What are the implications of low libido and decreased Dehydroepiandrosterone (DHEA) levels?

From the Guidelines

Low libido in patients with low DHEA levels can be treated with DHEA replacement therapy, specifically oral DHEA tablets at a dose of 25 mg as a single daily dose, guided by serum DHEA sulphate, androstenedione, and testosterone levels, as recommended by the consensus statement on the diagnosis, treatment, and follow-up of patients with primary adrenal insufficiency 1. When considering DHEA supplementation for low libido, it is essential to evaluate the patient's overall hormonal balance and rule out other potential causes of low libido, such as medication side effects, relationship issues, stress, depression, or other hormonal imbalances. Key points to consider when prescribing DHEA replacement therapy include:

• Starting with a low dose of 25 mg daily and adjusting as needed based on serum hormone levels
• Monitoring hormone levels regularly to avoid potential side effects like acne, hair loss, or hormonal imbalances
• Considering a 6-month trial period to evaluate the effectiveness of DHEA replacement therapy
• Emphasizing the importance of lifestyle modifications, including regular exercise, stress management, adequate sleep, and a balanced diet, to naturally improve DHEA levels and libido. As noted in the consensus statement, there is limited objective evidence of clinical benefit from large studies, but a pragmatic approach is to offer female patients with persistent low libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement a trial of DHEA replacement, which can be continued if clinically effective 1.

From the FDA Drug Label

INDICATIONS: Temporarily supports the body to rebalance Adrenal and DHEA output. Symptoms of imbalanced Adrenal and DHEA may include: low energy, depression, anxiety, dry eyes, skin, and hair, loss of head hair. The answer to low libido and DHEA levels is not directly addressed in the provided drug label. However, low libido can be related to hormonal imbalances, and DHEA is a hormone that may be involved in this process.

• The drug label mentions that the drug temporarily supports the body to rebalance Adrenal and DHEA output 2.
• It lists symptoms of imbalanced Adrenal and DHEA, but low libido is not explicitly mentioned. Given the information provided, no conclusion can be drawn about the direct relationship between the drug and low libido.

From the Research

Low Libido and DHEA Levels

• Low libido, or hypoactive sexual desire disorder (HSDD), can be caused by various factors, including hormonal imbalances, medical conditions, and psychological issues 3.
• Dehydroepiandrosterone (DHEA) is a steroid hormone that has been linked to sexual function and libido, with some studies suggesting that low DHEA levels may contribute to low libido 4, 5.
• However, the evidence for the use of DHEA supplementation to improve libido is mixed, with some studies showing benefits and others showing no effect 4, 5.
• Other hormonal factors, such as thyroid function and testosterone levels, can also impact libido and sexual function 6, 7.
• Hypogonadism, or low testosterone levels, is a common condition that can contribute to low libido, and testosterone therapy (TTh) may be effective in improving libido and sexual function 6.
• Thyroid dysfunction, including hypothyroidism and hyperthyroidism, can also impact libido and sexual function, with hypothyroidism associated with decreased libido and hyperthyroidism associated with increased risk of premature ejaculation and erectile dysfunction 7.

DHEA and Libido

• DHEA has been shown to improve sexual satisfaction and libido in women, particularly in those with adrenal insufficiency or low DHEA levels 4.
• However, the evidence for the use of DHEA supplementation to improve libido in men is limited, and some studies have shown no benefit 5.
• DHEA may have anti-inflammatory and immunomodulatory effects, which could potentially contribute to its benefits on libido and sexual function 4.

Diagnosis and Treatment

• Diagnosis of low libido and HSDD typically involves a comprehensive medical and psychological evaluation, including screening for underlying medical conditions and hormonal imbalances 3.
• Treatment for low libido and HSDD may involve a combination of pharmacologic and non-pharmacologic interventions, including hormone therapy, counseling, and lifestyle modifications 3.
• Flibanserin and bremelanotide are two medications that have been approved for the treatment of HSDD in women, and may be effective in improving libido and sexual function 3.