Can Birth Control Pills Cause Low DHEA Levels?
Yes, oral contraceptive pills containing estrogen consistently decrease DHEA and DHEA-S (dehydroepiandrosterone sulfate) levels by approximately 20-60% compared to baseline. This effect is well-documented and occurs through suppression of adrenal androgen production.
Mechanism and Magnitude of Effect
The reduction in DHEA levels with combined oral contraceptives occurs through multiple pathways:
Estrogen-containing oral contraceptives reduce plasma DHEA, DHEA-S, and androstenedione levels by inhibiting delta5-pregnenolone synthesis from cholesterol, which is a precursor in the androgen synthesis pathway 1
The decrease in DHEA-S levels averages approximately 57% (from mean 2,062 ng/mL to 895 ng/mL) and likely results from reduced adrenocorticotropic hormone (ACTH) release, leading to decreased adrenal secretion 2
Treatment with a COC containing 30 mcg ethinylestradiol and 3 mg drospirenone reduces exposure to DHEA and DHEA-S by at least 20%, affecting both adrenal and ovarian androgen production 3
Dose-Dependent Effects
The magnitude of DHEA suppression varies with estrogen dose:
Higher estrogen doses (35 mcg ethinylestradiol) produce significantly greater reductions in DHEA-S (from 7.26 to 5.22 micromol/L, p<0.02) compared to lower doses (25 mcg), though both formulations reduce levels 4
The 35 mcg formulation also produces more pronounced decreases in total and free testosterone compared to 25 mcg formulations, suggesting a dose-response relationship for androgen suppression 4
Clinical Implications
While the biochemical effect is clear, the clinical significance remains debated:
Co-administration of 50 mg daily DHEA can fully compensate for the loss of adrenal androgens during COC use, restoring total testosterone levels to baseline 3
However, DHEA supplementation (50 mg) did not result in consistent improvements in sexual function, mood, or quality of life in women taking ethinylestradiol/drospirenone, suggesting this dose may be insufficient for complete normalization of free testosterone 5
Small improvements were noted in autonomic reactions and behavior scores with DHEA supplementation, but the clinical relevance of these changes is uncertain 5
Important Caveats
Progestin-only contraceptives do not appear to have the same suppressive effect on DHEA levels, as the mechanism is primarily estrogen-mediated 6
The reduction in DHEA levels is reversible upon discontinuation of estrogen-containing contraceptives, as the effect is functional rather than structural
Individual variability is substantial, with some women experiencing more pronounced suppression than others based on baseline adrenal function 4