How DHEA Works
DHEA (dehydroepiandrosterone) functions as a precursor hormone that the body converts into androgens (testosterone) and estrogens, thereby increasing circulating levels of these sex hormones to address symptoms related to hormonal deficiency, particularly in postmenopausal women and those with adrenal insufficiency. 1, 2
Mechanism of Action
DHEA works through hormonal conversion pathways:
DHEA serves as one of the main precursors of androgens, which are subsequently converted to both testosterone and estrogens in peripheral tissues. 3 This conversion mechanism allows DHEA to potentially increase estrogen and testosterone levels in women with declining ovarian function or adrenal insufficiency. 3
The hormone acts to rebalance adrenal and DHEA output in the body, addressing symptoms that arise from hormonal deficiency states. 4
Primary Clinical Applications
For vaginal/vulvar symptoms: DHEA (prasterone) is recommended by the American College of Obstetricians and Gynecologists specifically for treating vaginal dryness and pain with sexual activity in postmenopausal women. 2 When used vaginally, DHEA has demonstrated significant improvements in sexual desire, arousal, pain, and overall sexual function. 2
For sexual dysfunction: DHEA supplementation shows effectiveness in improving sexual function, with studies demonstrating modest but statistically significant benefits (SMD 0.31) compared to placebo. 3 The improvements are more consistent in elderly women than in men, particularly regarding sexual interest and satisfaction. 5
For adrenal insufficiency: DHEA is most appropriate for female patients with primary adrenal insufficiency who exhibit persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement. 1
Dosing and Monitoring
Standard dosing regimen:
- The typical starting dose is 25 mg as a single daily morning dose, with a potential range of 10-50 mg based on clinical response. 1, 2
- For women, the recommended dose is 10-50 mg daily, while men may require 100 mg. 5
Monitoring protocol:
- Treatment efficacy should be guided by monitoring serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels, with measurements taken in the morning prior to DHEA ingestion. 1, 2
- DHEA should be offered as a 6-month trial therapy and continued only if clinically effective in improving symptoms. 1
Safety Profile and Adverse Effects
Common androgenic side effects:
- DHEA is associated with androgenic side effects, primarily acne (OR 3.77), which are frequent but reversible with dose adjustment or discontinuation. 3 Other androgenic effects include greasy skin and increased growth of body hair. 5
Cancer-related concerns:
- The National Comprehensive Cancer Network recommends using DHEA with caution due to potential risks of hormone-dependent cancers. 2 Treatment should be taken under close medical supervision to detect possible hormone-dependent cancers such as breast cancer in women and prostatic cancer in men. 5
- DHEA should be used with particular caution in survivors receiving aromatase inhibitor therapy, as vaginal DHEA increases levels of circulating androgens. 1, 2
- DHEA should not be used by men with breast cancer. 2
Long-term safety:
- Long-term effects of DHEA replacement therapy are not fully known, so treatment should be used with caution. 1, 2
What DHEA Does NOT Do
Quality of life: There is no evidence that DHEA improves overall quality of life in postmenopausal women (SMD 0.16, not statistically significant). 3
Menopausal symptoms: It remains unclear whether DHEA effectively reduces typical menopausal symptoms like hot flushes and night sweats, as trial results are inconsistent and cannot be reliably pooled. 3
Cardiovascular and cognitive benefits: There is no further evidence that DHEA supplementation is useful in the prevention of cardiovascular disease or cognitive impairment. 6
Specific Populations Where DHEA May Be Beneficial
Beyond the primary indications, DHEA supplementation is probably effective in: