Does Dehydroepiandrosterone (DHEA) help with cortisol levels?

DHEA's Effect on Cortisol Levels

DHEA supplementation can lower cortisol levels, particularly in women, but has limited evidence supporting its widespread use for cortisol management. 1

Role of DHEA in Adrenal Function and Cortisol Regulation

• DHEA (dehydroepiandrosterone) is an adrenal androgen that may have opposing effects to cortisol, with research showing it can decrease plasma cortisol concentrations when administered as a supplement 1
• The cortisol-lowering effect appears more pronounced in women than in men, with significant reductions observed after approximately 1-2 weeks of supplementation 1
• DHEA and cortisol have a complex relationship - they are both produced by the adrenal glands but may have antagonistic physiological effects 2

Evidence for DHEA's Effect on Cortisol

• A placebo-controlled study found that 200mg daily DHEA administration resulted in decreased plasma cortisol concentrations (mean, peak, and/or AUC) in healthy older adults 1
• Women showed more sustained cortisol reduction than men, with lower levels maintained even during the washout period 1
• The cortisol/DHEA ratio is considered a potential biological marker in certain conditions, with an elevated ratio observed in treatment-resistant depression 3

Clinical Applications in Primary Adrenal Insufficiency

• In primary adrenal insufficiency (PAI), patients are deficient in adrenal androgen secretion, including DHEA, which can result in androgen deficiency, particularly in female patients 4
• Clinical guidelines recommend DHEA replacement only for specific situations in PAI:
  • For female patients with persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement 4
  • Typically administered as oral DHEA tablets (10-50 mg), often 25 mg as a single daily dose 4
  • Dosing should be guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 4

Limitations and Cautions

• There is only limited objective evidence of clinical benefit from large studies regarding DHEA supplementation 4
• Guidelines recommend a cautious approach - offering a 6-month trial of DHEA replacement that can be continued if clinically effective 4
• Long-term effects of DHEA replacement therapy in patients are not well established, warranting caution in its use 4
• DHEA supplementation can increase androgen levels in women to above gender-specific young adult ranges, which may have unintended effects 5

Potential Benefits Beyond Cortisol Regulation

• DHEA supplementation has been associated with:
  • Increased serum IGF-I levels in both men and women 5
  • Decreased fat body mass and increased muscle strength in men 5
  • Potential improvement in psychological well-being, possibly related to its effects on cortisol 2
  • Possible protective role against depression when cortisol levels are high 6

Practical Considerations for Use

• For those considering DHEA for cortisol management:
  • Effects may take 1-2 weeks to become apparent 1
  • Dosages studied range from 25-200mg daily, with higher doses showing more pronounced effects on cortisol 1, 5
  • Monitoring should include baseline and follow-up measurements of DHEAS, androstenedione, and testosterone levels 4
  • Gender differences in response should be anticipated, with women showing more pronounced hormonal changes 1, 5