydroepiandrosterone (DHEA) levels in females 2.
- DHEA and its sulfated metabolite DHEA-S are endogenous hormones secreted by the adrenal cortex in response to adrenocorticotrophin (ACTH), which is released in response to stress 2.
- However, the relationship between stress and DHEA levels is not fully understood and requires further research.
DHEA and Female Physiology
- DHEA administration has been shown to increase serum DHEA levels to those of young adults and serum DHEA-S to levels at or slightly above the young adult range in both sexes 3.
- In women, DHEA administration has been associated with increased levels of androgens, such as testosterone and dihydrotestosterone, which may have various effects on the body 3, 4.
- The effects of DHEA on female physiology are complex and may be influenced by various factors, including age, menopausal status, and the presence of hormonal imbalances or disorders.
DHEA and Adrenal Function
- DHEA is secreted by the zona reticularis of the adrenal cortex and plays a role in the regulation of adrenal function 3, 2.
- Adrenal insufficiency, a condition characterized by impaired adrenal function, may be associated with decreased DHEA levels, and DHEA replacement therapy has been shown to have beneficial effects on health-related quality of life in patients with this condition 5.
- However, the relationship between DHEA and adrenal function is complex and requires further research to fully understand its role in human physiology.