What are the risks and benefits of using Dehydroepiandrosterone (DHEA) as a supplement?

DHEA Supplementation: Risks and Benefits

DHEA supplementation has specific therapeutic benefits for certain conditions but should be used with caution due to potential side effects and limited long-term safety data.

Therapeutic Benefits of DHEA

• DHEA is recommended by the American College of Obstetricians and Gynecologists 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
• DHEA supplementation has shown effectiveness in improving sexual function compared to placebo in clinical studies (SMD 0.31,95% CI 0.07 to 0.55, P = 0.01) 2
• DHEA can be offered as a treatment option for female patients with persistent lack of libido and/or low energy levels, typically at doses of 10-50 mg daily 3
• DHEA has demonstrated effectiveness in women with adrenal insufficiency, helping to restore hormone levels, reduce total cholesterol, improve well-being, sexual satisfaction, insulin sensitivity, and prevent loss of bone mineral density 4

Dosing Recommendations

• The typical recommended dose range is 10-50 mg daily, with 25 mg being a common starting dose 3, 1
• For vaginal symptoms, DHEA (prasterone) is available in specific formulations for local application 1
• Treatment efficacy should be guided by monitoring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 3
• Morning measurements of these hormones prior to DHEA ingestion provide the most accurate assessment for dose adjustment 3

Safety Concerns and Side Effects

• DHEA supplementation is associated with androgenic side effects, primarily acne (OR 3.77,95% CI 1.36 to 10.4, P = 0.01) 2
• The National Comprehensive Cancer Network recommends using DHEA with caution due to potential risks of hormone-dependent cancers 1
• DHEA should be used with caution in patients receiving aromatase inhibitor therapy, as it increases circulating androgen levels 1
• The American Society of Clinical Oncology advises that DHEA should not be used by men with breast cancer 1
• Long-term effects of DHEA replacement therapy are not fully known, so treatment should be used with caution 3, 4
• DHEA should not be prescribed to men who are currently trying to conceive, as it can suppress normal sperm production 3

Special Considerations for Different Populations

• For postmenopausal women, DHEA may improve sexual satisfaction and help with age-related vaginal atrophy 4, 5
• In systemic lupus erythematosus, DHEA has shown steroid-sparing effects 4
• DHEA appears to have protective effects in asthma and allergy by attenuating T helper 2 allergic inflammation and reducing eosinophilia and airway hyperreactivity 4
• DHEA may have cardiovascular benefits through anti-inflammatory, vasorelaxant, and anti-remodeling effects 4
• For women with infertility, DHEA supplementation may be beneficial, particularly in those with diminished ovarian reserve 5

Quality Control Concerns

• As with other supplements, quality control is always a concern with DHEA products, and different brands may contain different amounts of active ingredient 6
• DHEA is marketed and sold as a dietary supplement in many countries, which means less regulatory oversight than prescription medications 4

Research Limitations

• Many studies on DHEA have shown inconsistent results due to differences in dosing protocols, rapid metabolism of DHEA, co-morbidities, and organ-specific differences 4
• Large-scale randomized controlled trials are still needed to fine-tune the indications and optimal dosing protocols before DHEA can be fully integrated into routine clinical practice 4, 6