ESPE Yearbook of Paediatric Endocrinology

J Clin Endocrinol Metab. 2022; 107(6): 1679-1685. PMID: 35254428https://pubmed.ncbi.nlm.nih.gov/35254428/

Brief Summary: This review summarizes the evidence on the potential benefits and risks of androgen prohormones, such as dehydroepiandrosterone (DHEA), in normal women and those with DHEA-deficient states.

Physiologically, the concentrations of DHEA and DHEAS increase during adrenarche and throughout puberty, and peak in the late 20s to 30s before declining with age, independent of menopausal status. This narrative review discusses the issues surrounding Dehydroepiandrosterone (DHEA) supplementation, given that DHEA is currently available over the counter or via the internet in many countries, as a supplement outside of the remit of medicines regulatory bodies, such as FDA or EMA. However, quality control of DHEA is inconsistent, while data are lacking on the physiologic dose of this hormone and the benefit of DHEA in women with adrenal insufficiency at any age. In premenopausal women with low DHEAS concentrations, one could argue that DHEA therapy might have potential benefits on wellbeing, understanding that the physiologic dose of DHEA in women is somewhere around 25 and not 50 mg/day. In postmenopausal women, one must consider the additional impact of conversion to testosterone and estradiol to her breast and bone health and the cardiac risks, and discuss the pros and cons of a short-term trial. Long-term supplementation in DHEA deficient states is not well-established, while there is much discussion on DHEA supplementation in non-deficient states. Among the non-deficient states, DHEA supplementation has no clear benefit on anti-aging effects, physical and psychological wellbeing, libido, cognition and perimenopausal symptoms. Other conditions where DHEA supplementation is discussed include anorexia nervosa (where small studies show potential benefits), mood disorders (no suggested benefit), bone health (effects on bone in women are less than estrogen or other FDA-approved osteoporosis medications, and no data available on fracture risk). The studies on the potential metabolic effects, genitourinary symptoms, or infertility have not provided sufficient data to suggest that it should be used consistently.