Recommended DHEA Dosage for Women
For women with primary adrenal insufficiency (PAI), the recommended DHEA dosage is 25 mg as a single daily dose, which should be guided by serum DHEA sulfate (DHEAS), androstenedione, and testosterone levels to maintain them within normal range. 1
Dosage Guidelines by Clinical Context
Women with Adrenal Insufficiency
- DHEA replacement is indicated for women with PAI who experience persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement 1
- Dosage range: 10-50 mg daily, with 25 mg being the most common starting dose 1
- Morning blood levels of DHEAS, androstenedione, and testosterone should guide dosage adjustments 1
- Blood tests should be performed prior to DHEA ingestion to accurately assess levels 1
Healthy Women (Non-Adrenal Insufficiency)
- There is limited objective evidence of clinical benefit for DHEA supplementation in healthy women 1, 2
- Studies have used doses ranging from 25-100 mg daily in research settings 3, 4, 5
- Doses above 50 mg/day result in supraphysiological levels that exceed normal young adult ranges 6
- Doses above 300 mg/day reach a plateau effect with increased risk of side effects 6
Monitoring and Duration of Treatment
Initial Trial and Evaluation
- A 6-month trial of DHEA replacement is recommended for women with PAI before determining long-term use 1
- Treatment effect should be evaluated after 3-6 months 1
- DHEA therapy should possibly be limited to 24 months due to limited long-term safety data 1
Laboratory Monitoring
- Monitor morning serum DHEAS, androstenedione, and testosterone levels to maintain them in the normal range 1
- Blood samples should be taken in the morning prior to DHEA ingestion 1
- No routine monitoring tests beyond hormone levels are required but may be prompted by specific symptoms 1
Safety Considerations and Side Effects
Potential Risks
- Long-term effects of DHEA replacement therapy in women are not well established 1, 2
- High physiologic or pharmacologic doses may cause androgenic and estrogenic side effects 2
- Women show greater metabolic conversion of DHEAS to DHEA than men, potentially leading to higher androgen levels 3
Special Populations
- DHEA is generally contraindicated in breast cancer survivors 1
- Women with BRCA1/2 mutations without personal history of breast cancer may consider DHEA after prophylactic bilateral salpingo-oophorectomy 1
- For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy is preferred over DHEA 1
Clinical Benefits
Potential Benefits in Women with Adrenal Insufficiency
- May improve quality of life and mood 2
- May help with persistent lack of libido 1
- Small benefits in bone turnover have been observed in women over 70 years 4
- Improvements in skin status (hydration, epidermal thickness, sebum production) have been reported 4
Limited Evidence for Other Conditions
- No consistent beneficial effects for menopausal symptoms, sexual function, cognition, or overall wellbeing in normal women 2
- Local administration shows benefit for vulvovaginal atrophy 2
- Not recommended to improve ovulation response in women with diminished ovarian reserve 2