What are the side effects of taking 50 mg of Dehydroepiandrosterone (DHEA) daily in an adult?

DHEA: Overview and Side Effects of 50 mg Daily Dosing

Taking 50 mg of DHEA daily is generally safe in adults and restores hormone levels to those of young adults, with minimal side effects at this dose, though women may experience androgenic effects including increased testosterone levels, mild acne, and oily skin. 1, 2

What is DHEA?

DHEA (dehydroepiandrosterone) is an endogenous steroid hormone produced by the adrenal glands and ovaries that serves as a precursor to both testosterone and estrogen. 3 Blood levels naturally decline with aging, and supplementation aims to restore these levels to those seen in younger adults. 2, 4

Expected Effects at 50 mg Daily Dose

Hormonal Changes

• Serum DHEA and DHEA-sulfate levels increase 3-4 fold within 2 weeks, restoring concentrations to young adult ranges. 2, 5
• The hormone has a terminal half-life exceeding 20 hours, providing sustained levels throughout the day without accumulation. 2
• Doses of 50 mg result in hormone levels at or near the upper limit of normal for healthy young adults, making this an appropriate therapeutic dose. 4

Gender-Specific Responses

Women experience more pronounced androgenic effects than men at this dose:

• Women show significant increases in androstenedione, testosterone, and DHT—sometimes exceeding normal ranges. 6
• Men typically show minimal changes in these androgens at 50 mg daily. 6
• The metabolic conversion of DHEA-sulfate back to DHEA is significantly greater in women than men. 2

Common Side Effects at 50 mg Daily

Androgenic Effects (Primarily in Women)

• Mild acne and oily skin are the most common side effects, particularly in women due to increased androgen conversion. 1, 6
• Hirsutism (excess hair growth) can occur with prolonged use. 1
• Voice deepening and clitoral enlargement represent signs of excessive androgen exposure requiring immediate dose reduction. 1

Metabolic Changes

• In men, a 50 mg dose may increase IGF-I levels by approximately 16%, potentially contributing to improved muscle strength. 6, 5
• Women may experience a 31% increase in IGF-I levels. 6
• Sex hormone binding globulin (SHBG) decreases, particularly in women (up to 40% reduction). 6

Body Composition Effects

• Men may experience a modest decrease in fat mass (approximately 6%) and increases in muscle strength (13-15%) after 6 months. 6
• Women typically show minimal changes in body composition at this dose. 6
• No significant changes occur in bone mineral density, basal metabolic rate, or lipid profiles. 6

Immune System Effects

• Immune function activation occurs within 2-20 weeks, including increased monocyte and B cell numbers. 5
• Natural killer cell activity increases by approximately 45% after 18-20 weeks. 5
• These effects may be beneficial but are not typically perceived as side effects by patients. 5

What Does NOT Occur at 50 mg Daily

• No significant elevation in urinary testosterone/epitestosterone ratios, with values remaining well below the 6:1 threshold used in athletic drug testing. 3
• No adverse effects on cortisol levels. 6
• No changes in fasting glucose or insulin levels. 6
• No cardiovascular events or serious adverse effects reported in clinical trials. 2, 6
• No accumulation of steroids with daily dosing. 2

Critical Safety Considerations

Absolute Contraindications

• DHEA is contraindicated in individuals with hormone-dependent cancers, particularly breast cancer, due to conversion to estrogen and testosterone. 1, 7, 8
• Extreme caution is required in patients on aromatase inhibitor therapy, as DHEA may interfere with treatment efficacy. 1, 8

Monitoring Requirements

• Establish baseline hormone levels (DHEA-sulfate, testosterone, androstenedione) before starting therapy to enable appropriate dose titration. 1, 8
• Monitor for signs of virilization in women, including hirsutism, voice changes, or clitoral enlargement. 1
• Evaluate treatment response after 3-6 months based on subjective symptom improvement. 1, 7

Dosing Context

• The Endocrine Society recommends 25 mg as the standard starting dose, with adjustments between 10-50 mg based on clinical response. 1, 7
• 50 mg represents the upper end of the typical therapeutic range for most indications. 1, 4
• Doses above 50 mg provide minimal additional benefit and increase the risk of androgenic side effects. 4
• Doses exceeding 300 mg daily reach a plateau effect and result in supraphysiologic concentrations with increased side effects. 4

Duration of Therapy

• Implement a 6-month trial period before determining long-term use, continuing only if patients report subjective benefit. 1, 7
• Consider limiting therapy to 24 months due to limited long-term safety data beyond this timeframe. 1, 7
• Therapy should be discontinued if no clinical benefit is observed or if androgenic side effects become problematic. 1

Primary Clinical Indications

The most evidence-based uses for DHEA supplementation include:

• Vaginal atrophy and sexual dysfunction in postmenopausal women, with significant improvements in dryness, dyspareunia, desire, and arousal. 1, 7, 8
• Adrenal insufficiency with persistent low libido or energy despite optimized hormone replacement. 1, 7
• These represent the only indications with strong guideline support for DHEA use. 1, 7