EvidenceBModerateGood evidence in people with one real weakness. New studies could change the answer.
Oral DHEA did little for healthy older adults in the larger, longer trials: no gain in strength, thinking or quality of life. A vaginal form eases menopause-related dryness and pain.
Who it's for
Postmenopausal women with vaginal dryness or painful sex; not shown to help others.
What to expect
Little or no change in strength, mood or memory; small vaginal gains.
Watch out for
Hormone effects in women, and no data on breast cancer history.
What guidelines say
The Endocrine Society recommends against routine use of DHEA in women, because data on how well it works and how safe it is are limited1Guideline · 2014Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guidelineThe Endocrine Society and its partner societies recommend against the routine use of DHEA, because data on its effectiveness and safety are limited, both in healthy women and in women with adrenal insufficiency.Endocrine Society. A Polish expert panel was more favorable for some women, including those with vaginal atrophy from menopause or low bone density, and reported no serious side effects11Guideline · 2020Supplementation of dehydroepiandrosterone (DHEA) in pre- and postmenopausal women - position statement of expert panel of Polish Menopause and Andropause Society.Currently available clinical trials also suggest that DHEA supplementation is probably effective in postmenopausal women with hypoactive sexual disorders, infertile women with diminished ovarian reserve, women suffering from depression and anxiety, and women with obesity and insulin resistance. No serious adverse…Ginekol Pol.
What the studies show
A 2-year trial of 144 older men and women with low DHEA found no useful gains in body composition, physical performance, insulin sensitivity or quality of life. Bone density rose slightly at two sites, the hip in men and the forearm in women3Randomized trial · 2006 · 87 peopleDHEA in elderly women and DHEA or testosterone in elderly men.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. (ClinicalTrials.gov number, NCT00254371 [ClinicalTrials.gov].).N Engl J Med.
A 1-year trial of 280 healthy people aged 60 to 80 found 50 mg a day did not improve muscle strength or thigh muscle and fat size9Randomized trial · 2003Effect of 1-year oral administration of dehydroepiandrosterone to 60- to 80-year-old individuals on muscle function and cross-sectional area: a double-blind placebo-controlled trial.The compensation of the deficit of dehydroepiandrosterone during aging using a 50-mg/d dose does not induce beneficial effects on muscle state in healthy subjects. The conditions in which dehydroepiandrosterone could contribute to preserve or improve muscle strength and morphological features still need to be…Arch Intern Med.
Short trials of 2 weeks to 3 months (40 and 46 people) found no benefit for thinking, memory or well-being6Randomized trial · 1997 · 40 peopleEffects of a two-week physiological dehydroepiandrosterone substitution on cognitive performance and well-being in healthy elderly women and men.20). In conclusion, the present data do not support the idea of strong beneficial effects of a physiological DHEA substitution on well-being or cognitive performance in healthy elderly individuals.J Clin Endocrinol Metab,8Randomized trial · 2001 · 46 peopleSalivary cortisol and DHEA: association with measures of cognition and well-being in normal older men, and effects of three months of DHEA supplementation.These findings are consistent with an impairing effect of high cortisol on episodic memory and mood in older men, which may be attenuated by DHEA. When treatment effects were analysed, no significant effects of DHEA were observed on any of the trial outcomes, providing no support for benefits of DHEA supplementation…Psychoneuroendocrinology.
Results on body fat conflict. A 6-month trial of 56 people aged 65 to 78 found belly fat fell about 13 cm² with DHEA while placebo A dummy treatment that looks like the real one, so people can't tell which they got. rose about 3 cm², with better insulin response5Randomized trial · 2004 · 56 peopleEffect of DHEA on abdominal fat and insulin action in elderly women and men: a randomized controlled trial.DHEA replacement could play a role in prevention and treatment of the metabolic syndrome associated with abdominal obesity.JAMA. A 6-month trial in 36 people found less fat mass and slightly higher bone density10Randomized trial · 2000 · 10 peopleEffects of DHEA replacement on bone mineral density and body composition in elderly women and men.The results provide preliminary evidence that DHEA replacement in those elderly women and men who have very low serum DHEAS levels can partially reverse age-related changes in fat mass, fat-free mass, and BMD, and raise the possibility that increases in IGF-I and/or testosterone play a role in mediating these effects…Clin Endocrinol (Oxf). The larger 2-year trial found no body-composition effect3Randomized trial · 2006 · 87 peopleDHEA in elderly women and DHEA or testosterone in elderly men.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. (ClinicalTrials.gov number, NCT00254371 [ClinicalTrials.gov].).N Engl J Med. Small trials like these can give chance results.
Very small early trials (about 30 and 19 people) reported better well-being, and in the smaller trial, stronger muscles in men only2Randomized trial · 1994 · 17 peopleEffects of replacement dose of dehydroepiandrosterone in men and women of advancing age.In conclusion, restoring DHEA and DS to young adult levels in men and women of advancing age induced an increase in the bioavailability of IGF-I, as reflected by an increase in IGF-I and a decrease in IGFBP-1 levels. These observations together with improvement of physical and psychological well-being in both genders…J Clin Endocrinol Metab,4Randomized trial · 1998 · 10 peopleThe effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women.A daily oral 100 mg dose of DHEA for 6 months resulted in elevation of circulating DHEA and DS concentrations and the DS/cortisol ratio. Biotransformation to potent androgens near and slightly above the range of their younger counterparts occurred in women with no detectable change in men. Given this hormonal milieu,…Clin Endocrinol (Oxf). These were tiny and used crossover designs, so they carry little weight.
In a trial of 482 postmenopausal women, a daily vaginal DHEA insert for 12 weeks cut pain during sex by 0.36 points on a severity scale beyond placebo. Dryness improved by 0.27 points beyond placebo. Vaginal discharge occurred in about 6%7Randomized trial · 2016 · 325 peopleEfficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause.The daily intravaginal administration of 0.50% (6.5 mg) DHEA (Prasterone) has shown clinically and highly statistically significant effects on the four coprimary parameters suggested by the US Food and Drug Administration. The strictly local action of Prasterone is in line with the absence of significant drug-related…Menopause.
Key studies
Study
Who
What it found
Trial, 20063Randomized trial · 2006 · 87 peopleDHEA in elderly women and DHEA or testosterone in elderly men.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. (ClinicalTrials.gov number, NCT00254371 [ClinicalTrials.gov].).N Engl J Med
144 older men and women, 2 years
No useful gains in body, strength or quality of life
Trial, 20039Randomized trial · 2003Effect of 1-year oral administration of dehydroepiandrosterone to 60- to 80-year-old individuals on muscle function and cross-sectional area: a double-blind placebo-controlled trial.The compensation of the deficit of dehydroepiandrosterone during aging using a 50-mg/d dose does not induce beneficial effects on muscle state in healthy subjects. The conditions in which dehydroepiandrosterone could contribute to preserve or improve muscle strength and morphological features still need to be…Arch Intern Med
280 healthy adults aged 60 to 80, 1 year
No gain in muscle strength or size
Trial, 20045Randomized trial · 2004 · 56 peopleEffect of DHEA on abdominal fat and insulin action in elderly women and men: a randomized controlled trial.DHEA replacement could play a role in prevention and treatment of the metabolic syndrome associated with abdominal obesity.JAMA
56 adults aged 65 to 78, 6 months
Less belly fat and better insulin response
Trial, 20167Randomized trial · 2016 · 325 peopleEfficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause.The daily intravaginal administration of 0.50% (6.5 mg) DHEA (Prasterone) has shown clinically and highly statistically significant effects on the four coprimary parameters suggested by the US Food and Drug Administration. The strictly local action of Prasterone is in line with the absence of significant drug-related…Menopause
482 postmenopausal women, 12 weeks
Vaginal DHEA eased pain and dryness slightly
Safety
The 2-year trial reported no major side effects3Randomized trial · 2006 · 87 peopleDHEA in elderly women and DHEA or testosterone in elderly men.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. (ClinicalTrials.gov number, NCT00254371 [ClinicalTrials.gov].).N Engl J Med. In women, oral DHEA raised androgen (male-type hormone) levels and slightly lowered HDL ("good") cholesterol2Randomized trial · 1994 · 17 peopleEffects of replacement dose of dehydroepiandrosterone in men and women of advancing age.In conclusion, restoring DHEA and DS to young adult levels in men and women of advancing age induced an increase in the bioavailability of IGF-I, as reflected by an increase in IGF-I and a decrease in IGFBP-1 levels. These observations together with improvement of physical and psychological well-being in both genders…J Clin Endocrinol Metab,4Randomized trial · 1998 · 10 peopleThe effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women.A daily oral 100 mg dose of DHEA for 6 months resulted in elevation of circulating DHEA and DS concentrations and the DS/cortisol ratio. Biotransformation to potent androgens near and slightly above the range of their younger counterparts occurred in women with no detectable change in men. Given this hormonal milieu,…Clin Endocrinol (Oxf). Estrogen is a breakdown product of prasterone (vaginal DHEA), and it hasn't been studied in women with a history of breast cancer12Guideline · 2026Prasterone: FDA drug label (prescribing information)Warnings and precautions: Current or Past History of Breast Cancer. 5.1 Current or Past History of Breast Cancer Estrogen is a metabolite of prasterone. Use of exogenous estrogen is contraindicated in women with a known or suspected history of breast cancer. INTRAROSA has not been studied in women with a history of …US Food and Drug Administration. Vaginal DHEA is the prescription form; a prescriber decides if it suits you.
What we don't know
Whether oral DHEA is safe over many years, since the longest trial ran 2 years.
Whether small bone or belly-fat gains have any lasting health benefit, such as fewer fractures.
Written by AI from the studies listed, without review by a clinician, and graded with the GRADE method. It can be wrong, so check the studies it cites. Education, not medical advice.