Safely Increasing DHEA Levels
For individuals with low DHEA levels, oral DHEA supplementation at 10-50 mg daily (typically 25 mg) is recommended for women with persistent lack of libido and/or low energy levels, guided by serum DHEA sulfate, androstenedione, and testosterone levels, which should be maintained in the normal range. 1
DHEA Supplementation Recommendations
For Women with Primary Adrenal Insufficiency (PAI)
- Start with 25 mg oral DHEA as a single daily dose
- Monitor serum DHEA sulfate (DHEAS), androstenedione, and testosterone levels
- Maintain hormone levels within normal range when measured in the morning before DHEA ingestion
- Consider a 6-month trial for women with persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement
- Continue if clinically effective after 6 months
For Men with Primary Adrenal Insufficiency
- DHEA supplementation shows less benefit in men compared to women
- Men with adrenal insufficiency and hypogonadism may benefit from DHEA supplementation 2
- Less pronounced effects on androgen levels compared to women
Monitoring Parameters
- Morning serum DHEAS levels (target: normal young adult range)
- Androstenedione and testosterone levels (should remain in normal range)
- Clinical symptoms: energy levels, libido, mood
- Body composition changes (may see reduction in fat mass)
Benefits of DHEA Supplementation
In Adrenal Insufficiency
- Restoration of circulating androgens, particularly beneficial in women 3
- May improve libido parameters, especially in women over 70 4
- Potential improvements in skin hydration, epidermal thickness, and sebum production 4
- Possible reduction in body fat percentage 3
- In patients with Addison's disease, may decrease total cholesterol and LDL 3
In Age-Related DHEA Decline
- May increase serum IGF-I levels in both men and women 5
- In men: potential decrease in fat body mass and increase in muscle strength 5
- In women: potential increase in total body mass 5
Cautions and Limitations
- Long-term effects of DHEA replacement therapy are not well established 1
- Use with caution due to limited objective evidence of clinical benefit from large studies 1
- Benefits are more pronounced in those with adrenal insufficiency than in those with age-related decline 6
- In women, DHEA can increase testosterone and androstenedione levels above the normal range 5
- No significant improvement in glucose metabolism or insulin sensitivity has been observed 3
Important Considerations
- DHEA is considered a "dietary supplement" in the US but a "hormone" in many European countries 2
- DHEA should not be used to create "supermen/women" (doping) 4
- Dosage of 50 mg/day for one year has shown no harmful consequences in studies 4
- Individuals with normal adrenal function but age-related decline in DHEA show less benefit from supplementation 6
Always consult with an endocrinologist before starting DHEA supplementation, especially for those with adrenal insufficiency who require careful monitoring of hormone replacement therapy.