Guidelines for DHEA (Dehydroepiandrosterone) Supplementation
DHEA supplementation is not routinely recommended for general use due to insufficient evidence of clinical benefit and potential risks, though it may be considered in specific clinical scenarios such as primary adrenal insufficiency or vaginal atrophy in postmenopausal women. 1
Approved Clinical Indications
Primary Adrenal Insufficiency
- DHEA replacement therapy is recommended in patients with primary adrenal insufficiency who are deficient in adrenal androgens 1
- Dosing should be guided by monitoring serum DHEAS, androstenedione, and testosterone levels
- Benefits may include improved physical and psychological well-being, muscle strength, and insulin sensitivity
Vaginal Atrophy in Postmenopausal Women
- Vaginal DHEA (prasterone) can be considered for vaginal dryness or pain with sexual activity 1
- May improve sexual satisfaction and vaginal atrophy in postmenopausal women
- Should be used with caution in cancer survivors receiving aromatase inhibitor therapy, as vaginal DHEA increases levels of circulating androgens
Monitoring and Interpretation of DHEA Levels
- DHEAS is the most reliable measure of adrenal androgen production 1
- Age-specific reference ranges are crucial when interpreting DHEAS levels
- DHEAS levels should never be interpreted in isolation but as part of a comprehensive clinical and biochemical assessment
- Liquid chromatography with tandem mass spectrometry (LC-MS/MS) is preferred over direct immunoassays for accurate measurement
Physiological Considerations
- DHEA/DHEAS levels reach maximum concentrations between ages 20-30, followed by a steady decline at approximately 2% per year 1, 2
- By age 70-80, DHEAS concentrations are only 10-20% of those in young adults 3
- DHEA serves as an indirect precursor to estrogen and testosterone and other steroid hormones 2
Potential Benefits Under Investigation
- Immunomodulatory effects: May increase monocytes, T cells expressing TCRγδ, and natural killer cells in elderly 4
- Bone health: May reduce loss of bone mineral density in adrenal insufficiency 4
- Metabolic effects: May improve insulin sensitivity and reduce total cholesterol 4
- Anti-inflammatory properties: Potential benefits in systemic lupus erythematosus and inflammatory bowel disease 4
Cautions and Limitations
- Quality control is a major concern with DHEA supplements as they are not FDA-regulated 5
- Different brands may contain varying amounts of active ingredient 5
- Long-term effects of DHEA replacement therapy are not well established 1
- Safety data for androgen-based therapy in survivors of hormonally mediated cancers are limited 1
- Potential side effects may include acne, hirsutism, and other androgenic effects
Special Considerations
- Low DHEAS levels may indicate primary adrenal insufficiency, normal age-related decline, or adrenal suppression from exogenous steroid use 1
- Elevated DHEAS levels may suggest polycystic ovary syndrome in women, adrenal hyperplasia, or adrenal tumors 1
- In cases of suspected adrenal insufficiency, adrenal function testing with an ACTH stimulation test should be considered 1
Despite promising results in some studies, large-scale randomized controlled trials are still needed before DHEA can be recommended for routine clinical use in conditions other than those specifically approved 4, 5.