DHEA Replacement Therapy in Women with Adrenal Insufficiency
Dosage Guidelines
- The recommended DHEA dosage for women with primary adrenal insufficiency (PAI) is 25 mg as a single daily dose, guided by serum DHEA sulfate, androstenedione, and testosterone levels to maintain them within normal range 1, 2, 3
- DHEA replacement is indicated for women with PAI who experience persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement 1
- The dosage range is 10-50 mg daily, with 25 mg being the most common starting dose 1, 3
Monitoring and Duration of Treatment
- A 6-month trial of DHEA replacement is recommended for women with PAI before determining long-term use 1, 3
- Treatment effect should be evaluated after 3-6 months 4, 5
- DHEA therapy should possibly be limited to 24 months due to limited long-term safety data 4, 5
Laboratory Monitoring
- Morning serum DHEA sulfate, androstenedione, and testosterone levels should be monitored to maintain them in the normal range 1, 3
- Blood samples should be taken in the morning prior to DHEA ingestion 1
Safety Considerations and Side Effects
- DHEA is generally contraindicated in breast cancer survivors 4
- Women with BRCA1/2 mutations without personal history of breast cancer may consider DHEA after prophylactic bilateral salpingo-oophorectomy 4
- For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy is preferred over DHEA 4