DHEA for Women: Dosage, Benefits and What the Research Shows
The short answer
There is no established DHEA dose for women; most trials of oral DHEA used 25 to 50 mg a day, and the evidence that it helps libido is weak. A meta-analysis of 23 trials in postmenopausal women found oral DHEA did not significantly improve libido or sexual function, while a low-dose vaginal DHEA insert (prasterone, 6.5 mg) is FDA-approved for painful sex after menopause.
What is DHEA?
DHEA (dehydroepiandrosterone) is a steroid hormone made mostly by the adrenal glands. It has little effect on its own. Instead, tissues throughout the body convert it into testosterone and estrogen as needed. In the blood it circulates mainly as DHEA-S (DHEA sulfate), which is what a lab test usually measures.
DHEA levels peak in young adulthood and then fall steadily with age, so by your 60s and 70s they are a fraction of what they were at 25. Unlike estrogen, this decline is gradual and isn't tied to menopause itself. Because DHEA falls as libido, energy and bone density often fall, it was marketed for years as an anti-aging hormone (Rutkowski 2014). The research has mostly not borne that out.
In the US, oral DHEA is sold as a dietary supplement, which means it is not reviewed by the FDA for safety or effectiveness before sale, and the amount in a capsule may not match the label. A vaginal form, prasterone (Intrarosa), is a prescription drug with an FDA approval for one specific use.
What DHEA dose do women take?
There isn't an evidence-based "right" dose of DHEA for women, and the Endocrine Society's guideline on androgen therapy recommends against routine DHEA use in women, citing limited and inconsistent evidence of benefit and unknown long-term safety (Wierman 2014). Here is what has been studied:
| Form and dose | Where it's been studied | Status |
|---|---|---|
| Oral, 25 to 50 mg a day | Most trials in postmenopausal women; 50 mg in women with adrenal insufficiency | Supplement; not FDA-approved for any use |
| Oral, 10 mg or less | A few small studies in older women | Supplement; not FDA-approved |
| Skin cream or gel | Small studies; absorption varies | Compounded or supplement; not FDA-approved |
| Vaginal insert, 6.5 mg nightly (prasterone) | Phase 3 trials in postmenopausal women with painful sex | FDA-approved as Intrarosa for moderate to severe painful sex due to menopause |
Women generally need much lower doses than men, because the same dose produces proportionally larger rises in testosterone. That's also why side effects like acne and hair growth show up more in women. If a clinician does suggest a trial of oral DHEA, they will usually check DHEA-S beforehand and again after starting, so levels don't climb above the normal range for young women.
Does DHEA help libido in women?
This is the most common reason women try DHEA, and the evidence is disappointing:
- A 2014 meta-analysis of 23 randomized trials with 1,188 postmenopausal women found that systemic DHEA did not significantly improve libido or sexual function. It also had no clear effect on cholesterol, blood sugar, weight or bone density. Confidence in the evidence was low (Elraiyah 2014).
- A 2015 Cochrane review of 28 trials concluded DHEA may slightly improve sexual function compared with placebo, but found no improvement in quality of life and more androgenic side effects such as acne and hair growth. When oral DHEA was analyzed separately, it showed no clear benefit; the signal came largely from a vaginal DHEA trial (Scheffers 2015).
By the numbers
DHEA and libido: what the trials found
The one group where systemic DHEA has shown clearer benefits is women whose adrenal glands don't work (adrenal insufficiency). In a 1999 trial in that group, 50 mg a day improved well-being and sexual interest and satisfaction (Arlt 1999). Those women have almost no DHEA at all, so the results don't carry over to healthy women whose levels are simply lower with age.
If low libido is your main concern, other options have stronger evidence. After menopause, testosterone therapy has the best data for distressing low desire; see testosterone and libido in women. For the other reasons desire changes in midlife, see low libido during menopause.
Does DHEA help with menopause or perimenopause symptoms?
For hot flashes, night sweats, mood and sleep, the Cochrane review found trial results too inconsistent to say whether DHEA helps (Scheffers 2015). There is no good evidence that DHEA improves energy, memory or body composition in women with normal adrenal function, and the meta-analysis found no effect on bone density. Menopausal hormone therapy remains the most effective treatment for hot flashes and night sweats.
Perimenopause is driven by swings in ovarian estrogen and progesterone, not by DHEA. Taking DHEA during perimenopause doesn't correct those swings, and the effect of adding extra androgen while your own hormones are still fluctuating hasn't been well studied.
Vaginal DHEA (prasterone) for dryness and painful sex
This is where DHEA has solid evidence. Prasterone is DHEA in a 6.5 mg vaginal insert used nightly at bedtime. Vaginal cells convert it into small amounts of estrogen and testosterone right where they're needed.
In a 12-week placebo-controlled trial in postmenopausal women with moderate to severe pain during sex, prasterone improved pain, dryness, vaginal pH and the health of the vaginal lining compared with placebo, while blood hormone levels stayed within the normal postmenopausal range. The main side effect was vaginal discharge, from the insert melting, in about 6% of women (Labrie 2016).
DHEA side effects and who should avoid it
Because DHEA turns into testosterone and estrogen, its side effects look like those of extra androgen:
- acne and oily skin
- increased facial or body hair
- scalp hair thinning
- at high doses, voice changes or other masculinizing effects
Talk to a clinician before taking DHEA, and generally avoid it, if you:
- have had breast, uterine or ovarian cancer, or another hormone-sensitive condition
- have polycystic ovary syndrome (PCOS) or already have high androgen levels
- are pregnant, breastfeeding or trying to conceive
- take menopausal hormone therapy, testosterone, or medicines affected by hormone levels
- have liver disease or a mood disorder, since DHEA has been linked to mood changes in some people
DHEA vs other options for low desire
| Option | Evidence for desire | Status |
|---|---|---|
| Oral DHEA | Weak, inconsistent | Supplement |
| Vaginal prasterone | Helps painful sex and dryness, which can indirectly help desire | FDA-approved for painful sex after menopause |
| Transdermal testosterone | Modest benefit in postmenopausal HSDD | Off-label for women in the US |
| Bremelanotide (Vyleesi) or flibanserin (Addyi) | Modest benefit in HSDD | FDA-approved for specific groups of women |
For a broader look, including supplements, see female libido pills: what works.
Some telehealth services also prescribe compounded, non-hormonal options. Amie offers Blys™, a rapid-dissolve tablet with PT-141 (bremelanotide), oxytocin and tadalafil, taken 30 to 60 minutes before intimacy for low desire and arousal and designed with women on antidepressants in mind. Blys is not FDA-approved, and use is off-label. A licensed clinician reviews your health history to decide whether it's appropriate. Because it contains tadalafil, it must never be taken with nitrate medicines, and heart or blood pressure conditions need careful review.
Questions to ask before trying DHEA
- What am I hoping DHEA will do, and is there a better-studied option for that goal?
- Should we check my DHEA-S level first, and when will we recheck it?
- Does my cancer history, PCOS or current hormone therapy make DHEA a bad idea?
- If my real problem is dryness or pain with sex, would vaginal prasterone or vaginal estrogen make more sense?
- How long should I try it before deciding it isn't helping?
Common questions
What is the right DHEA dose for a woman?
No dose has been established as safe and effective for women in general. Most oral studies used 25 to 50 mg a day, and supplement strengths vary. Because DHEA turns into testosterone and estrogen, it should only be taken with a clinician's guidance and, ideally, a baseline DHEA-S blood test.
Does DHEA increase libido in women?
Not reliably. A meta-analysis of 23 trials found no significant improvement in libido or sexual function in postmenopausal women taking DHEA, and a Cochrane review found at most a slight benefit along with more acne and unwanted hair growth.
Is vaginal DHEA the same as a DHEA supplement?
No. Intrarosa (prasterone) is a 6.5 mg prescription vaginal insert approved by the FDA for moderate to severe painful sex due to menopause. It acts mainly in vaginal tissue. Oral DHEA supplements are not FDA-approved for any condition.
What are the side effects of DHEA in women?
The most common are acne, oily skin and increased facial or body hair. Higher doses can cause scalp hair thinning and other androgen effects. Because it can raise estrogen and testosterone, it is generally avoided by women with hormone-sensitive cancers.
Sources
- Elraiyah T et al. Benefits and harms of systemic DHEA in postmenopausal women: systematic review and meta-analysis. J Clin Endocrinol Metab 2014
- Scheffers CS et al. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev 2015
- Wierman ME et al. Androgen therapy in women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2014
- Labrie F et al. Intravaginal DHEA for dyspareunia and vaginal dryness. Menopause 2016
- Intrarosa (prasterone) vaginal insert prescribing information, DailyMed
- Arlt W et al. DHEA replacement in women with adrenal insufficiency. N Engl J Med 1999
- Rutkowski K et al. Dehydroepiandrosterone (DHEA): hypes and hopes. Drugs 2014
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