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

DHEA Supplementation: Risks and Benefits

DHEA supplementation should be used with caution due to limited evidence of long-term safety, though it may benefit specific populations such as postmenopausal women with sexual dysfunction and those with adrenal insufficiency. 1, 2

Potential Benefits

Sexual Function

• DHEA has shown significant improvements in sexual desire, arousal, pain, and overall sexual function in postmenopausal women 1, 2
• The American College of Obstetricians and Gynecologists recommends DHEA (prasterone) for treating vaginal dryness and pain with sexual activity in postmenopausal women 2
• DHEA may improve sexual satisfaction in women with adrenal insufficiency 3

Other Potential Benefits

• May temporarily support adrenal function, potentially addressing symptoms like low energy, depression, anxiety, and dry skin/hair 4
• Can improve physical and psychological well-being, muscle strength, and bone density in elderly individuals 3
• May have immunomodulatory effects, increasing monocytes, T cells, and natural killer cells 3
• Shows potential benefits in systemic lupus erythematosus as a steroid-sparing agent 3

Risks and Safety Considerations

Cancer Risk

• The National Comprehensive Cancer Network recommends using DHEA with caution due to potential risks of hormone-dependent cancers 2
• DHEA should not be used by men with breast cancer according to the American Society of Clinical Oncology 2
• Use with caution in patients receiving aromatase inhibitor therapy, as DHEA increases circulating androgen levels 1, 2

Side Effects

• DHEA is associated with androgenic side effects, primarily acne 5
• Other potential side effects include hirsutism and other androgenic effects 3
• Long-term effects of DHEA replacement therapy are not fully known, warranting cautious use 1

Dosing Recommendations

Standard Dosing

• The typical dose range is 10-50 mg daily, with 25 mg being a common starting dose 1, 2
• For vaginal symptoms, specific vaginal DHEA formulations may be used 5

Monitoring

• Treatment efficacy should be guided by monitoring 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

Special Considerations

Quality Control Issues

• As with other supplements, quality control is a concern, and different brands may contain different amounts of active ingredient 6
• DHEA is marketed as a dietary supplement in many countries, leading to variable product quality 3

Evidence Quality

• Despite promising results in some studies, large-scale randomized controlled trials are still needed to establish definitive indications and optimal dosing protocols 3, 6
• A Cochrane review found that DHEA did not improve quality of life but may slightly improve sexual function compared to placebo 5

Specific Recommendations by Population

Postmenopausal Women

• May be beneficial for vaginal dryness, pain with sexual activity, and sexual dysfunction 2, 5
• Polish Menopause and Andropause Society suggests DHEA is effective for postmenopausal women with low bone mineral density and/or osteoporosis 7

Women with Adrenal Insufficiency

• DHEA supplementation is effective in women with adrenal insufficiency and those chronically treated with exogenous glucocorticoids 7
• Can restore DHEA/DHEAS and androstenedione levels, reduce total cholesterol, improve well-being, sexual satisfaction, and insulin sensitivity 3

Other Potential Indications

• May be helpful for premenopausal women with sexual disorders and low libido 7
• Possibly effective for women with obesity and insulin resistance 7
• May benefit women suffering from depression and anxiety 7