Treatment Options for Low DHEA Levels
DHEA replacement therapy at a dose of 25-50 mg orally once daily in the morning is recommended for patients with adrenal insufficiency who have persistent symptoms despite adequate primary replacement therapy. 1
Diagnosis and Evaluation
Before initiating treatment for low DHEA levels, proper diagnosis is essential:
- Morning serum DHEA/DHEAS measurement to confirm deficiency
- Evaluate for underlying adrenal insufficiency with morning cortisol and ACTH levels
- Rule out other causes of symptoms that might mimic DHEA deficiency
Treatment Recommendations
For Adrenal Insufficiency
DHEA replacement is most clearly indicated in patients with adrenal insufficiency:
- Starting dose: 25-50 mg orally once daily in the morning 1
- Monitor symptoms and DHEA/DHEAS levels to adjust dosing
- Continue primary replacement therapy with glucocorticoids and mineralocorticoids as needed
Clinical Benefits of DHEA Replacement
DHEA replacement in adrenal insufficiency has been shown to:
- Improve quality of life and psychological well-being 2
- Enhance sexual satisfaction 3
- Improve body composition and bone mineral density 2, 3
- Reduce total cholesterol and improve insulin sensitivity 3
- Restore normal immune function 1
Special Populations
Women
DHEA may be particularly beneficial for women with:
- Low libido despite adequate hormone replacement 1
- Persistent fatigue or reduced energy 1, 3
- Age-related vaginal atrophy 3
Elderly Patients
- DHEA levels naturally decline with age (approximately 2% per year) 4
- While some have proposed DHEA as an "anti-aging" treatment 5, evidence for routine supplementation in healthy elderly individuals is limited
- Consider treatment only when symptoms correlate with documented low levels
Monitoring and Follow-up
- Regular assessment of DHEA/DHEAS levels
- Monitor for androgenic side effects (acne, hirsutism, hair loss)
- Annual follow-up should include assessment of overall well-being, weight, blood pressure, and electrolytes 1
- Bone mineral density assessment every 3-5 years 1
Important Caveats
- DHEA is considered a dietary supplement in the US but a hormone in many European countries 6
- Quality and potency of over-the-counter DHEA supplements vary significantly
- Pharmaceutical-grade DHEA should be preferred when available
- DHEA replacement should not be used in patients with hormone-sensitive cancers
- Benefits may not be apparent for several weeks to months after initiating therapy
Alternative Approaches
For patients with mild symptoms or those who cannot take DHEA:
- Address underlying causes of adrenal stress
- Ensure adequate sleep and stress management
- Optimize nutrition and physical activity
While DHEA has been marketed as an anti-aging supplement 4, its use should be limited to patients with documented deficiency and related symptoms, particularly those with adrenal insufficiency.