학술논문
Should Dehydroepiandrosterone Be Administered to Women?
Approach to the Patient
Approach to the Patient
Document Type
Academic Journal
Source
Journal of Clinical Endocrinology & Metabolism. June 2022, Vol. 107 Issue 6, p1679, 7 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Physiology of Androgen Prohormones: DHEA and Androstenedione The pathway of adrenal steroidogenesis is reviewed in Fig. 1. Importantly, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), and androstenedione are not themselves androgens but [...]
Context: Androgen prohormones such as dehydroepiandrosterone (DHEA) increase in early puberty, peak in the second and third decade, and thereafter decline, independent of menopausal status. Investigators have examined their potential beneficial effects in normal women and those with DHEA-deficient states. Evidence Acquisition: A review of the literature from 1985 to 2021 on the potential benefits and risks of androgen prohormones in women Evidence Synthesis: Studies have examined the potential benefit of DHEA therapy for anti-aging, sexual dysfunction, infertility, metabolic bone health, cognition, and wellbeing in hormone-deficient states such as primary adrenal insufficiency, hypopituitarism, and anorexia as well as administration to normal women across the lifespan. Conclusions: Data support small benefits in quality of life and mood but not for anxiety or sexual function in women with primary or secondary adrenal insufficiency or anorexia. No consistent beneficial effects of DHEA administration have been observed for menopausal symptoms, sexual function, cognition, or overall wellbeing in normal women. Local administration of DHEA shows benefit in vulvovaginal atrophy. Use of DHEA to improve induction of ovulation response in women with diminished ovarian reserve is not recommended. Risks of high physiologic or pharmacologic use of DHEA include androgenic and estrogenic side effects which are of concern for long-term administration. Clinical Case: A 49-year-old woman with Addison's disease who is on low dose estrogen with cyclic progesterone therapy for menopausa symptoms returns for follow-up. She is on a stable glucocorticoid replacement strategy of hydrocortisone 10 mg in the morning and 5 mg in the early afternoon and fludrocortisone 0.05 mg each morning. She has read on the internet that additional therapy with DHEA may help her overal quality of life and libido. She asks whether she should add this therapy to her regimen and at what dose. Key Words: DHEA, androstenedione, testosterone, hormonal therapies
Context: Androgen prohormones such as dehydroepiandrosterone (DHEA) increase in early puberty, peak in the second and third decade, and thereafter decline, independent of menopausal status. Investigators have examined their potential beneficial effects in normal women and those with DHEA-deficient states. Evidence Acquisition: A review of the literature from 1985 to 2021 on the potential benefits and risks of androgen prohormones in women Evidence Synthesis: Studies have examined the potential benefit of DHEA therapy for anti-aging, sexual dysfunction, infertility, metabolic bone health, cognition, and wellbeing in hormone-deficient states such as primary adrenal insufficiency, hypopituitarism, and anorexia as well as administration to normal women across the lifespan. Conclusions: Data support small benefits in quality of life and mood but not for anxiety or sexual function in women with primary or secondary adrenal insufficiency or anorexia. No consistent beneficial effects of DHEA administration have been observed for menopausal symptoms, sexual function, cognition, or overall wellbeing in normal women. Local administration of DHEA shows benefit in vulvovaginal atrophy. Use of DHEA to improve induction of ovulation response in women with diminished ovarian reserve is not recommended. Risks of high physiologic or pharmacologic use of DHEA include androgenic and estrogenic side effects which are of concern for long-term administration. Clinical Case: A 49-year-old woman with Addison's disease who is on low dose estrogen with cyclic progesterone therapy for menopausa symptoms returns for follow-up. She is on a stable glucocorticoid replacement strategy of hydrocortisone 10 mg in the morning and 5 mg in the early afternoon and fludrocortisone 0.05 mg each morning. She has read on the internet that additional therapy with DHEA may help her overal quality of life and libido. She asks whether she should add this therapy to her regimen and at what dose. Key Words: DHEA, androstenedione, testosterone, hormonal therapies