What is the recommended treatment for low Dehydroepiandrosterone (DHEA) levels in females?

Treatment for Low DHEA Levels in Females

For women with low DHEA levels, oral DHEA supplementation at 25 mg daily is recommended, particularly for those with primary adrenal insufficiency or persistent symptoms of low libido and energy levels despite optimized hormone replacement. 1

Understanding DHEA Deficiency

DHEA (Dehydroepiandrosterone) is an adrenal androgen that naturally declines with age. Low levels can be particularly significant in women with:

• Primary adrenal insufficiency (PAI)
• Premature ovarian insufficiency
• Postmenopausal status
• Chronic glucocorticoid therapy

Treatment Algorithm

First-line approach:

1. Confirm DHEA deficiency:

   • Measure morning serum DHEA sulfate (DHEAS)
   • Measure androstenedione and testosterone levels
   • Assess for symptoms: low energy, decreased libido, depression, anxiety, dry skin/eyes/hair

2. For women with primary adrenal insufficiency (PAI):

   • Oral DHEA 10-50 mg daily (typically 25 mg)
   • Take as single morning dose
   • Monitor DHEAS, androstenedione, and testosterone levels 1

3. For women without PAI but with symptomatic low DHEA:

   • Consider 6-month trial of DHEA 25 mg daily
   • Continue if clinically effective for symptoms 1, 2

Monitoring and Adjustment:

• Check hormone levels after 3 months
• Target DHEAS, androstenedione, and testosterone in normal range
• Measure levels in the morning prior to DHEA ingestion
• Continue treatment if symptomatic improvement occurs 1

Clinical Applications

For women with primary adrenal insufficiency:

DHEA replacement should be considered after optimizing glucocorticoid and mineralocorticoid replacement if symptoms of low energy and decreased libido persist 1

For postmenopausal women:

• May improve bone mineral density in those with low BMD/osteoporosis
• Can help with sexual disorders and low libido
• Beneficial for vulvovaginal atrophy 2
• Intravaginal DHEA may be more effective than oral DHEA for vaginal symptoms 3

For women with decreased libido:

• Vaginal DHEA (prasterone) may be considered, especially for breast cancer survivors on aromatase inhibitors who haven't responded to other treatments 4
• Consider as part of treatment for hypoactive sexual desire disorder 2

Important Considerations

Benefits:

• Improves libido and sexual function
• Increases energy levels
• May improve mood and reduce anxiety/depression
• Can improve bone mineral density
• May benefit women with insulin resistance 2, 5

Caution:

• Long-term effects of DHEA replacement are not fully known 1
• Use with caution in women with history of hormone-sensitive cancers
• Monitor for androgenic side effects (acne, hirsutism)
• May lower HDL cholesterol levels 3

Dosing specifics:

• Start with 25 mg daily oral dose 5
• Adjust based on clinical response and hormone levels
• Morning dosing mimics natural circadian rhythm

Special Populations

Women on aromatase inhibitors:

• Vaginal DHEA may be considered when other treatments have failed 4
• Monitor for potential interference with endocrine therapy

Women with cognitive concerns:

• May improve cognition in those with mild-to-moderate impairment
• Less effective for women without cognitive impairment 3

DHEA supplementation appears most beneficial for specific populations rather than as a general anti-aging supplement. The strongest evidence supports its use in women with adrenal insufficiency and those with specific symptoms related to androgen deficiency 2, 6.