What is the recommended dose of Dehydroepiandrosterone (DHEA) for women?

DHEA Dosing for Women

For women with primary adrenal insufficiency, the recommended DHEA dose is 25 mg once daily, taken as a single morning dose, with monitoring of serum DHEA sulfate, androstenedione, and testosterone levels to maintain them within normal range. 1

Specific Dosing by Indication

Women with Adrenal Insufficiency

• Starting dose: 25 mg daily as a single morning dose 1, 2
• Dosage range: 10-50 mg daily, with 25 mg being the most common and appropriate starting point 1
• DHEA replacement is specifically indicated for women with primary adrenal insufficiency who experience persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement 1
• Pharmacokinetic studies demonstrate that 50 mg DHEA restores DHEA sulfate to baseline physiological levels in young women, while 100 mg produces supraphysiological concentrations 2

Healthy Elderly Women (>60 years)

• Dose: 50 mg once daily 3, 4
• This dose is supported by controlled trials showing benefits in women over 70 years old for bone turnover, libido parameters, and skin status 4
• The recommended dose for elderly women is lower than for men (who may receive 100 mg) 3

Perimenopausal Women

• Studies have examined 50 mg daily, but this dose does not improve perimenopausal symptoms, mood, or well-being compared to placebo despite significantly altering endocrine profiles 5
• DHEA supplementation is not recommended for routine perimenopausal symptom management 6, 5

Monitoring Requirements

Laboratory Monitoring

• Measure morning serum DHEA sulfate, androstenedione, and testosterone levels to maintain them in the normal range 1
• Blood samples should be taken in the morning prior to DHEA ingestion 1
• Monitor for androgenic side effects including greasy skin, acne, and increased body hair growth 3

Duration and Trial Period

• Conduct a 6-month trial before determining long-term use 1
• Evaluate treatment effect after 3-6 months 1
• Consider limiting therapy to 24 months due to limited long-term safety data 1

Important Contraindications and Precautions

Absolute Contraindications

• DHEA is generally contraindicated in breast cancer survivors 1
• Women with BRCA1/2 mutations without personal history of breast cancer may consider DHEA only after prophylactic bilateral salpingo-oophorectomy 1

Relative Contraindications

• For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy is preferred over DHEA 1
• Close medical supervision is required to detect possible hormone-dependent cancers 3

Clinical Pitfalls and Caveats

Common mistake: Prescribing DHEA to normal women for anti-aging, sexual dysfunction, or menopausal symptoms. No consistent beneficial effects have been observed for these indications in normal women 6. The evidence supports use primarily in DHEA-deficient states like adrenal insufficiency.

Dose adjustment: If androgenic side effects occur (greasy skin, acne, hirsutism), these are reversible with dose reduction 3. Start at 25 mg and only increase if clinically indicated and hormone levels remain in normal range.

Monitoring frequency: Do not continue DHEA indefinitely without reassessment. The 6-month trial period is critical to determine if the patient is actually benefiting 1.

Special Populations

Local Vaginal Administration

• Local administration of DHEA shows benefit specifically for vulvovaginal atrophy 6
• This represents a distinct indication from systemic DHEA replacement

Infertility

• DHEA is not recommended to improve induction of ovulation response in women with diminished ovarian reserve 6