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DHEA

Q: What is DHEA?

The body produces 5–8 mg of DHEA every day, mostly in the adrenal glands. DHEA is made from another steroid hormone, pregnenolone, which itself is made from cholesterol. In humans, DHEA is the second most abundant steroid after its sulfate ester, DHEA-S. Rather than DHEA levels, blood tests usually measure DHEA-S levels, which are about a hundred times higher and fluctuate less during the day. The secretion of DHEA or supplementation with DHEA leads to increased levels of DHEA-S, a hydrophilic storage form of DHEA that stays in circulation. DHEA is the form that is transported into the tissues to be converted into the sex hormones (e.g., androgens and estrogens). Both DHEA and DHEA-S decrease significantly with age, with people in their 70s having less than 20% of the peak DHEA-S levels of young adults. Since DHEA and DHEA-S are the most abundant circulating steroids in the body, and they decline with age, there is speculation that supplementation with DHEA and/or DHEA-S may reduce age-related declines in health.

Q: What are DHEA’s effects in older women?

During the perimenopausal period, there are large reductions in estrogens and progesterones. By the time menopause begins, DHEA and testosterone levels have also reduced by 55%–60%. DHEA has been studied as a potential therapeutic for postmenopausal women. A systematic review found that in postmenopausal women, supplementation with vaginal DHEA, testosterone, and estrogen were all associated, in a dose-response manner, with improvements in genitourinary complaints such as vaginal atrophy and sexual function. Like other androgens, DHEA supplementation increases testosterone in postmenopausal women, but it is unique among supplemental androgens in also increasing estrogens.

Q: What are DHEA’s effects in older men?

A 2013 meta-analysis found that men over 50 taking DHEA had mild decreases in fat mass, but not after controlling for testosterone and estradiol levels. In other words, DHEA worked to increase testosterone (which may have reduced fat mass), but did not have any effects on fat mass on its own. Also, DHEA had no impact on lipids, glycemic metabolism, sexual function, or quality of life in older men. In terms of muscle strength and physical function, one systematic review reported no consistent effects in men over 60.

Q: What are DHEA’s effects on aging and cognition?

As the body ages, in addition to DHEA levels decreasing, the catabolic (i.e., breakdown-causing) hormone cortisol generally increases, which can negatively affect cognition. Fortunately, regular exercise seems to increase DHEA-S levels and decrease cortisol levels in adults 65 and older. Despite DHEA decreasing with age, cortisol increasing with age, and DHEA levels being higher in the central nervous system (suggesting a higher need for DHEA in the brain), DHEA supplementation does not appear to benefit cognitive function in adults over 50.

Q: What are DHEA’s effects on stress and mood?

Cortisol, and perhaps DHEA, increase after exposure to situations that a person interprets as stressful. It has been hypothesized that DHEA may counteract some of the effects of cortisol, and that having higher levels of cortisol and lower levels of DHEA after stressful situations increases the risk of negative mood states, such as depression, anxiety, or anger. It does appear that DHEA supplementation decreases cortisol, though its effects on subjective stress levels or mood seem less consistent.

Q: What are DHEA’s effects on body composition and performance?

Although DHEA supplementation increases androgens, these small increases may only prompt zero-to-small changes to muscle size and strength: a 2018 systematic review of randomized controlled trials (RCTs) concluded that supplementation with DHEA had no effects on muscle size or strength, and a 2020 meta-analysis of RCTs found small benefits (often at doses 50–100 mg) to body composition: increased lean body mass (0.99 lbs) and decreased fat mass (-1%).

Q: What are DHEA’s effects on fertility?

The evidence for DHEA and fertility outcomes is inconsistent. It might help outcomes in women with poor ovarian response undergoing in vitro fertilization (IVF), but one meta-analysis of randomized controlled trials in women with poor/diminished ovarian response found that while DHEA supplementation increased follicle count, ultimately there was no significant improvement in live birth rates.

Q: What are DHEA’s effects on cardiovascular disease?

While lower DHEA-S levels have some associations with worsened health outcomes, such as cardiovascular disease, supplementation with DHEA has not been shown to improve most of the biomarkers associated with negative cardiovascular outcomes. For example, supplementation with DHEA mostly has no effect on blood lipids, though researchers did note one negative effect: a reduction in high-density lipoprotein cholesterol, with a stronger effect noted in women.

Q: What are DHEA’s main drawbacks?

DHEA is well-tolerated, but may cause side effects by increasing estrogen or testosterone levels. For example, in a study of postmenopausal women, 3 of 38 women in the DHEA group experienced acne, and 2 of 38 experienced facial hair growth. Based on the possible increased risks of breast cancer, anyone supplementing with DHEA should discuss their plans with their doctor.

Also known as: DHEA, Pradesterone, Hydroxyandrosterone, 3β-Hydroxy-5-Androstene-17-one, Dehydroepiandrosterone

Overview

DHEA is a steroid hormone produced by the adrenal glands. It’s a precursor to (i.e., is made into) estrogen and testosterone, and can exert weak benefits on its own. As an “antiaging” or performance enhancing supplement, its benefits are inconsistent.

Benefits

DHEA is believed to work indirectly by being converted to androgens or estrogens in peripheral target cells, and might theoretically also work directly by stimulating neurotransmitter receptors in the brain.

How it works

The strongest evidence for DHEA is for increasing estrogens and androgens (e.g., testosterone) in women over 60, and for improving postmenopausal symptoms. However, DHEA might also increase testosterone levels in younger (<60 years old) populations. While the evidence that DHEA supplementation increases androgens is fairly consistent, the evidence that DHEA supplementation increases estrogens is as consistent, if not more so. However, these androgen and estrogen increases tend to be small; DHEA supplementation has had no clinical effect on muscle strength, muscle size, fat loss, or sexual function in older men.

Side effects

DHEA has been studied at dosages of 25–200 mg/day, with dosages of 50–100 mg/day being more frequently examined. A subgroup analysis in one meta-analysis of randomized controlled trials found that dosages of over 50 mg/day resulted in higher testosterone levels than less than 50 mg/day. However higher dosages of DHEA are likely to result in higher levels of estrogens as well.

Dosage

DHEA is well-tolerated, but may cause side effects by increasing estrogen or testosterone levels. For example, in a study of postmenopausal women, 3 of 38 women in the DHEA group experienced acne, and 2 of 38 experienced facial hair growth. In another study, the researchers noted an increase in voice lowering, another common effect of testosterone supplementation in women, among the DHEA group as compared to the placebo group. Supplementation with testosterone itself may adversely affect cardiovascular risk factors. However, trials examining cardiovascular-risk-related outcomes (blood pressure and liver enzymes) have found no change after DHEA supplementation. There are commonly occurring associations between sex hormones and the risk of certain types of cancer. For example, supplemental estrogen may increase the risk of some breast and gynecological cancers, and supplemental testosterone and its metabolite, dihydrotestosterone (DHT), may increase the risk of prostate cancer. Based on the possible increased risks of breast cancer, anyone supplementing with DHEA should discuss their plans with their doctor, with whom the benefits and risks of DHEA supplementation, and the resultant possible changes in sex hormones, can be appropriately evaluated for their individual situation.

FAQs

What is DHEA?

The body produces 5–8 mg of DHEA every day, mostly in the adrenal glands. DHEA is made from another steroid hormone, pregnenolone, which itself is made from cholesterol. In humans, DHEA is the second most abundant steroid after its sulfate ester, DHEA-S. Rather than DHEA levels, blood tests usually measure DHEA-S levels, which are about a hundred times higher and fluctuate less during the day. The secretion of DHEA or supplementation with DHEA leads to increased levels of DHEA-S, a hydrophilic storage form of DHEA that stays in circulation. DHEA is the form that is transported into the tissues to be converted into the sex hormones (e.g., androgens and estrogens). Both DHEA and DHEA-S decrease significantly with age, with people in their 70s having less than 20% of the peak DHEA-S levels of young adults. Since DHEA and DHEA-S are the most abundant circulating steroids in the body, and they decline with age, there is speculation that supplementation with DHEA and/or DHEA-S may reduce age-related declines in health.

What are DHEA’s main benefits?

What are DHEA’s effects in older women?

During the perimenopausal period, there are large reductions in estrogens and progesterones. By the time menopause begins, DHEA and testosterone levels have also reduced by 55%–60%. DHEA has been studied as a potential therapeutic for postmenopausal women. A systematic review found that in postmenopausal women, supplementation with vaginal DHEA, testosterone, and estrogen were all associated, in a dose-response manner, with improvements in genitourinary complaints such as vaginal atrophy and sexual function. Like other androgens, DHEA supplementation increases testosterone in postmenopausal women, but it is unique among supplemental androgens in also increasing estrogens.

What are DHEA’s effects in older men?

A 2013 meta-analysis found that men over 50 taking DHEA had mild decreases in fat mass, but not after controlling for testosterone and estradiol levels. In other words, DHEA worked to increase testosterone (which may have reduced fat mass), but did not have any effects on fat mass on its own. Also, DHEA had no impact on lipids, glycemic metabolism, sexual function, or quality of life in older men. In terms of muscle strength and physical function, one systematic review reported no consistent effects in men over 60.

What are DHEA’s effects on aging and cognition?

As the body ages, in addition to DHEA levels decreasing, the catabolic (i.e., breakdown-causing) hormone cortisol generally increases, which can negatively affect cognition. Fortunately, regular exercise seems to increase DHEA-S levels and decrease cortisol levels in adults 65 and older. Despite DHEA decreasing with age, cortisol increasing with age, and DHEA levels being higher in the central nervous system (suggesting a higher need for DHEA in the brain), DHEA supplementation does not appear to benefit cognitive function in adults over 50.

What are DHEA’s effects on stress and mood?

Cortisol, and perhaps DHEA, increase after exposure to situations that a person interprets as stressful. It has been hypothesized that DHEA may counteract some of the effects of cortisol, and that having higher levels of cortisol and lower levels of DHEA after stressful situations increases the risk of negative mood states, such as depression, anxiety, or anger. It does appear that DHEA supplementation decreases cortisol, though its effects on subjective stress levels or mood seem less consistent.

What are DHEA’s effects on body composition and performance?

Although DHEA supplementation increases androgens, these small increases may only prompt zero-to-small changes to muscle size and strength: a 2018 systematic review of randomized controlled trials (RCTs) concluded that supplementation with DHEA had no effects on muscle size or strength, and a 2020 meta-analysis of RCTs found small benefits (often at doses 50–100 mg) to body composition: increased lean body mass (0.99 lbs) and decreased fat mass (-1%).

What are DHEA’s effects on fertility?

The evidence for DHEA and fertility outcomes is inconsistent. It might help outcomes in women with poor ovarian response undergoing in vitro fertilization (IVF), but one meta-analysis of randomized controlled trials in women with poor/diminished ovarian response found that while DHEA supplementation increased follicle count, ultimately there was no significant improvement in live birth rates.

What are DHEA’s effects on cardiovascular disease?

While lower DHEA-S levels have some associations with worsened health outcomes, such as cardiovascular disease, supplementation with DHEA has not been shown to improve most of the biomarkers associated with negative cardiovascular outcomes. For example, supplementation with DHEA mostly has no effect on blood lipids, though researchers did note one negative effect: a reduction in high-density lipoprotein cholesterol, with a stronger effect noted in women.

What are DHEA’s main drawbacks?

DHEA is well-tolerated, but may cause side effects by increasing estrogen or testosterone levels. For example, in a study of postmenopausal women, 3 of 38 women in the DHEA group experienced acne, and 2 of 38 experienced facial hair growth. Based on the possible increased risks of breast cancer, anyone supplementing with DHEA should discuss their plans with their doctor.