The Significance of DHEA Supplementation in Medical Treatment
DHEA supplementation has limited clinical significance with proven benefits only in specific conditions such as primary adrenal insufficiency, vaginal atrophy, and possibly depression, while lacking strong evidence for anti-aging or general health benefits. 1
Clinical Applications with Established Evidence
Primary Adrenal Insufficiency
- DHEA replacement (10-50 mg daily, often 25 mg) is recommended for women with primary adrenal insufficiency who experience persistent lack of libido and/or low energy despite optimized glucocorticoid and mineralocorticoid replacement 2
- Dosing should be guided by serum DHEA sulfate (DHEAS), androstenedione, and testosterone levels, which should be maintained in the normal range 2
- Treatment can be continued if clinically effective after a 6-month trial 2
Vaginal Health
- Vaginal DHEA (prasterone) is FDA-approved for treating vaginal dryness or pain with sexual activity in postmenopausal women 2
- Studies have shown that vaginal DHEA leads to significant improvements in sexual desire, arousal, pain, and overall sexual function in survivors of breast or gynecologic cancer 2
- Safety warning: The FDA label for prasterone warns that exogenous estrogens are contraindicated in women with a history of breast cancer 2
Conditions with Limited Evidence
Sexual Function
- DHEA may improve sexual satisfaction in elderly women more consistently than in men 3
- For women, improvements in sexual function have been demonstrated in some studies (SMD 0.31,95% CI 0.07 to 0.55) 4
- However, a Cochrane review found that evidence for DHEA's effect on menopausal symptoms was inconsistent 4
Depression
- Some evidence suggests DHEA may be beneficial in major depressive illnesses 3
- However, large-scale randomized controlled trials are still needed to confirm this benefit
Conditions with Insufficient Evidence
Anti-Aging Claims
- Despite marketing as an "anti-aging" supplement, evidence for DHEA's effectiveness in this regard remains limited 5
- While some studies suggest improvements in physical and psychological well-being, muscle strength, and bone density in the elderly, these findings are not consistent across all studies 5
General Health Benefits
- Claims regarding DHEA's benefits for conditions such as diabetes mellitus, Alzheimer's disease, and certain cancers lack sufficient supporting evidence 6
- Quality of life was not significantly improved compared to placebo in a meta-analysis (SMD 0.16,95% CI -0.03 to 0.34) 4
Dosing and Administration
- For women: 25-50 mg once daily 3
- For men: 100 mg once daily 3
- For primary adrenal insufficiency: 10-50 mg daily, often 25 mg 2
- Monitoring: Serum DHEAS, androstenedione, and testosterone levels should guide dosing 2, 1
Side Effects and Safety Concerns
- Androgenic side effects are common (OR 3.77,95% CI 1.36 to 10.4) 4
- Greasy skin, acne, increased growth of body hair
- These effects are generally reversible with dose adjustment 3
- Long-term effects of DHEA replacement therapy are not well established 2
- Caution is advised in patients with hormone-sensitive conditions:
Clinical Bottom Line
DHEA supplementation should be reserved for specific clinical scenarios with demonstrated benefit, particularly primary adrenal insufficiency and vaginal atrophy in postmenopausal women. The evidence does not support its widespread use for anti-aging or general health promotion. When prescribed, DHEA should be used under close medical supervision with appropriate monitoring for side effects and potential risks.