What are the effects and uses of Dehydroepiandrosterone (DHEA)?

DHEA Effects and Clinical Applications

DHEA supplementation is primarily recommended for specific clinical conditions including primary adrenal insufficiency with persistent low libido/energy despite optimized hormone replacement, and for postmenopausal women with vaginal dryness or pain during sexual activity (in vaginal form as prasterone). 1

Physiological Role and Production

• DHEA (dehydroepiandrosterone) and its sulfated form DHEAS are the most abundant circulating steroid hormones in humans 2
• DHEA is primarily produced in the adrenal cortex and serves as a precursor to estrogen and testosterone 3
• DHEA levels follow a characteristic age-related pattern:
  • Peak production occurs in the 20s-30s
  • Levels decline gradually at approximately 2% per year thereafter 3
  • By age 70-80, levels are typically 10-20% of young adult levels 2

Evidence-Based Clinical Applications

Adrenal Insufficiency

• DHEA replacement (10-50 mg daily, often 25 mg) is recommended for patients with primary adrenal insufficiency experiencing persistent lack of libido and/or low energy despite optimized glucocorticoid and mineralocorticoid replacement 1
• Dosing should be guided by serum DHEAS, androstenedione, and testosterone levels 1
• Treatment can be continued if clinically effective after a 6-month trial 1

Vaginal Atrophy in Postmenopausal Women

• Vaginal DHEA (prasterone) is FDA-approved for treating vaginal dryness or pain with sexual activity in postmenopausal women 1
• Studies show significant improvements in sexual desire, arousal, pain, and overall sexual function 1
• Safety warning: Contraindicated in women with history of breast cancer due to potential estrogenic effects 1

Monitoring and Side Effects

• Common androgenic side effects include:
  • Greasy skin
  • Acne
  • Increased body hair growth 4
• These side effects are typically reversible with dose adjustment 4
• Long-term effects are not well established 1
• Caution is advised in patients with hormone-sensitive conditions such as:
  • Breast cancer
  • Prostate cancer
  • Other hormone-dependent cancers 1

Dosing Guidelines

• Women: 25-50 mg once daily orally
• Men: 100 mg once daily orally
• Vaginal DHEA (prasterone): As prescribed for local application 4

Laboratory Assessment

• DHEAS is the most reliable measure of adrenal androgen production 1
• Low DHEAS levels may indicate:
  • Primary adrenal insufficiency
  • Normal age-related decline
  • Adrenal suppression from exogenous steroid use 1
• Elevated DHEAS levels may suggest:
  • Polycystic ovary syndrome (PCOS) in women
  • Adrenal hyperplasia
  • Adrenal tumors 1
• DHEAS should never be interpreted in isolation but as part of a comprehensive clinical and biochemical assessment 1

Limitations and Controversies

• Despite marketing as an "anti-aging" supplement, evidence for this claim remains limited 5, 6
• Quality control is a concern with over-the-counter supplements, as different brands may contain different amounts of active ingredient 5
• Many studies show inconsistent results due to:
  • Different dosing protocols
  • Rapid metabolism of DHEA
  • Co-morbidities
  • Organ-specific differences 2

Clinical Cautions

• DHEA should be used under close medical supervision to monitor for potential hormone-dependent cancers 4
• Patients should be informed about potential risks and the limited definitive evidence for many claimed benefits 4
• DHEA should be used with caution in cancer survivors receiving aromatase inhibitor therapy 1

DHEA has legitimate medical applications in specific conditions, but its widespread use as a supplement for general health promotion or anti-aging remains controversial and not strongly supported by current evidence.