Short answer: DHEA (dehydroepiandrosterone) is a hormone made by the adrenal glands that the body converts into small amounts of testosterone and estrogen. As an oral supplement, the evidence in women is mixed at best: large reviews found no improvement in quality of life, inconsistent effects on sexual function and more androgen side effects such as acne. The one FDA-approved form is a prescription vaginal insert (Intrarosa) for painful sex after menopause. If you try DHEA, a clinician should check your levels first and watch for side effects.
What Is DHEA?
The NIH Office of Dietary Supplements describes DHEA as a steroid hormone secreted by the adrenal cortex that the body can convert to testosterone, androstenedione and estradiol. The Intrarosa label calls prasterone (the drug name for DHEA) an inactive steroid that is converted into active androgens and/or estrogens. In other words, DHEA itself does little; its effects come from what your tissues turn it into.
What the Research Shows for Women
Two systematic reviews pooled the randomized trials:
- Cochrane review (2015): 28 trials with 1,273 peri- and postmenopausal women. Compared with placebo, DHEA did not improve quality of life, may have slightly improved sexual function, and was linked to more androgen side effects, mainly acne. Whether it eased menopausal symptoms was unclear because results were inconsistent.
- Mayo Clinic meta-analysis (2014): 23 trials with 1,188 postmenopausal women with normal adrenal function. DHEA was not associated with a significant improvement in libido or sexual function and had no significant effect on cholesterol, blood sugar, weight, BMI or bone density. The authors rated their confidence in the evidence as low.
The Endocrine Society’s guideline on androgen therapy in women recommends against the routine use of DHEA because of limited data on its effectiveness and safety.
DHEA for libido
Results are mixed. The Cochrane review found a small improvement in sexual function across studies, but when it looked only at oral DHEA the effect was not statistically significant. For postmenopausal women with low sexual desire that bothers them (hypoactive sexual desire disorder), the Endocrine Society says the evidence supports the short-term effectiveness and safety of testosterone, not DHEA. See testosterone for women and what has been the best thing after menopause for your libido?
DHEA for vaginal dryness and painful sex
This is where DHEA has the strongest evidence, and it is the vaginal form. Intrarosa is a 6.5 mg vaginal insert used once daily at bedtime. In two 12-week placebo-controlled trials (255 and 558 postmenopausal women), it reduced the severity of painful sex and improved vaginal cell and pH measures. The Menopause Society lists vaginal DHEA as an option for genitourinary symptoms of menopause. Related: what do I do about vaginal atrophy?
DHEA Side Effects for Women
- Androgen effects. The NIH Office of Dietary Supplements notes that months of DHEA use in women significantly raises testosterone, which can cause acne and facial hair growth. Acne was the main side effect in the Cochrane review.
- Limited safety data. The same NIH source says studies have not adequately assessed DHEA’s safety.
- Hormone-sensitive conditions. Because estrogen is a breakdown product, the Intrarosa label notes that estrogen is contraindicated in women with a known or suspected history of breast cancer and that Intrarosa hasn’t been studied in them. The label also says unexplained vaginal bleeding should be evaluated before starting.
- Vaginal insert. The most common side effect of Intrarosa in trials was vaginal discharge (5.7% vs 3.7% on placebo); abnormal Pap smears were reported in 2.1% at 52 weeks.
- Athletes. The NCAA and World Anti-Doping Agency ban DHEA.
Why DHEA Should Be Clinic-Guided
Because DHEA turns into testosterone and estrogen, taking it is a hormone decision, not just a supplement choice. A clinic-guided approach means:
- Checking DHEA-S and related hormone levels before starting, so your provider has a baseline, keeping in mind the Endocrine Society notes that androgen levels in women haven’t been shown to match specific symptoms (see what labs are required for women’s HRT?)
- Matching the goal to the option with the best evidence: The Menopause Society calls hormone therapy the most effective treatment for hot flashes and recommends low-dose vaginal estrogen or vaginal DHEA for dryness and painful sex, and the Endocrine Society supports short-term testosterone for bothersome low desire after menopause
- Rechecking labs and watching for acne, oily skin or unwanted hair if you do use DHEA
DHEA Dosage for Women
There is no FDA-approved oral DHEA product for women, so there is no labeled oral dose; trials used a range of doses and forms. The only labeled dose is for the vaginal insert (6.5 mg once daily at bedtime). Your provider decides whether DHEA makes sense for you and at what dose, based on your labs and goals.
Getting DHEA Through Viking
Viking Alternative Medicine is a national telehealth clinic: visits happen by video or phone, labs are drawn at a local lab near you, and a licensed provider reviews your results before recommending any treatment. Learn more on our DHEA page or browse women’s health and menopause care. Start your online visit.
Frequently Asked Questions
What does DHEA do for women?
DHEA is an adrenal hormone that the body converts into small amounts of testosterone and estrogen. Its effects come from those hormones, which is why it can cause androgen side effects like acne.
Does DHEA help women’s libido?
The evidence is mixed. A Cochrane review found a small improvement in sexual function overall, but not for oral DHEA alone, and a 2014 meta-analysis found no significant improvement. For bothersome low desire after menopause, the Endocrine Society says the evidence supports testosterone.
Does DHEA help with menopause symptoms?
It’s unclear. The Cochrane review couldn’t confirm a benefit for menopausal symptoms because trial results were inconsistent, and it found no improvement in quality of life. Vaginal DHEA (Intrarosa) is FDA-approved for painful sex caused by menopause.
What are the side effects of DHEA for women?
Acne is the most common in trials, and longer use can raise testosterone enough to cause facial hair. Because it converts to estrogen, it needs extra caution with a history of breast cancer.
Is DHEA FDA-approved?
Only as Intrarosa, a prescription vaginal insert for moderate to severe painful sex due to menopause. Oral DHEA is not an FDA-approved drug.
Is DHEA or testosterone better for women?
For postmenopausal women with bothersome low sexual desire, the Endocrine Society says evidence supports short-term testosterone and recommends against routine DHEA use. Your provider can help decide based on your symptoms and labs.
Sources
- Scheffers CS et al. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev. 2015 (PubMed)
- Elraiyah T et al. The benefits and harms of systemic DHEA in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014 (PubMed)
- Wierman ME et al. Androgen therapy in women: a reappraisal. Endocrine Society clinical practice guideline. 2014 (PubMed)
- Intrarosa (prasterone) vaginal inserts prescribing information, DailyMed
- NIH Office of Dietary Supplements: Dietary Supplements for Exercise and Athletic Performance (DHEA section)
- The 2022 hormone therapy position statement of The North American Menopause Society (PubMed)
Medical disclaimer: This article is general education, not medical advice, and it does not create a patient relationship. Prescription medicines are only appropriate after evaluation by a licensed clinician who knows your history and lab results. If you have chest pain, trouble breathing, signs of a blood clot or stroke, or another emergency, call 911.