What is the treatment for low serum Dehydroepiandrosterone (DHEA) levels?

Treatment for Low Serum DHEA Levels

DHEA replacement can be considered for patients with low serum DHEA levels, particularly in women with low libido and/or energy who are otherwise well-managed on standard hormone replacement therapy. 1

Diagnostic Approach

• Low serum DHEA levels should be evaluated in the context of overall adrenal function, with paired measurement of serum cortisol and plasma ACTH to determine if primary adrenal insufficiency is present 1
• In patients with suspected adrenal insufficiency, evaluate morning levels of ACTH, cortisol, basic metabolic panel (sodium, potassium, CO2, glucose), renin, and aldosterone 1
• For indeterminate results (morning cortisol between 3-15 μg/dL), consider standard dose ACTH stimulation testing 1

Treatment Recommendations

For Primary Adrenal Insufficiency

• Primary treatment should focus on glucocorticoid replacement, typically with hydrocortisone 15-20 mg daily in divided doses (2/3 in morning, 1/3 in early afternoon) 1
• Mineralocorticoid replacement with fludrocortisone (0.05-0.1 mg/day) is typically required 1
• DHEA supplementation can be considered as an adjunctive therapy after primary hormone replacement is established 1

For Isolated Low DHEA

• DHEA supplementation can be offered at doses of 10-50 mg daily, with 25 mg being a common starting dose 2
• Monitor treatment efficacy by measuring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 2
• Benefits are most established for women with low libido and/or energy levels 2

Expected Benefits of DHEA Supplementation

• Improved overall well-being, reduced depression and anxiety 3
• Enhanced sexual interest and satisfaction, particularly in women 3
• May help reduce body fat percentage 4
• In adrenal insufficiency, may help restore normal levels of DHEAS and androstenedione 4

Monitoring and Follow-up

• Monitor serum DHEAS levels to ensure they return to the normal range 4
• In women, monitor testosterone and androstenedione levels, which typically increase with DHEA supplementation 4
• In men with adrenal insufficiency, DHEA may decrease SHBG levels without significantly altering testosterone 4

Important Considerations and Cautions

• Long-term effects of DHEA replacement therapy are not fully established, so treatment should be used with caution 2
• DHEA should be used with particular caution in cancer survivors receiving aromatase inhibitor therapy 2
• Benefits appear more pronounced in women than men, particularly for sexual function 3, 4
• DHEA is considered a dietary supplement in the US but is regulated as a hormone in many European countries 5

Alternative Options for Related Symptoms

• For female sexual dysfunction, consider FDA-approved medications like flibanserin for premenopausal women 2
• Pelvic floor muscle training may improve sexual function in some cases 2
• For vaginal symptoms, consider vaginal moisturizers and lubricants 2

DHEA replacement should be considered as part of a comprehensive approach to hormone replacement in patients with confirmed adrenal insufficiency or as a targeted therapy for specific symptoms in patients with isolated low DHEA levels.