top of page
Search

Dehydroepiandrosterone (DHEA) Supplementation as an Adjunctive Approach to Supporting Testosterone Levels in Borderline Hypogonadism: A Comprehensive Review - San Antonio Integrative Functional Medici


DHEA for Testosterone Support
DHEA for Testosterone Support

Introduction

Dehydroepiandrosterone (DHEA) is an endogenous steroid hormone produced mainly by the adrenal glands. It serves as a precursor to both androgens (e.g., testosterone) and estrogens, making it a key player in hormonal balance. Interest in DHEA supplementation has grown within functional and integrative medicine, especially for managing borderline hypogonadism—a state in which testosterone levels are at the low end of normal but not frankly deficient.

Men with borderline hypogonadism often report fatigue, low libido, reduced muscle mass, and diminished vitality. For these patients, physicians are exploring whether DHEA might offer a safer and more physiologic alternative to full testosterone replacement. This article reviews the mechanisms, clinical evidence, dosing strategies, and safety profile of DHEA, with insights from meta-analyses and randomized controlled trials.


Mechanism of Action

DHEA acts primarily as a prohormone, converting into testosterone, dihydrotestosterone (DHT), or estrogens through enzymatic pathways such as 3β-hydroxysteroid dehydrogenase and 17β-hydroxysteroid dehydrogenase.

  • Age-related decline: DHEA levels peak in the 20s and decline steadily thereafter, mirroring reductions in testosterone.

  • Restorative potential: Supplementing DHEA may help restore hormonal balance without directly suppressing the hypothalamic-pituitary-gonadal (HPG) axis, a risk sometimes seen with testosterone therapy.

  • Tissue-specific conversion: Because conversion happens in peripheral tissues, DHEA may provide a subtler, more individualized effect compared with exogenous testosterone.


Clinical Evidence on DHEA and Testosterone

Research findings on DHEA’s effects are nuanced but overall promising:

  • Meta-analyses: A dose-response meta-analysis found that oral DHEA significantly increases serum testosterone, with effects most pronounced at >50 mg daily. Gains were evident in both men and women, with women experiencing larger relative increases. [2]

  • Middle-aged men: Short-term dosing (50 mg) elevated free testosterone during high-intensity exercise and blunted post-exercise declines. [7]

  • Older men: Trials with 100 mg/day for six months restored DHEA-S and modestly increased testosterone, though effects were less dramatic than in women. [5]

  • Younger men: Resistance-trained young men saw little to no benefit in testosterone or muscle adaptation.

  • Long-term outcomes: A two-year study in elderly men showed no major testosterone increase with DHEA alone but noted additive effects when combined with testosterone therapy. [9]

Beyond hormone levels, DHEA has been associated with improvements in libido, erectile function, lean muscle mass, and fat reduction, especially in individuals with age-related decline.


Dosing Recommendations

Dosing must be individualized, but clinical studies provide useful guidance:

  • Common range: 25–100 mg per day.

  • Effective threshold: >50 mg daily is more consistently linked with testosterone elevation.

  • Men with borderline hypogonadism: Start with 25–50 mg once daily, titrating up to 100 mg under medical supervision if needed.

  • Monitoring: Serum DHEA-S, testosterone, and estrogen should be checked every 3–6 months to avoid supraphysiological levels.


Safety Profile and Side Effects

DHEA is generally safe for up to two years at doses ≤50 mg/day. Reported side effects include:

  • Mild: Acne, oily skin, hair changes, gastrointestinal upset, mood swings.

  • Hormonal imbalance: Excess estrogen/testosterone may lead to gynecomastia in men or virilization in women.

  • Cautions: Avoid combining with testosterone therapy due to the risk of androgen excess. Use caution in patients with prostate disease, hormone-sensitive cancers, or cardiovascular risk.

Because long-term data are limited, regular lab monitoring and individualized dosing remain essential.


Conclusion

DHEA supplementation offers a potential middle ground between doing nothing and initiating full testosterone replacement in men with borderline hypogonadism. Evidence supports dose-dependent increases in testosterone, particularly at doses above 50 mg, with additional benefits for sexual health and body composition.

However, responses vary, and safety concerns underscore the importance of personalized treatment plans, routine monitoring, and physician oversight. While not a replacement for testosterone therapy in all cases, DHEA is a valuable adjunct in functional medicine approaches to age-related hormonal decline.

Further large-scale, long-term studies are needed to refine clinical guidelines and establish safety profiles for broader use.


Edited by Yoon Hang Kim MD

Virtual Integrative Functional Medicine - serving IA, IL, MO, FL, GA, and TX


References

  1. He, S., et al. (2025). Impact of DHEA supplementation on testosterone and estradiol levels in postmenopausal women: A meta-analysis of randomized controlled trials assessing dose and duration effects. Diabetology & Metabolic Syndrome, 17(1), 258. https://doi.org/10.1186/s13098-025-01770-0

  2. Li, Y., et al. (2020). A dose-response and meta-analysis of dehydroepiandrosterone (DHEA) supplementation on testosterone levels. Experimental Gerontology, 141, 111110. https://doi.org/10.1016/j.exger.2020.111110

  3. Elraiyah, T., et al. (2020). Impact of DHEA supplementation on testosterone concentrations and BMI in elderly women: A meta-analysis. Complementary Therapies in Medicine, 53, 102620. https://doi.org/10.1016/j.ctim.2020.102620

  4. Smith, T., & Batur, P. (2021). Prescribing testosterone and DHEA: The role of androgens in women. Cleveland Clinic Journal of Medicine, 88(1), 35-44.

  5. Walther, A., & Seuffert, J. (2020). Testosterone and dehydroepiandrosterone treatment in ageing men: Are we all set? World Journal of Men's Health, 38(2), 178-190. https://doi.org/10.5534/wjmh.190006

  6. Therapeutic Research Center. (2024). DHEA. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-331/dhea

  7. Liu, T.-C., et al. (2013). Effect of acute DHEA administration on free testosterone in middle-aged and young men following high-intensity interval training. European Journal of Applied Physiology, 113(7), 1783-1792. https://doi.org/10.1007/s00421-013-2607-x

  8. Mayo Clinic. (2025). Dehydroepiandrosterone (DHEA). https://www.mayoclinic.org/drugs-supplements-dhea/art-20364199

  9. Villareal, D. T., & Holloszy, J. O. (2004). Effect of DHEA on abdominal fat and insulin action in elderly women and men: A randomized controlled trial. JAMA, 292(18), 2243-2248. https://doi.org/10.1001/jama.292.18.2243

 
 
 

Comments

bottom of page