From the Guidelines
Elevated DHEA levels in females should be investigated to determine the underlying cause, with management depending on the specific diagnosis, and prioritizing lifestyle modifications and medications that address the root cause, as evidenced by the most recent study 1. When evaluating elevated DHEA levels, it is crucial to consider the potential causes, including polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, adrenal tumors, or Cushing's syndrome.
Key Considerations
- The most recent study 1 suggests that total testosterone (TT) and calculated free testosterone (cFT) should be used as the first-line laboratory tests to assess biochemical hyperandrogenism in the diagnosis of PCOS.
- Lifestyle modifications, such as weight loss through diet and exercise, can help normalize hormone levels and are often recommended as a first-line treatment.
- Medications, including combined oral contraceptives, metformin, or anti-androgens like spironolactone, may be prescribed to regulate menstrual cycles, reduce androgen effects, or improve insulin sensitivity.
- Regular monitoring of hormone levels is essential to assess treatment effectiveness and prevent long-term complications like metabolic disorders and cardiovascular issues.
Diagnostic Approach
The diagnostic approach should involve assessing different androgen measures, including TT, cFT, free androgen index (FAI), androstenedione (A4), dehydroepiandrosterone sulfate (DHEAS), and dihydrotestosterone (DHT), to determine the underlying cause of elevated DHEA levels, as recommended by the study 1.
Treatment Options
Treatment options will depend on the specific diagnosis, but may include:
- Lifestyle modifications, such as weight loss through diet and exercise
- Medications, including combined oral contraceptives, metformin, or anti-androgens like spironolactone
- Surgical intervention for adrenal tumors
- Regular monitoring of hormone levels to assess treatment effectiveness and prevent long-term complications.
From the Research
Elevated DHEA in Females
- Elevated DHEA levels in females can be associated with polycystic ovary syndrome (PCOS), a common endocrine disorder characterized by androgen excess, oligo-ovulation, and polycystic ovaries 2
- In PCOS patients, adrenal androgen (AA) excess is detectable primarily by elevated dehydroepiandrosterone sulfate (DHEAS) levels, which is observed in 20-30% of patients 2
- The mechanisms of AA excess in PCOS are unclear, but it is likely a complex trait modulated by both intrinsic and acquired factors, including altered factors regulating glucose-mediated glucose disposal and increased peripheral metabolism of cortisol 2
Effects of DHEA on Females
- DHEA has been shown to improve sexual satisfaction, fertility, and age-related vaginal atrophy in women 3
- It also exerts an immunomodulatory action, increasing the number of monocytes, T cells, and natural killer cells, which can be beneficial for overall health 3
- Additionally, DHEA has been found to reduce body fat, improve muscle strength and bone density, and stimulate procollagen/sebum production, which can help with age-related skin atrophy 3
Clinical Significance of DHEA
- Low levels of DHEAS have been correlated with increased cardiovascular disease and all-cause mortality, suggesting that DHEA may have a protective effect 3
- DHEA has also been found to modulate cardiovascular signaling pathways, exerting an anti-inflammatory, vasorelaxant, and anti-remodeling effect 3
- Furthermore, DHEA has been shown to attenuate T helper 2 allergic inflammation, reduce eosinophilia, and airway hyperreactivity, making it a potential therapeutic agent for asthma and allergy 3