DHEA Therapy Assessment and Management

Essential Baseline Assessments

Morning cortisol and ACTH levels must be assessed to rule out or confirm adrenal insufficiency before starting DHEA, as recommended by the Journal of Internal Medicine and Journal of Clinical Oncology 1, 2
Baseline DHEAS, androstenedione, and testosterone should be measured in the morning prior to any DHEA administration to guide dosing, according to the Journal of Internal Medicine 1
Subjective assessment of energy levels, fatigue patterns, and sleep quality should be considered as these are key indicators for DHEA therapy candidacy, as suggested by the Journal of Internal Medicine 1

DHEA replacement is specifically indicated for women with primary adrenal insufficiency who have persistent lack of libido and/or low energy despite optimized glucocorticoid and mineralocorticoid replacement, as recommended by the Journal of Internal Medicine 1
The evidence for clinical benefit remains limited, warranting a pragmatic 6-month trial approach, according to the Journal of Internal Medicine 1

Prostate cancer in men and breast cancer or history of DVT in women are contraindications to androgen therapy, as stated by the Journal of Clinical Oncology 4, 5

Measure morning DHEAS, androstenedione, and testosterone levels to maintain values in the normal range, as recommended by the Journal of Internal Medicine 1

Never start DHEA before ensuring adequate cortisol replacement in patients with adrenal insufficiency—this can precipitate life-threatening adrenal crisis, as warned by the Journal of Clinical Oncology 3, 4
Long-term safety data for DHEA replacement remains limited, so use cautiously, according to the Journal of Internal Medicine 1