Treatment Approach for Abnormal DHEA Levels
The treatment approach for abnormal DHEA levels should be tailored based on the underlying cause, with DHEA supplementation (10-50 mg daily) recommended for women with low DHEA levels who experience persistent lack of libido or low energy levels, while elevated DHEA levels may indicate adrenal pathology requiring specific evaluation and treatment. 1, 2
Diagnostic Approach for Abnormal DHEA Levels
Low DHEA Levels
- Evaluate in context of overall adrenal function with paired measurement of serum cortisol and plasma ACTH to determine if primary adrenal insufficiency is present 2
- Consider morning levels of ACTH, cortisol, basic metabolic panel, renin, and aldosterone for comprehensive evaluation 2
- For indeterminate results, standard dose ACTH stimulation testing may be necessary 2
Elevated DHEA Levels
- Elevated DHEA-S levels may indicate adrenocortical carcinoma (ACC), especially when accompanied by clinical signs of virilization 3
- Serum testing for excess androgen should be performed in cases of suspected ACC and/or when clinical signs of virilization are present 3
- Additional testing may include 17b-estradiol, 17-OH progesterone, androstenedione, 17-OH pregnenolone, 11-deoxycorticosterone, progesterone, and estradiol 3
Treatment Recommendations
For Low DHEA Levels
In Primary Adrenal Insufficiency:
- Primary treatment should focus on glucocorticoid and mineralocorticoid replacement 2
- DHEA supplementation can be considered as adjunctive therapy after primary hormone replacement is established 2
- A 6-month trial of DHEA replacement (typically 25 mg daily) can be offered to female patients with persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement 1
- Continue DHEA therapy only if clinically effective after the trial period 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 1, 2
- Monitor treatment efficacy by measuring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 1
- Morning measurements of these hormones prior to DHEA ingestion provide the most accurate assessment for dose adjustment 1
For Elevated DHEA Levels:
- Unilateral adrenalectomy is recommended for adrenal masses causing androgen excess, with minimally-invasive surgery when feasible 3
- For mild autonomous cortisol secretion (MACS) with progressive metabolic comorbidities, adrenalectomy could be considered, particularly in younger patients 3
Special Considerations
For Women:
- DHEA supplementation has shown significant improvements in sexual desire, arousal, pain, and overall sexual function in clinical trials 1
- In women with adrenal insufficiency, DHEA can restore DHEAS and androstenedione levels, reduce total cholesterol, improve well-being, sexual satisfaction, and insulin sensitivity 4
For Men:
- DHEA supplementation may decrease fat body mass (6.1%) and increase knee muscle strength (15.0%) and lumbar back strength (13.9%) 5
- Should not be prescribed to men who are currently trying to conceive, as it can suppress normal sperm production 1
Monitoring Protocol
- Baseline hormone levels should be established before initiating therapy 1
- Follow-up hormone levels should be maintained in the normal range when measured in the morning prior to DHEA ingestion 1
- Clinical effectiveness should be assessed after 6 months to determine whether to continue therapy 1
Safety Considerations
- Long-term effects of DHEA replacement therapy are not fully known, so treatment should be used with caution 1, 2
- DHEA should be used with particular caution in cancer survivors receiving aromatase inhibitor therapy 1
- No significant adverse effects were observed in studies using 100 mg daily for 6 months 5