Positives

• Yale immunologist Akiko Iwasaki’s landmark Long COVID work identified abnormally low circulating cortisol as the single most highly predictive factor for having Long COVID, supporting an HPA-axis-targeted approach (DHEA, low-dose hydrocortisone) for the deficient subset Health Rising.
  
  

Negatives

• DHEA converts to both testosterone and estradiol, so unmonitored supplementation can cause acne, oily skin, hair loss in women (androgenic), or breast tenderness and mood changes (estrogenic) — effects that vary widely by sex, dose, and baseline hormones Dr Hagmeyer.
  
  

Hurdles & Side Effects

• DHEA is OTC in the US but should be supervised by a clinician familiar with hormone testing; checking baseline DHEA-S, total/free testosterone, and estradiol before starting and at 6-8 weeks helps catch over-conversion early RTHM.
  
  
• Patients with hormone-sensitive cancers (breast, ovarian, prostate) or pregnancy should avoid DHEA entirely; 7-keto DHEA bypasses sex-hormone conversion and may be a safer alternative for patients targeting metabolism and cortisol regulation without androgenic/estrogenic effects RTHM.