DHEA Supplementation

An adrenal steroid that declines with age

Dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) are adrenal steroids whose secretion and blood levels decrease profoundly with age, according to a 2000 report from a French research group led by Etienne-Emile Baulieu. The report framed the central question of the field: whether giving the steroid to compensate for that decline counteracts defects associated with ageing. A later review describes DHEA and DHEAS as the most abundant circulating steroid hormones in humans.

From animal findings to a consumer supplement

A 2014 review in the journal Drugs states that animal studies linked low DHEA levels with age-related changes, including reduced lifespan, and that extrapolating from animals turned DHEA into a so-called superhormone and an anti-ageing panacea. The same review reports that it was aggressively marketed and sold in large quantities as a dietary supplement. The Baulieu report likewise described its commercial availability in the United States outside the regular pharmaceutical and medical network as a public health problem that long-term clinical trials in older adults might resolve.

The sources reviewed do not give a dated account of when DHEA first reached the supplement market. A National Institutes of Health fact sheet states that the United States regulates dietary supplements under the Dietary Supplement Health and Education Act of 1994, which does not require premarket review or approval by the Food and Drug Administration. That page describes this for performance supplements in general and does not itself trace DHEA's classification.

The vaginal product

Intravaginal prasterone is a separate, later development. A 2018 review reports that prasterone, the synthetic equivalent of endogenous DHEA, was approved by the US Food and Drug Administration for moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy due to menopause. A 2022 appraisal states that intravaginal DHEA was licensed in the European Union in 2018 for moderate to severe vulvovaginal atrophy in postmenopausal women.

Names and chemical forms

DHEA is the common abbreviation for dehydroepiandrosterone, a steroid hormone secreted by the adrenal cortex. DHEAS is its sulfated form, which the Baulieu report describes as the sulfate ester that also declines with age. The NIH Office of Dietary Supplements notes that the body can convert DHEA into testosterone, androstenedione and estradiol, which is why sources describe it as a hormone precursor rather than an end hormone.

Prasterone is the drug name used for the synthetic equivalent of endogenous DHEA when it is supplied as a licensed vaginal product. The Mayo Clinic describes the supplement version as synthetic DHEA sold as a tablet, capsule, powder, topical cream or gel. The two uses differ in route, setting and regulation, so findings for one are not carried to the other on this page.

Related Machipedia pages

This page is a member of the Machipedia family page Hormone Replacement Therapy, which covers menopausal estrogen with or without progestogen, testosterone therapy and compounded preparations; this page does not repeat that material. Related Machipedia pages include Low-Dose Vaginal Estrogen, Testosterone Therapy in Women, Nutritional Therapy and Peptide Therapy. The 2022 Menopause Society statement discusses vaginal DHEA alongside vaginal estrogen, which is why the vaginal pages sit close together.

The nonprescription supplement

In the United States DHEA is sold as a dietary supplement that people can obtain without a prescription. The NIH Office of Dietary Supplements states that such products differ from medications in not requiring premarket review or approval by the Food and Drug Administration, and that manufacturers are responsible for determining that their products are safe and their label claims truthful. Mayo Clinic staff list the reasons people use it as an antiaging treatment, better physical performance, depression and symptoms of menopause.

The licensed vaginal product

Prasterone is placed in the vagina and acts locally. A 2022 appraisal describes intravaginal DHEA as a locally metabolized estrogen and androgen precursor, and the 2018 review reports that serum hormone levels stayed within the range seen in normal postmenopausal women in the development trials. The sources reviewed do not describe how it is applied in practice, and this page does not give regimens.

Who delivers it

The supplement is usually chosen by the consumer, sometimes with advice from a clinician, and the sources reviewed describe no register, protected title or training standard specific to DHEA supplementation. The vaginal product is prescribed within gynecologic and menopause care. The Menopause Society, a professional body, lists vaginal DHEA among therapies for genitourinary symptoms of menopause in a 2022 consensus statement. No other professional-body statement on DHEA could be opened and verified for this page.

Ageing and well-being

The most common claim for DHEA supplements is that restoring the declining hormone slows features of ageing. Mayo Clinic describes the theory that maintaining DHEA levels could improve well-being, thinking skills and body composition, and states that research has not shown this to be true so far. The 2014 Drugs review notes that some placebo-controlled studies reported effects on well-being, muscle strength, bone density and skin, and that results were inconsistent across studies.

Other uses sources list

Mayo Clinic lists depression, osteoporosis, vaginal dryness in postmenopausal women when treated through the vagina, and physical performance among the uses it assessed, and says DHEA might eventually be shown to help in certain conditions such as adrenal insufficiency and lupus but that further studies are needed. The NIH Office of Dietary Supplements assessed DHEA for exercise and athletic performance and found no evidence of benefit. These are claims that people make and that sources assessed, not established uses.

Older adults

A 2006 randomized trial in the New England Journal of Medicine gave DHEA or placebo for two years to 57 older women and 87 older men with low DHEAS levels, with testosterone as an additional arm in men. Women had a bone density increase at one site, the ultradistal radius. The authors concluded that neither DHEA nor low-dose testosterone had physiologically relevant benefits on body composition, physical performance, insulin sensitivity or quality of life, and reported no major adverse effects.

Other trials gave mixed signals. The Baulieu group's one-year placebo-controlled study of 280 healthy people aged 60 to 79 reported small increases in testosterone and estradiol, improved bone turnover in women over 70, and its authors concluded there was no harmful accumulation of steroids. A six-month trial in 99 frail women, all in an exercise program, found gains in lower-extremity strength but no change in bone density. A Cochrane review of cognition in healthy older people found the little controlled evidence did not support a benefit.

Menopause and vaginal use

A Cochrane review of DHEA in peri- and postmenopausal women pooled trials of any route and dose. It found no evidence of improved quality of life, uncertainty about menopausal symptoms, and a small gain in sexual function versus placebo. A 2024 systematic review of 46 trials of hormonal treatments for genitourinary symptoms found, with low certainty, that vaginal DHEA may improve dryness, dyspareunia and distress, while systemic DHEA may provide no benefit.

An independent appraisal of four vaginal DHEA trials noted that benefit over placebo was small: in two trials the additional reduction in dyspareunia was 0.4 points on a three-point scale. The authors described the outcome measures as unvalidated and the follow-up as short.

The Menopause Society's 2022 statement lists vaginal DHEA among other therapies for bothersome genitourinary symptoms in women without an indication for systemic hormone therapy; the abstract does not describe the trial evidence behind that listing.

Adrenal insufficiency, lupus and assisted reproduction

A systematic review of ten randomized trials in women with adrenal insufficiency found a small effect on quality of life (effect size 0.21), which the authors called perhaps trivial, and judged the evidence insufficient to support routine use. A Cochrane review of seven trials (842 participants) in systemic lupus erythematosus found little effect on disease activity, a modest short-term quality-of-life gain and about double the rate of acne.

A 2024 Cochrane review of androgens in assisted reproduction included 28 trials, mostly in women identified as poor responders to standard IVF protocols. For DHEA versus placebo or no treatment it found likely little to no difference in live birth or ongoing pregnancy (odds ratio 1.30, 95 percent confidence interval 0.95 to 1.76, moderate certainty); an earlier 2015 version had reported higher live birth rates that lost significance when trials at high risk of bias were removed.

Adverse effects reported

Sources agree on androgenic effects. The Cochrane review in menopausal women found acne more common with DHEA than placebo (odds ratio 3.77), the lupus review found the risk of acne roughly doubled, and the NIH Office of Dietary Supplements states that months of use in women raises serum testosterone but not estrogen, which can cause acne and growth of facial hair. Mayo Clinic adds oily skin and male-pattern hair growth in women and says DHEA might lower HDL cholesterol.

The same sources caution about knowledge gaps. The NIH page states that studies have not adequately assessed the safety of DHEA, and the 2024 systematic review noted that trials of vaginal DHEA were short and underpowered to detect infrequent serious harms. The two-year trial in older adults reported no major adverse effects, but trial populations were small and selected.

Contraindications and interactions

Mayo Clinic advises that people with a hormone-sensitive cancer should not use DHEA, and states that high doses or long use might raise the risk of hormone-sensitive cancers such as prostate and breast cancer, though more research is needed. It also advises against use in pregnancy or breastfeeding, suggests considering avoidance with high cholesterol or ischemic heart disease, and reports that DHEA might worsen mental health conditions and raise the risk of mania in people with mood disorders. It lists interactions with estrogen, testosterone, certain antidepressants and triazolam. Its overall summary is to avoid the supplement.

Quality, oversight and sport

Mayo Clinic states that studies have shown quality control of this supplement to often be low. The NIH Office of Dietary Supplements states that supplements are not reviewed or approved by the Food and Drug Administration before sale, and that manufacturers decide whether their products are safe. The sources reviewed give no product-testing data that could be verified here, and this page does not name products or brands.

The NIH fact sheet states that the National Collegiate Athletic Association and the World Anti-Doping Agency ban DHEA, citing their 2016 lists, and that research does not support taking DHEA supplements to enhance exercise or athletic performance. Athletes subject to testing would need to check current lists directly.

Care boundary

Menopausal symptoms, adrenal insufficiency, lupus and infertility are conditions managed within conventional medical care. The sources reviewed describe DHEA supplementation as uncertain for these conditions outside the vaginal product, and nothing on this page should delay or replace assessment or treatment by a qualified clinician. The Menopause Society statement and the Cochrane reviews each treat the supplement and the licensed product separately, and their findings are not interchangeable.