Dehydroepiandrosterone (DHEA) is a steroid hormone precursor synthesized by the adrenal glands and the ovaries. This hormone serves as a building block for producing potent sex hormones, including testosterone and estrogen. DHEA levels peak in early adulthood and then steadily decline with age. This age-related reduction is linked to diminished ovarian reserve (DOR) and decreased egg quality in women attempting to conceive. For those facing fertility challenges, understanding an optimal DHEA level is crucial for optimizing the chances of a successful pregnancy.
How DHEA Influences Egg Quality
DHEA’s positive influence on egg quality is linked to its function as a precursor to androgens, such as testosterone, within the ovarian environment. Although often considered a male hormone, testosterone plays a role in the early stages of follicular development in women. Adequate androgen levels create a supportive microenvironment within the ovary, which enhances the growth and survival of developing follicles.
The process of egg maturation begins months before the egg is ready for ovulation or retrieval, specifically in the pre-antral and early antral follicle stages. DHEA supplementation helps to increase the concentration of androgens in the ovaries, which is hypothesized to recruit a healthier cohort of follicles for maturation. This improved hormonal balance supports better ovarian function and response to fertility treatments.
Furthermore, DHEA may positively affect the integrity of the egg itself. It is believed to improve mitochondrial function within the egg cells, which are the energy-producing centers. Better mitochondrial health is associated with reduced aneuploidy, or chromosomal abnormalities, in the developing eggs and embryos. By addressing this aspect of egg health, DHEA can potentially improve embryo quality and lower the risk of miscarriage, particularly in women diagnosed with DOR.
Understanding DHEA Testing and Measurement
To determine an individual’s DHEA status, a blood test is performed. The specific form measured by medical professionals is DHEA-Sulfate (DHEA-S), which is the sulfated form of DHEA. DHEA-S is preferred for testing because it is significantly more stable in the bloodstream and its levels fluctuate less throughout the day than unconjugated DHEA.
The results of this blood test are most commonly reported in micrograms per deciliter (\(\mu\)g/dL). Standard reference ranges for DHEA-S are often very broad and differ depending on the patient’s age and the specific laboratory conducting the analysis.
When testing DHEA-S levels, the timing can be relevant, especially if a patient is already taking a DHEA supplement. Some protocols recommend testing in the morning, as DHEA-S levels can be highest then, and temporarily pausing supplementation for a few days before the blood draw to ensure accurate baseline or monitoring results. While the standard reference range indicates general adrenal health, the goal for fertility optimization is to reach a specific therapeutic level, which is distinct from the typical non-fertility “normal” range.
Target DHEA Levels for Fertility Success
For women seeking to optimize fertility, particularly those with diminished ovarian reserve, the goal is to achieve a DHEA-S level that is often higher than the general population’s “normal” range. This higher concentration is referred to as the therapeutic range and is intended to maximize the androgen-rich environment necessary for healthy follicular development. While there is no single, universally agreed-upon “good” level, many reproductive endocrinologists aim for a DHEA-S level in the range of 180 to 250 \(\mu\)g/dL.
Some studies have suggested that aiming for DHEA-S levels that mimic a woman in her mid-twenties could be beneficial, though this higher range is often debated. A level of DHEA-S below approximately 180 \(\mu\)g/dL may suggest a potential benefit from supplementation, especially if total testosterone levels are also low. Conversely, DHEA-S levels that are too high can carry risks, necessitating a careful, individualized approach to treatment.
The precise target level is highly individualized and must be determined by a reproductive endocrinologist based on the patient’s age, specific diagnosis, and overall hormonal profile. The therapeutic goal is to elevate the level enough to support ovarian function without causing significant androgenic side effects. Due to the potent nature of DHEA as a hormone precursor, this optimization process requires continuous professional supervision and regular monitoring of DHEA-S and other related hormones, like testosterone.
Guidance on DHEA Supplementation
If testing reveals a DHEA-S level below the desired therapeutic range, supplementation may be recommended to improve fertility outcomes. The most commonly adopted dosage is 75 mg of micronized DHEA daily. This dose is typically divided into three separate 25 mg doses taken throughout the day to maintain a stable concentration of the hormone in the bloodstream.
DHEA is not a quick-fix measure, as its effects align with the long maturation cycle of an egg. It is generally recommended that women supplement for a minimum duration of 6 to 12 weeks, with benefits often peaking after three to four months of consistent use. This extended pretreatment period ensures that the developing egg follicles are exposed to the optimized hormonal environment during their entire growth phase.
Because DHEA is converted into androgens, supplementation must be closely monitored for potential side effects. Common androgenic effects can include oily skin and acne, or more pronounced changes such as increased facial hair growth or a slight deepening of the voice. Ongoing monitoring of DHEA-S and testosterone blood levels is necessary to ensure the dosage is effective without causing adverse hormonal imbalances.