DHEA (Dehydroepiandrosterone)

What it is

DHEA is formed mainly in the adrenal glands. In the blood, what is usually measured is its storage form DHEA sulfate, DHEAS for short. Its significance lies in the fact that tissues such as skin, bone, fat and brain make their own sex hormones from it as needed. Levels fall markedly with age, and precisely this decline gave rise to the idea of simply topping DHEA back up.

As a drug substance, DHEA is called prasterone. In the US it is permitted as a dietary supplement; in Germany it is prescription-only. Approved in the EU is a vaginal insert with 6.5 mg prasterone.

How it is supposed to work

The effect runs almost entirely through conversion into other hormones. After menopause, almost all of a woman’s androgens and all of her estrogens are formed from DHEA in the peripheral tissues. The principle is called intracrinology: each cell builds the hormone it currently needs from the precursor, and the blood sees only part of it.

This mechanism has been well measured in humans. A meta-analysis of 21 studies in postmenopausal women found a rise in testosterone of 24.31 ng/dl and in estradiol of 7.86 pg/ml on DHEA, stronger from 50 mg per day. In older men, DHEAS and estradiol rose in pooled studies; a rise in testosterone was not reported there. The chain of effects is thus confirmed. What remains open is how much of it ultimately reaches bone, muscle, libido or mood.

What users are looking for

People who take DHEA are usually looking for energy, libido or compensation for the age-related decline. Several studies tested exactly this idea: they specifically enrolled older people with low DHEAS and raised the level back to that of young adults. What came out of this is described further below.

What the studies show

The two-year study in the NEJM

87 older men with low DHEAS and low testosterone and 57 older women with low DHEAS were treated with DHEA, testosterone or placebo for 2 years. DHEAS rose by a median of 3.4 µg/ml in men and 3.8 µg/ml in women. Body composition, muscle strength, maximal oxygen uptake, insulin action and quality of life did not change. Bone density rose at the femoral neck in men and at the forearm in women. No major side effects occurred.

The Cochrane review on menopause

28 studies with 1,273 women. Quality of life did not improve significantly. Sexual function improved slightly, with a standardized difference of 0.31 in 5 studies with 261 women. Androgenic side effects, above all acne, were more frequent, with an odds ratio of 3.77. Whether hot flashes and other symptoms improve remained unclear.

The pooled bone studies

4 similarly designed, double-blind studies with a total of 295 women and 290 men aged 55 and older over 12 months. In the women, testosterone and estradiol rose, bone density at the lumbar spine rose by 1.0 percent, and the hip remained stable. In the men there was no bone benefit, but 0.4 kg less fat mass. The authors see DHEA as a possible option for preserving bone in women and call for longer studies.

Where the data stop

The fountain of youth is not supported. The most careful long-term study, over 2 years, found no effect on muscle, fat, strength, endurance, insulin action or quality of life. Likewise, 50 mg per day over 12 months changed neither abdominal fat nor glucose metabolism in 58 women and 61 men aged 60 to 88. On libido, the reviews contradict each other: a meta-analysis of 23 studies with 1,188 women found an effect of 0.35 that was narrowly not significant, the Cochrane review a small significant effect. Taken orally, the effect was not significant in the Cochrane comparison; it became clear mainly with vaginal use. The mood advantage rests on very low-quality evidence. On cognition, a review of 4 studies in women after menopause found no benefit. In artificial insemination with poor ovarian reserve, the live birth rate did not rise in the randomized trials. The bone effects are in the range of 1 percent, and there are no data on fractures. Long-term data beyond 2 years are lacking for the tablet, as are data on cancer risk. In its 2014 guideline, the Endocrine Society therefore recommends against routine use of DHEA in women, including in adrenal insufficiency.

Status, approval and legal

In Germany, DHEA is listed under the name prasterone in Annex 1 of the Ordinance on Prescription-Only Medicines (Arzneimittelverschreibungsverordnung) and is thus prescription-only. Approved in the EU is the vaginal insert Intrarosa with 6.5 mg for moderate to severe symptoms of vulvovaginal atrophy after menopause. In the US, DHEA is exempt from controlled substances law and permitted as a dietary supplement. In sport, DHEA is on the World Anti-Doping Agency’s 2026 list under S1.1 among the anabolic steroids and is banned at all times, as is 7-keto-DHEA. In Germany, it is additionally listed by name in the annex to the Anti-Doping Act. The studies on the tablet mostly used 50 mg per day; this is a statement about studies, not a recommendation.

Safety

In the controlled studies of up to 2 years, no major side effects occurred. Typical are androgenic effects, above all acne, which in the Cochrane review was markedly more frequent than on placebo. The US Anti-Doping Agency also lists facial hair, hair loss, a deeper voice and rising blood pressure. On 50 mg per day, protective HDL cholesterol fell. Because DHEA is converted into estrogens and testosterone, it is considered risky in hormone-dependent cancers such as breast, ovarian or prostate cancer. In young patients with anorexia and open growth plates, one study found a possible disadvantage for bone density. Anyone with hormonal disorders or taking hormones should have DHEA assessed by a physician, especially as it requires a prescription in Germany anyway.

Sources

• Nair et al., N Engl J Med 2006 – DHEA and testosterone in older adults, 2 years
• Scheffers et al., Cochrane Database Syst Rev 2015 – DHEA in menopause
• Elraiyah et al., J Clin Endocrinol Metab 2014 – meta-analysis in postmenopausal women
• Alkatib et al., J Clin Endocrinol Metab 2009 – DHEA in adrenal insufficiency
• Jankowski et al., Clin Endocrinol 2019 – bone density, pooled analysis of 4 RCTs
• Labrie et al., Menopause 2016 – vaginal prasterone, phase III
• He et al., Diabetol Metab Syndr 2025 – testosterone and estradiol on DHEA
• Peixoto et al., J Neurosci Res 2020 – DHEA and depressive symptoms
• Wierman et al., J Clin Endocrinol Metab 2014 – guideline on androgen therapy in women
• EMA – Intrarosa (prasterone), marketing authorization