What are the Dehydroepiandrosterone (DHEA) levels?

From the Guidelines

DHEA levels should be managed with caution, and replacement therapy should only be considered in female patients with primary adrenal insufficiency (PAI) who have a persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement, with a typical dosage of 25 mg daily guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 1. When considering DHEA replacement, it's essential to monitor serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels to ensure they remain in the normal range.

• The normal range for DHEA-S (sulfated form) blood levels varies between laboratories, but typical ranges are 80-560 mcg/dL in adult men and 35-430 mcg/dL in women.
• DHEA replacement therapy should be used with caution due to the limited objective evidence of clinical benefit from large studies and the unknown long-term effects of DHEA or testosterone replacement therapy in patients with PAI 1.
• A pragmatic approach is to offer female patients with PAI a 6-month trial of DHEA replacement, which can be continued if clinically effective, and regular monitoring through blood tests every 3-6 months is recommended to ensure levels remain within optimal range and to adjust dosage if needed.
• Lifestyle factors that may naturally support DHEA production include regular exercise, stress management, adequate sleep, and a balanced diet rich in healthy fats.

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 Dhea levels is not directly addressed in the provided drug label. Key points:

• The label mentions supporting the body to rebalance Adrenal and DHEA output.
• It lists symptoms of imbalanced Adrenal and DHEA, but does not provide information on DHEA levels. 2

From the Research

DHEA Levels and Adrenal Insufficiency

• DHEA is an androgen produced by the zona reticularis of the adrenal gland, and patients with adrenal insufficiency will have a deficiency of DHEA 3.
• DHEA deficiency is associated with morbidity, including adverse impacts on metabolic function, quality of life, and sexuality in multiple studies 3, 4.
• The benefits of DHEA supplementation have been demonstrated in historical studies of patients with primary and secondary adrenal insufficiency, including improvements in quality of life, body composition, bone health, and metabolic markers 3, 4.

DHEA Replacement Therapy

• Replacement of zona reticularis function by DHEA is of considerable interest, as current replacement therapy with glucocorticoids and mineralocorticoids fails to fully restore health-related quality of life in patients with adrenal insufficiency 4.
• Available studies have demonstrated beneficial effects of DHEA on health perception, vitality, fatigue, and sexuality in women 4, 5.
• The optimal dose and duration of DHEA replacement in adrenal failure are unclear, and large-scale randomized controlled trials are needed to inform on this topic 3, 4, 5.

DHEA and Aging

• DHEA has been found to have immunomodulatory, anti-inflammatory, and anti-aging effects, and may be useful in the treatment of age-related diseases such as cancer, atherosclerosis, and diabetes 5, 6.
• However, clinical trials have produced no clear evidence of benefit in parameters such as body composition, peak volume of oxygen consumption, muscle strength, or insulin sensitivity, possibly due to inadequate dosing 6.
• The development of DHEA analogs that lack androgenic and estrogenic action may provide a better understanding of DHEA's potential therapeutic utility 6.

DHEA Dosage and Side Effects

• The optimal dose of DHEA is unclear, but studies have used doses ranging from 1.25-50 mg per day 4, 7.
• Side effects of DHEA are mostly mild and related to androgenic activity, including increased sebum production, facial acne, and changes in hair status 4, 7.
• Excessive doses of DHEA may have negative effects, including decreased normal cell telomere length and increased cancer cell telomere length 7.