DHEA for Women: Are There Special Considerations?
DHEA (dehydroepiandrosterone) is often marketed as an "anti-ageing" hormone or a natural way to support energy, libido and body composition. For women, its effects differ in important ways from those in men, because a larger share of circulating androgens in women comes from DHEA. The editorial team explains what is known, what is not, and why caution is essential.
What DHEA is and why it matters more for women
DHEA is a steroid hormone produced mainly by the adrenal glands, with smaller amounts made by the ovaries. Its sulphated form, DHEA-S, circulates in much higher concentrations and acts as a reservoir. In tissues, DHEA can be converted into testosterone, dihydrotestosterone and oestrogens, depending on local enzymes.
In men, most testosterone comes from the testes, so DHEA contributes relatively little to overall androgen levels. In women, the situation is different: before the menopause roughly half, and after the menopause the large majority, of androgens are thought to be made in peripheral tissues from adrenal precursors such as DHEA.
This means that taking DHEA can have a proportionally larger impact on androgen levels in women than in men. It also explains why androgenic side effects, such as acne or unwanted hair growth, are among the most common complaints in female users.
DHEA levels peak in the mid-twenties and decline steadily with age, falling to a fraction of peak levels by the seventies. This natural decline led to the idea that replacing DHEA might reverse aspects of ageing, a hypothesis that has largely not been supported by controlled trials.
Legal status in the UK and anti-doping rules
DHEA is not a food supplement in the UK. It is listed under Schedule 4 Part 2 of the Misuse of Drugs Regulations along with anabolic steroids, which makes supplying it without a prescription illegal, although possession for personal use in medicinal form is not an offence. Products bought online from abroad may be seized at the border.
A licensed vaginal DHEA product (prasterone, 6.5 mg pessaries) is available on prescription in the UK for vulvovaginal atrophy in postmenopausal women. Systemic oral DHEA is not licensed for any indication in the UK.
DHEA is prohibited at all times by the World Anti-Doping Agency as an endogenous anabolic androgenic steroid when administered exogenously. Female athletes subject to testing by UK Anti-Doping should therefore avoid it entirely, unless a Therapeutic Use Exemption is granted for a documented medical condition.
| Aspect | UK situation |
|---|---|
| Classification | Schedule 4 Part 2 controlled drug (with anabolic steroids) |
| Sale as a supplement | Not permitted |
| Licensed products | Vaginal prasterone pessaries for postmenopausal vulvovaginal atrophy |
| WADA status | Prohibited at all times (S1 anabolic agents) |
| Supplement contamination risk | Present in some products bought abroad |
What the research shows in women
A systematic review and meta-analysis in postmenopausal women with normal adrenal function, published in 2014, found that systemic DHEA did not significantly improve sexual function, quality of life, bone density or metabolic markers compared with placebo, while it was associated with androgenic side effects.
The Endocrine Society's guideline on androgen therapy in women recommends against the routine use of DHEA in women with low androgen levels or in healthy postmenopausal women, citing limited and inconsistent evidence and unknown long-term safety.
Women with adrenal insufficiency (Addison's disease or hypopituitarism) have very low DHEA levels. In a well-known trial published in the New England Journal of Medicine in 1999, 50 mg of DHEA daily improved well-being and sexuality in such women. Later studies were less consistent, and DHEA in adrenal insufficiency is a specialist decision made on an individual basis.
In reproductive medicine, DHEA has been studied as an adjunct for women with diminished ovarian reserve undergoing IVF, typically at doses of 25 mg three times daily in published studies. Results have been mixed and its use remains controversial; it should only be considered within a fertility clinic.
Vaginal prasterone is the best-supported use: randomised trials showed improvements in painful intercourse and vaginal dryness in postmenopausal women, with minimal changes in circulating hormone levels because of the local action and low dose.
Side effects and risks specific to women
Because DHEA can be converted into both androgens and oestrogens, side effects in women span both directions. Their frequency increases with dose and duration of use.
- Androgenic: acne, oily skin, increased facial and body hair (hirsutism), scalp hair thinning, deepening of the voice.
- Menstrual: irregular periods or changes in cycle length.
- Oestrogenic: breast tenderness; theoretical concerns for hormone-sensitive cancers.
- Metabolic: possible reduction in HDL cholesterol.
- Psychological: irritability, mood changes, sleep disturbances.
Voice changes and hair growth can persist even after stopping DHEA, as with other androgens. This is why any signs of virilisation should prompt immediate discontinuation and medical review.
Women with a history of breast, ovarian or endometrial cancer, polycystic ovary syndrome (PCOS), which already involves raised androgens, or liver disease should not take DHEA outside specialist care. It is also contraindicated in pregnancy and breastfeeding.
DHEA, training and body composition
Some women take DHEA hoping to increase muscle mass, strength or fat loss. Controlled trials in older adults have generally shown small or no effects on muscle strength and body composition, and there is no good evidence of benefit in young, healthy, trained women.
Given the androgenic side effects, the legal restrictions in the UK and the anti-doping prohibition, the risk-benefit balance for this purpose is clearly unfavourable. A structured resistance training programme, adequate protein intake and sufficient energy availability are far more effective and safe.
Symptoms that might prompt a woman to consider DHEA, such as fatigue, low libido or difficulty building muscle, can have many causes. These include low energy availability, iron deficiency, thyroid disorders, perimenopause and depression. A medical assessment can identify treatable problems.
For perimenopausal and postmenopausal women with bothersome symptoms, NICE-endorsed options such as HRT, and in selected cases testosterone therapy for low sexual desire, are supported by considerably more evidence than systemic DHEA.
Conclusions of the editorial team
DHEA has a proportionally greater impact on androgen levels in women than in men, making androgenic side effects more likely.
Evidence for benefit from systemic DHEA in healthy women is weak, and leading endocrine guidelines advise against routine use. Vaginal prasterone for postmenopausal symptoms is the best-supported and licensed use in the UK.
DHEA is a controlled drug in the UK and prohibited at all times by WADA. Women considering it should first seek medical assessment of their symptoms.
The editorial team also recommends our articles on hormonal testing for female athletes, on relative energy deficiency in sport (RED-S) and on menopause and strength training.
References
- 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(10):3489–3510.
- 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(10):3536–3542.
- Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. 1999;341(14):1013–1020.
- 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(3):243–256.
- Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660–4666.
- World Anti-Doping Agency. Prohibited List. Montreal: WADA; updated annually.
