Indications for DHEA Supplementation
DHEA supplementation is primarily indicated for female sexual dysfunction, adrenal insufficiency, and specific conditions with documented DHEA deficiency, but has limited evidence for general use.
Primary Indications
- Female sexual dysfunction: DHEA (prasterone) is effective for treating vaginal dryness and pain with sexual activity in postmenopausal women, with significant improvements in sexual desire, arousal, pain, and overall sexual function 1
- Adrenal insufficiency: DHEA supplementation is justified in patients with adrenal insufficiency to restore DHEA/DHEAS levels and improve well-being, sexual satisfaction, and insulin sensitivity 2, 3
- Prolonged glucocorticoid therapy: DHEA may be beneficial for patients on long-term glucocorticoid treatment to counteract side effects 2, 3
Secondary Indications with Moderate Evidence
- Low bone mineral density/osteoporosis: DHEA supplementation may benefit postmenopausal women with low bone density or osteoporosis 3
- Symptoms in elderly with low DHEA levels: May help with skin dryness/atrophy, muscle weakness, and neuropsychological symptoms in DHEA-depleted elderly patients 2
- Depression and anxiety: Some evidence suggests DHEA may be effective for patients suffering from depression and anxiety 3
Other Potential Uses (Limited Evidence)
- Low energy and well-being: DHEA may temporarily support rebalancing adrenal output in patients with symptoms of low energy and depression 4, 2
- Insulin resistance and obesity: Some evidence suggests potential benefits for women with obesity and insulin resistance 3
- Infertility: May help infertile women with diminished ovarian reserve 3
Dosing Recommendations
- Women: Typically 10-50 mg daily, with 25 mg being a common starting dose 5, 2
- Men: Higher doses of approximately 100 mg daily may be required 2
- Monitoring: Treatment efficacy should be guided by monitoring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 5
Safety Considerations and Contraindications
- Cancer risk: DHEA should be used with caution due to potential risks of hormone-dependent cancers (breast cancer in women, prostate cancer in men) 2
- Aromatase inhibitor therapy: Use with caution in patients receiving aromatase inhibitor therapy, as DHEA increases circulating androgen levels 1
- Testosterone/androgen supplementation: Should not be used by men with breast cancer 1
- Side effects: Androgenic side effects (greasy skin, acne, increased body hair growth) are common but reversible; dose adjustment is recommended 2
- Quality control concerns: As with other supplements, different brands may contain varying amounts of active ingredients 6
Important Clinical Considerations
- Long-term effects of DHEA replacement therapy are not fully established, warranting cautious use 5, 7
- DHEA is primarily a human molecule, making animal studies less reliable for determining efficacy 7
- Close medical supervision is required to monitor for potential adverse effects 2
- Large-scale randomized controlled trials are still needed to establish optimal dosing protocols for specific conditions 7