Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA.
J Clin Endocrinol Metab. 2022 May 17;107(6):1679-1685. doi: 10.1210/clinem/dgac130.
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.
A review of the literature from 1985 to 2021 on the potential benefits and risks of androgen prohormones in women.
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.
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.
A 49-year-old woman with Addison's disease who is on low dose estrogen with cyclic progesterone therapy for menopausal 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 overall quality of life and libido. She asks whether she should add this therapy to her regimen and at what dose.
雄激素前体如脱氢表雄酮（DHEA）在青春期早期增加，在第二和第三个十年达到峰值，此后下降，与绝经状态无关。研究人员已经研究了它们在正常女性和 DHEA 缺乏状态下的潜在有益作用。
对 1985 年至 2021 年关于女性雄激素前体潜在益处和风险的文献进行了综述。
研究已经研究了 DHEA 治疗在激素缺乏状态下（如原发性肾上腺功能不全、垂体功能减退和厌食症）的抗衰老、性功能障碍、不孕、代谢性骨健康、认知和幸福感的潜在益处，以及在整个生命周期内对正常女性的管理。
数据支持生活质量和情绪的小益处，但对原发性或继发性肾上腺功能不全或厌食症女性的焦虑或性功能没有益处。在正常女性中，DHEA 给药对绝经症状、性功能、认知或整体幸福感没有一致的有益影响。DHEA 的局部给药对阴道萎缩有益。不建议使用 DHEA 来改善卵巢储备减少的女性排卵反应的诱导。高生理或药理使用 DHEA 的风险包括雄激素和雌激素副作用，这是长期给药的关注。
一名 49 岁的女性患有 Addison 病，正在接受低剂量雌激素和周期性孕激素治疗绝经症状，她回来进行随访。她正在接受稳定的糖皮质激素替代治疗方案，即早上服用 10 毫克氢可的松和下午早些时候服用 5 毫克，每天早上服用 0.05 毫克氟氢可的松。她在网上读到，额外使用 DHEA 可能有助于提高她的整体生活质量和性欲。她询问是否应该在她的治疗方案中添加这种治疗方法，以及剂量是多少。
