Is DHEA (Dehydroepiandrosterone) supplementation effective for treating decreased libido in females?

DHEA Supplementation for Decreased Libido in Females

DHEA supplementation can be effective for treating decreased libido in females, particularly in those with adrenal insufficiency, postmenopausal women, and women with sexual disorders and low libido. 1

Effectiveness of DHEA for Female Sexual Dysfunction

Evidence for DHEA Use

• DHEA can be offered as a treatment option for female patients with persistent lack of libido and/or low energy levels, typically at doses of 10-50 mg daily (often 25 mg as a single daily dose) 2
• DHEA supplementation has shown significant improvements in sexual desire, arousal, pain, and overall sexual function in clinical trials involving female cancer survivors 2
• In women with adrenal insufficiency, DHEA replacement has been associated with increased sexual thoughts and fantasies as well as enhancement in mood and well-being 3
• DHEA supplementation appears particularly effective in women over age 70, where it has been linked to increased libido and enhanced sexual satisfaction 3

Physiological Basis

• DHEA and DHEAS are the most abundant circulating sex steroid hormones in women, providing a precursor reservoir for the production of androgens and estrogens 4
• DHEA levels naturally decline with age, with levels at 70-80 years being only 10-20% of those in young adults 5
• In women but not men, increased DHEAS levels from supplementation facilitate additional production of downstream androgens including testosterone, which is important for female sexual function 3

Recommended Dosing and Monitoring

Dosing Protocol

• The typical dose range is 10-50 mg daily, with 25 mg being a common starting dose 2
• DHEA should be taken as a single daily dose, preferably in the morning 2
• Treatment efficacy should be guided by monitoring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels 2

Monitoring Parameters

• Serum levels of DHEAS, androstenedione, and testosterone should be maintained in the normal range 2
• These levels should be measured in the morning prior to DHEA ingestion for accurate assessment 2
• A pragmatic approach is to offer a 6-month trial of DHEA replacement, which can be continued if clinically effective 2

Patient Selection

Best Candidates for DHEA Therapy

• Women with adrenal insufficiency (strongest evidence) 4, 1
• Postmenopausal women with sexual disorders and low libido 1
• Women chronically treated with exogenous glucocorticoids 1
• Premenopausal women with sexual disorders and low libido 1

Potentially Beneficial Groups

• Women with vulvovaginal atrophy due to menopause 1
• Postmenopausal women with hypoactive sexual disorders 1
• Women suffering from depression and anxiety 1
• Women with obesity and insulin resistance 1

Safety Considerations

Cautions and Contraindications

• Long-term effects of DHEA replacement therapy in patients are not fully known, so such regimens should be used with caution 2
• DHEA should be used with caution in survivors receiving aromatase inhibitor therapy, as vaginal DHEA increases levels of circulating androgens 2
• The FDA label for prasterone (pharmaceutical DHEA) warns that exogenous estrogens are contraindicated in women with a history of breast cancer 2

Safety Profile

• No serious adverse effects have been reported in clinical trials of DHEA supplementation 1
• However, safety data for long-term DHEA therapy are still lacking 4

Alternative Options for Female Sexual Dysfunction

Other Pharmacological Options

• Flibanserin is FDA-approved for acquired, generalized hypoactive sexual desire disorder in premenopausal women 2
• Ospemifene (a SERM) can be considered for dyspareunia in women without a history of estrogen-dependent cancers 2
• Bupropion and buspirone may be considered for hypoactive sexual desire disorder 2

Non-Pharmacological Approaches

• Pelvic physical therapy (pelvic floor muscle training) may improve sexual pain, arousal, lubrication, orgasm, and satisfaction 2
• Vaginal moisturizers and lubricants can help alleviate symptoms such as vaginal dryness and sexual pain 2
• Integrative therapies, including yoga and meditation, may be helpful for female survivors with sexual dysfunction 2

While DHEA shows promise for treating decreased libido in females, it's important to recognize that the evidence is strongest for women with adrenal insufficiency, and results may vary in other populations. A 6-month trial period is a reasonable approach to determine individual response.