Dehydroepiandrosterone (DHEA) is a steroid hormone naturally produced primarily by the adrenal glands, with smaller amounts coming from the ovaries. This substance functions as a precursor, meaning the body converts it into other hormones, including testosterone and estrogen. In reproductive medicine, DHEA is used as a supplement to potentially enhance ovarian function and improve the quality of eggs in women facing specific fertility challenges. It is not a medication, but a supplement that requires careful medical guidance due to its hormonal activity.
DHEA’s Targeted Use in Ovarian Health
DHEA is recommended for women diagnosed with diminished ovarian reserve (DOR) or those who have responded poorly to previous In Vitro Fertilization (IVF) cycles. The proposed mechanism centers on DHEA’s conversion into androgens, such as testosterone, within the ovarian environment. Adequate androgen levels are necessary during the early stages of follicular development, the process where eggs mature inside the ovary.
By increasing local androgen levels, DHEA may upregulate androgen receptors on the granulosa cells of small, growing follicles. This increase in receptor activity is hypothesized to improve the follicle’s sensitivity to Follicle-Stimulating Hormone (FSH). Some studies suggest that DHEA supplementation may enhance the function of mitochondria within the egg cells, potentially leading to better egg quality and fewer chromosomal abnormalities.
Establishing the Correct Dosing Protocol
The standard clinical dosing protocol used in most fertility studies is 75 milligrams (mg) per day of micronized DHEA. This daily dose is typically divided into three separate 25 mg administrations, taken in the morning, midday, and evening, to maintain a more consistent level in the bloodstream. However, the precise amount must be highly individualized and determined by a Reproductive Endocrinologist.
DHEA’s effectiveness is not immediate, as it must influence the early stages of follicle development, a process that takes several weeks. Specialists recommend taking the supplement consistently for 6 to 16 weeks before an IVF cycle is initiated. Titration, or adjusting the dose based on follow-up blood work, is necessary to ensure DHEA-S and testosterone levels remain within a target range.
Self-dosing with DHEA is discouraged because it is a potent hormone precursor, not a general vitamin. The dosage must be carefully managed to avoid excess androgen production, which could negatively impact the final stages of egg development, requiring direct supervision from a fertility specialist.
Potential Side Effects and Safety Warnings
DHEA side effects are primarily dose-dependent and related to increased androgen activity. The most frequently reported symptoms include oily skin and acne. Some women may notice mild hair loss on the scalp or an increase in body or facial hair, a condition known as hirsutism.
Less common side effects include a deepening of the voice, irregular menstrual cycles, and changes in mood or increased irritability. These androgenic effects are usually reversible if the dosage is lowered or if the supplement is discontinued. Individuals must inform their physician immediately if they experience any of these signs.
DHEA is not appropriate for everyone. Individuals with a history of hormone-sensitive cancers, such as breast, uterine, or ovarian cancer, must avoid DHEA because it can increase estrogen levels. It is also contraindicated for people with certain conditions like liver disease or Polycystic Ovary Syndrome (PCOS), as the latter is often associated with naturally elevated androgen levels. DHEA is sold as a dietary supplement and is not approved by the Food and Drug Administration (FDA) for the treatment of infertility.
Essential Medical Guidance and Testing
Before starting DHEA, a baseline blood test is necessary to measure the initial levels of DHEA-sulfate (DHEA-S) and total testosterone. DHEA-S is the sulfated, more stable form of the hormone, making it a reliable marker. Monitoring these levels allows the specialist to ensure the dosage is appropriate and prevents excessive androgen elevation.
Only use a pharmaceutical-grade, micronized form of DHEA. The supplement industry is not strictly regulated, and the potency and purity of over-the-counter DHEA products can vary significantly. Using a high-quality product minimizes the risk of inconsistent or contaminated doses.
DHEA supplementation must be discontinued immediately upon a confirmed pregnancy, as its effects on the developing fetus are not fully understood. Regular communication and follow-up testing with a Reproductive Endocrinologist is the safest approach for fertility support.