Dehydroepiandrosterone (DHEA) is an endogenous steroid hormone produced primarily by the adrenal glands. It functions as a precursor, or “prohormone,” to more potent sex hormones like estrogen and testosterone. DHEA levels naturally peak in early adulthood and then steadily decline with age, reaching only 10% to 20% of their peak by the time a woman reaches her 70s. This significant age-related decline has led researchers to investigate DHEA supplementation as a potential way to mitigate some effects of aging and hormone-related changes, particularly those experienced during and after menopause.
DHEA’s Role in Hormone Production
DHEA is not an active hormone itself but acts as a reservoir from which the body can synthesize sex steroids, a process known as intracrinology. After it is produced in the adrenal glands, DHEA travels to various peripheral tissues, where specific enzymes convert it into androgens and estrogens. This conversion is localized and tissue-specific, meaning the final active hormone is produced and acts within the same cell without significant release into the general bloodstream.
The amount of DHEA converted into either estrogen or testosterone depends on the individual’s specific biochemistry and the enzyme activity within the target tissue. Oral DHEA supplementation results in a more widespread and less controlled conversion compared to localized applications. This systemic administration leads to significant increases in circulating levels of DHEA-sulfate and testosterone, which contribute to its potential effects on the body. The unique mechanism of DHEA as a precursor is the central rationale for its use in women experiencing menopausal hormone decline.
Targeted Symptom Relief
The effectiveness of DHEA for menopausal symptoms depends heavily on the method of administration. Systemic oral DHEA supplementation has shown inconsistent results across various studies regarding overall well-being, mood, and general menopausal symptoms, such as hot flashes and night sweats. Current research does not support a consistent benefit for these common vasomotor symptoms with oral DHEA.
Oral DHEA may offer a modest improvement in sexual function, including increased libido, compared to a placebo, although the evidence remains mixed. The most compelling clinical evidence for DHEA use in menopause is with the localized, prescription-only vaginal insert, Prasterone. This low-dose product is specifically approved to treat moderate to severe pain during intercourse, a symptom of the Genitourinary Syndrome of Menopause (GSM).
The localized vaginal application is effective because DHEA is converted directly into estrogen and testosterone within the vaginal tissues. This leads to improvements in vaginal dryness, tissue integrity, and reduced pain, with a minimal increase in systemic hormone levels. This targeted delivery successfully addresses the local tissue changes associated with GSM.
Safety Profile and Side Effects
Because oral DHEA is a prohormone that converts into more potent androgens, the most common side effects are related to the resulting increase in male hormones. These androgenic effects are dose-dependent and include acne breakouts, oily skin (seborrhea), unwanted facial hair growth (hirsutism), and, less commonly, a slight deepening of the voice.
More serious concerns exist regarding the systemic use of oral DHEA, especially with higher doses or long-term administration. DHEA may negatively impact the cardiovascular profile by lowering high-density lipoprotein (HDL) cholesterol, which warrants caution for individuals with pre-existing heart conditions. DHEA can also affect liver function, and its use is contraindicated in individuals with liver disease.
The most significant risk involves hormone-sensitive cancers, such as breast, ovarian, or uterine cancers. Since DHEA can be converted into estrogen, it may potentially stimulate the growth of these malignancies. Therefore, individuals with any history of hormone-sensitive cancer should avoid DHEA supplementation, which underscores the necessity of professional medical guidance before starting any form of DHEA.
Important Considerations Before Use
While prescription vaginal DHEA (Prasterone) is regulated and approved for GSM, oral DHEA is widely available in the United States as an over-the-counter dietary supplement. This OTC status means that oral DHEA is not subject to the same strict manufacturing and purity standards as pharmaceuticals. Studies have found significant variability in the quality of OTC DHEA products, with some containing substantially less DHEA than claimed on the label.
Due to its hormonal activity and potential for side effects, DHEA should never be taken without consulting a healthcare provider. For systemic oral DHEA, medical monitoring is necessary to ensure safe delivery and dosing. This monitoring typically involves periodic blood tests, specifically checking levels of DHEA-sulfate (DHEA-S), to confirm levels remain within a safe, physiologic range.
In contrast, the localized vaginal DHEA insert is designed to deliver DHEA directly to the vaginal tissue with minimal systemic absorption. The decision to use any form of DHEA must be based on a thorough medical assessment, including a review of personal and family history of hormone-sensitive conditions.