Lowest Starting Dose of DHEA
The lowest recommended starting dose of DHEA is 25 mg daily taken as a single oral dose in the morning. 1
Dosing Considerations
DHEA replacement therapy should follow these guidelines:
- Initial dosing: 25 mg daily as a single morning dose 1
- Dose range: 25-50 mg daily depending on clinical response 1, 2
- Administration: Oral administration as a single morning dose 1, 3
- Duration of trial: At least 3-6 months to properly assess effects 1, 2
Pharmacokinetics and Monitoring
When initiating DHEA therapy at 25 mg daily:
- DHEA has a terminal half-life of more than 20 hours 3
- No concerning accumulation of steroids occurs at this dosage 3
- Back-hydrolysis of DHEAS (DHEA sulfate) provides long-lived unconjugated DHEA 3
- Metabolic conversion of DHEAS to DHEA is significantly greater in women than men 3
Clinical Effects and Evaluation
At the 25 mg starting dose:
- Benefits may include improved well-being, vitality, and reduced fatigue 1
- In women, improvements in sexuality have been documented 1, 2
- DHEA restores circulating androgens in women to normal range 1
- Increases IGF-1 levels 1
Treatment effects should be evaluated after 3-6 months 1. If clinical response is inadequate, dose can be increased to 50 mg daily, which has been shown to be safe in elderly subjects 3.
Side Effects and Cautions
Side effects at the 25 mg starting dose are typically mild and include:
- Increased sebum production
- Facial acne
- Changes in hair status
These effects are primarily related to the androgenic activity of DHEA in women 1.
Important Considerations
- DHEA is not currently considered part of standard replacement therapy for adrenal insufficiency 1
- Higher doses (100 mg) have been studied but may cause excessive androgenization in women 4
- The 50 mg dose has been used in longer-term studies (1 year) without harmful consequences 5
- Individual response varies, making the lower 25 mg starting dose prudent
While some studies have used 50 mg daily dosing 2, starting with the lower 25 mg dose allows for assessment of individual response and minimizes potential side effects, particularly in women who may be more sensitive to androgenic effects.