DHEA Supplementation in Perimenopausal Women

Introduction to DHEA Therapy

DHEA supplementation may be considered for perimenopausal women with low libido and/or energy if they are otherwise well-replaced hormonally, as DHEA replacement is a therapeutic option for women with deficiency symptoms despite being controversial, according to the American College of Clinical Oncology 1

Consider DHEA supplementation at a starting dose of 25 mg daily orally if the patient presents with symptoms of low energy and/or decreased libido, after evaluating for other hormonal deficiencies, particularly adrenal insufficiency, as recommended by the American College of Clinical Oncology 1
Evaluate for other hormonal deficiencies before initiating DHEA, particularly adrenal insufficiency, as DHEA should only be added after appropriate cortisol replacement if needed, as suggested by the American College of Clinical Oncology 2, 3

Monitor serum DHEA-S, androstenedione, and testosterone levels, which should be maintained in the normal range when measured in the morning prior to DHEA ingestion, as recommended by the American College of Internal Medicine 4
Consider a 6-month trial period to assess clinical benefit, continuing only if there is improvement in symptoms, as suggested by the American College of Internal Medicine 4
Titrate the dose between 10-50 mg daily based on symptom response and serum levels, according to the American College of Internal Medicine 4

If the patient is on aromatase inhibitors, DHEA should be used with caution as it increases circulating androgens that could impact AI activity, as recommended by the National Comprehensive Cancer Network 5
For women with a history of estrogen-dependent cancers, vaginal DHEA should be avoided or used with extreme caution, as suggested by the National Comprehensive Cancer Network 5, 6

DHEA replacement remains controversial despite evidence of benefit in specific populations, and long-term effects of DHEA replacement therapy are not well established, so treatment should be used with caution, as noted by the American College of Clinical Oncology and the American College of Internal Medicine 1, 4
Endocrinology consultation is recommended before initiating DHEA therapy to ensure appropriate diagnosis and treatment plan, according to the American College of Clinical Oncology 1