From the Guidelines
DHEA replacement therapy should be considered for 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 recommended dose of 25 mg as a single daily dose guided by serum DHEA sulphate (DHEAS), androstenedione and testosterone levels 1. When considering DHEA replacement therapy, it's essential to weigh the potential benefits against the limited objective evidence of clinical benefit from large studies 1.
- The typical dosage of DHEA replacement therapy 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 PAI a 6-month trial of DHEA replacement, which can be continued if clinically effective, while being cautious of the long-term effects of DHEA or testosterone replacement therapy in patients with PAI 1.
- It's crucial to monitor patients closely, as the long-term effects of DHEA replacement therapy are not well understood, and such a regimen should be used with caution 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 DHEA (PO) drug is used to temporarily support the body in rebalancing Adrenal and DHEA output. Key symptoms of imbalanced Adrenal and DHEA include:
- Low energy
- Depression
- Anxiety
- Dry eyes, skin, and hair
- Loss of head hair 2
From the Research
DHEA Replacement Therapy
- DHEA replacement therapy has been shown to have beneficial effects on health perception, vitality, fatigue, and sexuality in patients with adrenal insufficiency 3.
- The optimal dose of DHEA replacement therapy is still unclear, but a single oral dose of 25-50 mg DHEA in the morning has been suggested 3.
- DHEA replacement therapy has been found to improve well-being, reduce fatigue, and increase sexual satisfaction in women with adrenal insufficiency 4.
- In men, DHEA replacement therapy has been found to have limited effects on testosterone and 17-hydroxyprogesterone levels, but may decrease serum SHBG levels 5.
Effects on Metabolic Parameters
- DHEA replacement therapy has been found to decrease total cholesterol and low-density lipoproteins in patients with Addison's disease 5.
- DHEA replacement therapy has been found to reduce body fat mass percentage in patients with hypoadrenalism 5.
- DHEA replacement therapy has been found to have no significant effects on glucose metabolism and insulin sensitivity 5.
Effects on Bone Health
- DHEA replacement therapy has been found to decrease serum osteocalcin levels, which may indicate a decrease in bone turnover 5.
- DHEA replacement therapy has been found to improve bone density in patients with adrenal insufficiency 6.
Side Effects
- DHEA replacement therapy has been found to have mild side effects, including increased sebum production, facial acne, and changes in hair status, particularly in women 3.
- DHEA replacement therapy has been found to have limited side effects in men, but may decrease serum SHBG levels 5.