When to start Dehydroepiandrosterone (DHEA) supplementation?

DHEA Supplementation Timing Guidelines

DHEA supplementation should be initiated in women with persistent lack of libido and/or low energy levels, typically starting with a dose of 25 mg daily as a single morning dose, with effectiveness monitored through serum DHEA sulphate, androstenedione, and testosterone levels. 1, 2

Patient Selection and Timing

• DHEA supplementation is most appropriate for female patients with primary adrenal insufficiency who exhibit persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement 1
• DHEA can be offered as a 6-month trial therapy, which should be continued only if clinically effective in improving symptoms 1, 2
• In postmenopausal women, DHEA supplementation has shown benefits starting within 3 months of initiation, with continued improvements observed through 12 months of therapy 3

Dosing Recommendations

• The typical starting dose is 25 mg as a single daily morning dose, with a potential range of 10-50 mg based on clinical response 1, 2
• Dose adjustments should be guided by monitoring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels, which should be maintained in the normal range 1
• Morning measurements of these hormones prior to DHEA ingestion provide the most accurate assessment for dose adjustment 1

Monitoring Protocol

• Baseline hormone levels should be established before initiating therapy 1, 2
• Follow-up hormone measurements should be taken in the morning before DHEA ingestion 1
• Clinical effectiveness should be assessed after 6 months to determine whether to continue therapy 1
• Monitor for signs of androgen excess in women, particularly at higher doses 4

Special Populations

• For female cancer survivors with sexual dysfunction, DHEA has shown significant improvements in sexual desire, arousal, pain, and overall sexual function 1, 2
• DHEA should be used with caution in survivors receiving aromatase inhibitor therapy, as vaginal DHEA increases levels of circulating androgens 2
• DHEA should not be prescribed to men who are currently trying to conceive, as it can suppress normal spermatogenesis 1

Safety Considerations

• Long-term effects of DHEA replacement therapy are not fully known, so treatment should be used with caution 1, 4
• Quality control of DHEA supplements is a concern, as different brands may contain different amounts of active ingredient 5
• DHEA supplementation should be avoided in patients with hormone-sensitive cancers unless specifically indicated and monitored 2

Expected Benefits

• In women, improvements in libido, energy levels, and overall quality of life may be observed 1, 6
• In men, improvements in body composition (decreased fat mass) and increased muscle strength have been documented after 6 months of treatment 6
• Serum IGF-I levels typically increase in both genders, with more pronounced effects in women (31% vs. 16% in men) 6

DHEA supplementation requires careful patient selection and monitoring, with continuation based on demonstrated clinical effectiveness rather than indefinite use. The decision to start DHEA should weigh potential benefits against the limited long-term safety data.