Do You Need DHEA?
DHEA and DHEA-S are the most abundant steroid hormones floating around in your body! They are considered androgens and are made predominantly by your adrenal glands and your ovaries. DHEA is a “pro-hormone” or “precursor” that goes on to make hormones known as androstenedione and androstenediol. These two “A” hormones can then make testosterone, estrogens, or other downstream androgen hormones. Think of DHEA as being near the top of the funnel for your hormone production!
Because DHEA can make these other necessary hormones, low levels are often associated with:
Low mood
Low energy
Low libido
Bone loss
Loss of lean muscle mass
DHEA-S is known as the sulfated form of DHEA. It’s like a storage form. When your body cuts the “S” off, the DHEA (with no S) can now transform into those other hormones. If your body doesn’t need so much DHEA, it puts the “S” on to be used later. I think of it like a lid that goes on my glass container storing my leftovers from dinner. When I want to eat them the next day, I take the lid off.
Even though you have an abundance of these 2 forms through your younger years, they do decline with age <sigh> starting at about your late 20’s/early 30’s. This is independent of your menopausal transition however it means your DHEA and DHEA-S might be on the low side as you come upon your 40’s and 50’s (or beyond).
This begs the question, do you need to supplement with DHEA?
The answer is maybe.
Are your levels low and are you having those symptoms?
Oral DHEA is not FDA regulated as it is considered a dietary supplement despite it being a pro-hormone. Oral pills (depending on the dose) seem to increase testosterone and estrogens which may or may not be your goal (and come with risks). The typical dose for women is 5-25mg.
Side effects can include symptoms of elevated testosterone or estrogens. This might include increased acne, increased female or male pattern hair loss, breast tenderness, and heavier periods (if you have them). Again, this depends on how your body uses DHEA and the dose.
Some practitioners don’t like DHEA as they want to only use testosterone or estrogens and not leave it up to DHEA. This makes sense as the studies on oral DHEA are quite mixed which, coupled with its supplement status, is likely the reason we don’t have an FDA approved pharmacy version.
However, clinically I saw DHEA work wonders for women who needed it however I was always aware of the side effects and potential for increased testosterone and estrogens.
Lastly as I’m writing this the week before the Olympics, DHEA is on the USADA’s banned list for anti-doping and athletes. Be aware if this applies to you.
Vaginal DHEA is a little different. The FDA approved version is called Intrarosa at 6.5mg. It is only approved for moderate to severe pain during sex and with vulvar or vaginal atrophy (thinning) due to menopause. Vaginal DHEA at 6.5mg does not go systemic through your body and therefore does not raise your testosterone or estrogens like the pills can. There are other vaginal DHEA options such as compounding pharmacies, supplement companies creating DHEA suppositories, or creams such as Julva.
According to the North American Menopause Society, vaginal DHEA is safe with a history of breast cancer as it has not been shown to increase circulating estrogens. This might be a great option if you’re experiencing pain with intercourse or having vulvovaginal atrophy either with or instead of vaginal estrogens.
Vaginal DHEA should not be used as a lubricant for sex - your partner doesn’t need it! Please plan accordingly. I often prescribed vaginal DHEA nightly for 1-2 weeks to “prime the tissue” then insert vaginally 1-3 times per week as needed.
You can test both DHEA and DHEA-S in the blood, however DHEA-S is the most commonly tested form. You can also test DHEA-S in urine and saliva. Knowing your DHEA values before supplementing with the pill form might be helpful to know.
Always talk with your healthcare provider before starting any hormone, including DHEA!