From the Guidelines
A DHEA level of 74 in a 39-year-old female is considered low and may require replacement therapy, particularly if the patient is experiencing symptoms such as lack of libido and/or low energy levels, as guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 1. To determine the best course of action, it's essential to consider the patient's symptoms and medical history. According to the consensus statement on the diagnosis, treatment, and follow-up of patients with primary adrenal insufficiency, adrenal androgen replacement can be beneficial for female patients with severe androgen deficiency 1.
- The recommended dose for oral DHEA tablets is 10-50 mg, often 25 mg as a single daily dose, guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels, which should be maintained in the normal range when measured in the morning prior to DHEA ingestion 1.
- A pragmatic approach is to offer female patients with a persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement a 6-month trial of DHEA replacement, which can be continued if clinically effective 1. It's crucial to note that the long-term effects of DHEA or testosterone replacement therapy in patients with primary adrenal insufficiency are not well-known, and such a regimen should be used with caution 1.
- Lifestyle factors that support healthy adrenal function, such as stress management techniques, adequate sleep, regular physical activity, and a balanced diet rich in nutrients, should also be encouraged.
- Further evaluation of other hormones like testosterone, cortisol, and additional androgens may be warranted if the patient is experiencing symptoms despite normal DHEA levels.