- 01DHEA is raw material, and your sex decides what it becomes
In women, DHEA is a main source of androgens (testosterone-type hormones), so a DHEA pill raises testosterone, with its benefits and its acne and facial hair. In men the testes already make far more testosterone than DHEA can add, so the extra shows up mainly as DHEA-S and oestrogen. The same pill is a weak androgen for women and mostly an oestrogen source for men.
DHEA (dehydroepiandrosterone) is a hormone your adrenal glands make as raw material for testosterone and oestrogen, and what a DHEA pill becomes depends on your sex. In women it raises testosterone, so women feel androgen effects (the effects of testosterone-type hormones), good and bad. In men it barely moves testosterone and mostly adds DHEA-S and oestrogen. The large trials in healthy older people, the group the 'anti-ageing' marketing targets, came back largely empty 1.
What DHEA is, and why levels fall with age
DHEA is a steroid made mostly in the adrenal glands, the two small glands on top of the kidneys. On its own DHEA does little. Tissues such as fat, skin, bone and the ovaries convert it, through an in-between hormone called androstenedione, into testosterone or oestradiol as they need them. Most DHEA in the blood quickly has a sulfate tag added, making DHEA-S, a stable storage form. That is why a lab report shows DHEA-S rather than DHEA: DHEA itself rises and falls through the day, while DHEA-S holds steady enough to read.
How a DHEA pill turns into sex hormones
DHEA-S peaks in your 20s and then falls steadily. Orentreich and colleagues, measuring DHEA-S across adulthood (J Clin Endocrinol Metab, 1984), found that by the 70s and 80s it is roughly 10 to 20% of its young-adult peak 12. That decline is the whole basis of the anti-ageing pitch: if the hormone falls as we age, putting it back should slow ageing. The trials below tested that idea directly.
Wild yam creams and 'natural DHEA precursors' do not raise DHEA. Wild yam contains diosgenin, which a factory can turn into DHEA, but the human body cannot 15. DHEA in supplements is made in a lab.
What the evidence shows, benefit by benefit
Supplement pages tend to list every benefit as 'may help'. The table grades each claim against the human trials that tested it, including the ones that found nothing. Animal and lab studies are left out; rodents make very little DHEA, so results in mice translate poorly to people.
| Claimed benefit | What human trials found | Grade |
|---|---|---|
| Painful sex and vaginal dryness after menopause (vaginal DHEA) | 12 weeks of a daily vaginal insert improved pain at intercourse and dryness versus placebo; FDA-approved as Intrarosa in 2016 4 | Strong |
| Wellbeing and sexuality in women with adrenal insufficiency | 4 months of DHEA improved wellbeing and sexuality versus placebo 7; the 2016 Endocrine Society guideline suggests a 6-month trial 6 | Some |
| IVF in poor ovarian responders | Cochrane review of 8 trials (878 women): live birth or ongoing pregnancy rose from about 12% to between 15% and 26%, on low-quality evidence 5 | Some, low quality |
| Bone density | Spine density rose in older women over 1 to 2 years, little change in men 8; the 2-year NEJM trial found small gains at the wrist in women and the hip in men 1 | Some (women, spine) |
| Belly fat and insulin action | Positive at 6 months in 56 adults aged 65 to 78 2; no effect at 2 years in the larger NEJM trial 1 | Weak, conflicting |
| Muscle, strength and physical performance | No improvement over 2 years in 144 older men and women 1 | None |
| Midlife depression | Improved in a 46-person trial at high doses 10 | Weak (one small trial) |
| Libido in women with normal adrenal function (oral DHEA) | Meta-analysis: no significant gain, and HDL cholesterol fell slightly 9 | None |
| Skin and libido in women over 70 | DHEAge study of 280 people: small improvements in women over 70, no broad anti-ageing effect 11 | Weak |
| Memory, immunity, energy, 'anti-ageing' | No good human trials show a benefit | None |
If bone density is your worry, osteoporosis covers the scans and blood tests that matter more than DHEA.
The largest and longest trial ran at the Mayo Clinic. Nair and colleagues gave 144 older men and women DHEA or placebo for 2 years and measured body fat, muscle, strength, insulin sensitivity and quality of life 1.
Neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life.Nair KS et al., New England Journal of Medicine, 2006 1
The Villareal trial, which did show less belly fat and better insulin action after 6 months, is real and well run 2. It was smaller and shorter, and the 2-year NEJM trial did not reproduce it. When a small short trial and a large long trial disagree, the large long trial is the better guide.
DHEA for women
Women feel DHEA more than men because, after menopause especially, DHEA is the main source of their androgens. The same conversion that can lift libido in a woman with adrenal insufficiency also causes acne, oily skin and facial hair, and it lowers HDL ("good") cholesterol 9. If low sex drive is what brought you here, low libido covers the other causes and the tests that check them.
For painful sex after menopause, the vaginal form is the one with proof
Doctors' guidelines advise against routine oral DHEA for women, citing limited data on whether it works and whether it is safe 3.
The exception is women with Addison's disease who still have low libido, low mood or low energy once their cortisol and fludrocortisone (a salt-balancing hormone) doses are right. For them the Endocrine Society suggests a 6-month trial of DHEA, and it rates that suggestion weak 6. So if you are wondering how to treat low DHEA levels as a woman: a low DHEA-S alone is not a reason to supplement. It matters when it comes with proven adrenal insufficiency, so the first step is finding out why it is low.
If you are weighing DHEA for menopause or perimenopause symptoms such as hot flushes, sleep or mood, DHEA has no good evidence for those. As our HRT guide puts it, hormone therapy "is the most effective treatment for hot flushes and night sweats", and whether it suits you is a decision to make with your doctor. The menopause hub lists every menopause test in one place. For PCOS, DHEA is usually the wrong direction: many women with PCOS already have high DHEA-S and androgen symptoms, and a supplement adds more.
DHEA for men: does it raise testosterone?
Oral DHEA barely moves testosterone in men. DHEA-S rises sharply while total testosterone changes little, because the testes make far more testosterone than DHEA conversion can add 13. Part of the extra becomes oestrogen instead. The 2-year NEJM trial gave older men DHEA and found no gain in strength, muscle or body fat 1. Extra oestrogen is also the reason some men on DHEA notice tender or swollen breast tissue; see gynecomastia.
If the real worry is low testosterone, the useful first step is a morning total testosterone with SHBG (sex hormone-binding globulin, the protein that holds testosterone in the blood), repeated once, because SHBG decides how much testosterone is free to act. The male hormone panel guide walks through each line.
CalculatorFree testosterone calculatorTurns your total testosterone and SHBG into free testosterone, the part DHEA marketing claims to raise.Work it out DHEA and fertility (IVF)
Fertility clinics sometimes use DHEA before IVF in 'poor responders', women whose ovaries produce few eggs under stimulation. A Cochrane review found DHEA pretreatment was linked to higher live birth or ongoing pregnancy rates in this group, but rated the evidence low quality because the trials were small and some were not well blinded 5. That finding applies to a specific IVF group under a clinic's supervision. It does not support DHEA as general 'fertility support' for women trying naturally, and DHEA is unsafe once pregnant. The fertility hub covers the markers clinics check, starting with AMH.
Side effects and who should not take it
Most DHEA side effects come from the hormones it turns into, so they track how far DHEA-S, testosterone and oestradiol rise. In women the common ones are androgenic: acne, oily skin, scalp hair thinning, new facial or body hair, and a small fall in HDL cholesterol 9. If a blood test on DHEA shows testosterone above range, see high testosterone. In men, breast tenderness or swelling from extra oestrogen is the one to watch. Irritability and, rarely, mania have been reported in both sexes, especially in people with a mood disorder 15; mood swings covers the other causes. Long-term safety beyond 2 years is not known, because the main placebo-controlled trials ran for 2 years at most.
How much DHEA was used in the trials
The table lists what researchers gave in the studies above, so you can read a label or a paper in context. These amounts are not a starting dose. The right amount, if any, depends on your blood levels and on why you would take it, which is a conversation for your doctor.
| Use studied | Amount used in trials | Source |
|---|---|---|
| Healthy older adults | 50 mg women, 75 mg men, daily for 2 years | Nair 2006 1 |
| Belly fat and insulin, ages 65 to 78 | 50 mg daily for 6 months | Villareal 2004 2 |
| Women with adrenal insufficiency | 50 mg daily | Arlt 1999 7; Bornstein 2016 6 |
| IVF poor responders | 25 mg three times daily, usually for weeks before IVF | Cochrane 2015 5 |
| Midlife depression | 90 mg, then 450 mg daily for 6 weeks (a research dose under psychiatric supervision) | Schmidt 2005 10 |
| Painful sex after menopause | 6.5 mg vaginal insert daily | Labrie 2016 4 |
Testing before and while you take it
A blood test is the only way to know whether you started low and whether DHEA has pushed you too high. The useful baseline is DHEA-S plus the hormones DHEA turns into: total and free testosterone with SHBG, and oestradiol. For women, a lipid panel is worth asking about too, because HDL can fall. In the adrenal insufficiency guideline, DHEA-S is rechecked on treatment with the aim of a level in the middle of the normal range for age and sex 6. A DHEA-S well above the young-adult range for your sex means more DHEA than your body would ever make on its own.
If DHEA-S, testosterone or oestradiol comes back above the range for your age and sex while you take DHEA, stop and take the result to your doctor rather than adjusting the dose yourself. A DHEA supplement is one of the most common reasons for a high DHEA-S in women, so stopping it comes before looking for other causes such as PCOS or an adrenal problem. A very high DHEA-S when you are not taking DHEA, especially with fast-developing facial or body hair, a deepening voice or other sudden masculine changes, needs prompt medical review because it can come from an adrenal tumour.
DHEA also changes results you were not testing for. Any DHEA-S, testosterone or oestradiol drawn while you take it will reflect the supplement, so tell whoever orders the test. Supplements that affect blood tests lists the others, and the female hormone panel guide explains each line for women.
Read these beside DHEA
Buying DHEA: labels, legality and sport
- United States: sold over the counter as a dietary supplement. Congress specifically excluded DHEA from the Anabolic Steroid Control Act of 2004, so it is legal to buy without a prescription, and the FDA does not check the product before sale.
- United Kingdom: DHEA is a prescription-only medicine and a Class C controlled drug (listed as an anabolic steroid), so it cannot be sold as a food supplement; possession for personal use is not an offence.
- Sport: DHEA (prasterone) is on the World Anti-Doping Agency prohibited list as an anabolic agent, banned in and out of competition. Tested athletes can fail a test from an over-the-counter bottle.
- Label accuracy: when Parasrampuria and colleagues tested DHEA products, contents ranged from 0% to 150% of the stated amount 14. A third-party seal (USP Verified or NSF) is the closest thing to a check.
- 7-keto DHEA is a different molecule. It does not convert into testosterone or oestrogen, so none of the hormone evidence above applies to it. It is still on the WADA prohibited list, so it is not a safe swap for tested athletes.
What men compare DHEA with
Fatigue and 'adrenal fatigue' are the most common reasons people reach for DHEA. Adrenal fatigue is not a recognised diagnosis: as our adrenal fatigue guide puts it, a 2016 systematic review of 58 studies "found no consistent cortisol pattern in tired people". A low-normal DHEA-S in someone with healthy adrenals has not been shown to cause tiredness. A low DHEA-S on its own can also come from steroid or opioid medicines or a pituitary problem, which is why an abnormal result goes to a clinician.
Proven adrenal failure, Addison's disease, is a different situation, and DHEA there is decided alongside cortisol replacement. Signs that point to real adrenal failure rather than ordinary tiredness include unexplained weight loss, darkening skin, salt craving, dizziness on standing and low blood pressure; see a doctor. Vomiting, severe weakness or confusion with these signs is an emergency.
Citations
- Nair KS, Rizza RA, O'Brien P, et al. DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med 2006;355:1647-1659.
- Villareal DT, Holloszy JO. Effect of DHEA on abdominal fat and insulin action in elderly women and men: a randomized controlled trial. JAMA 2004;292:2243-2248.
- Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal. An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2014;99:3489-3510.
- Labrie F, Archer DF, Koltun W, et al. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause 2016;23:243-256.
- Nagels HE, Rishworth JR, Siristatidis CS, Kroon B. Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction. Cochrane Database Syst Rev 2015;CD009749.
- Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2016;101:364-389.
- Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 1999;341:1013-1020.
- Weiss EP, Shah K, Fontana L, et al. Dehydroepiandrosterone replacement therapy in older adults: 1- and 2-y effects on bone. Am J Clin Nutr 2009;89:1459-1467.
- Elraiyah T, Sonbol MB, Wang Z, et al. The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99:3536-3542.
- Schmidt PJ, Daly RC, Bloch M, et al. Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression. Arch Gen Psychiatry 2005;62:154-162.
- Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000;97:4279-4284.
- Orentreich N, Brind JL, Rizer RL, Vogelman JH. Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinol Metab 1984;59:551-555.
- Morales AJ, Nolan JJ, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 1994;78:1360-1367.
- Parasrampuria J, Schwartz K, Petesch R. Quality control of dehydroepiandrosterone dietary supplement products. JAMA 1998;280:1565.
- MedlinePlus. DHEA. US National Library of Medicine.
Educational context only, not medical advice or a diagnosis. Always discuss your results with a clinician.
