Dehydroepiandrosterone (DHEA, prasterone)

Endogenous C19 steroid precursor; an EU prescription drug for adrenal insufficiency and a vaginal form (Intrarosa); a freely available supplement in the United States

ATC code: A14AA-DHEA (Dehydroepiandrosterone (DHEA, prasterone))

Brand names

Prasterone (Intrarosa), DHEA (various US OTC brands)

Mechanism of action

The adrenal cortex secretes DHEA and its sulphate DHEA-S as sex-steroid precursors. In peripheral tissues DHEA is converted to androstenedione and further to testosterone and estradiol via 3β-HSD, 17β-HSD and aromatase. In women 50–75% of androgens derive from DHEA; in men the contribution is modest (5–10%) on top of testicular testosterone. DHEA levels fall by 70–80% from the peak at age 20–25, which underpins the «youth hormone» marketing concept. Clinically DHEA replaces adrenal androgen deficiency in patients with Addison disease.

Indications

Adrenal insufficiency

Adjunct

DHEA replaces adrenal androgen deficiency in women with Addison disease and secondary adrenal insufficiency. The Endocrine Society 2014 and SEEN 2022 frame DHEA as an optional add-on for persistent low mood and reduced libido after full glucocorticoid and mineralocorticoid replacement. Dose 25–50 mg in the morning. Men with adrenal insufficiency do not need DHEA: testicular testosterone covers the deficit. If DHEA was prescribed with preserved adrenal function, consider seeking a second endocrinologist opinion.

Sources

AEMPS: Ficha técnica de Prasterona (DHEA) (2022)

Low ovarian reserve in assisted reproduction

Adjunct

DHEA is a conditional add-on in low ovarian reserve before IVF. 2019 permits 75 mg/day for 6–12 weeks before stimulation in women with confirmed DOR (low AMH, low AFC). Evidence quality is low: Cochrane 2015 noted moderate increases in oocyte yield and clinical pregnancies, but study bias remains high. The reproductive specialist decides individually. Self-prescribing DHEA «for fertility» without confirmed DOR is not justified: the drug converts to testosterone and may worsen acne and hirsutism.

Sources

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Menopausal symptoms

Not recommended

DHEA is promoted as a «natural alternative» to menopausal hormone therapy. Oral systemic intake is ineffective for hot flushes: 2024 and IMS 2024 do not recommend it for systemic menopausal symptoms. Vaginal prasterone (Intrarosa) is approved by AEMPS and for moderate-to-severe vulvovaginal atrophy – a narrow local indication, not «rejuvenation». Oral systemic DHEA from US and iHerb stores is not registered in Spain. For hot flushes, night sweats or dryness in menopause, discuss with a gynaecologist the standard MHT (first-line therapy) or alternatives from NICE 2024.

Sources

«Hormonal balance» (marketing claim)

Not recommended

DHEA marketing relies on «adrenal fatigue» and «hormonal reset» claims. The Endocrine Society 2014 and SEEN 2022 do not recognise «adrenal fatigue» as a diagnosis: the term is absent from ICD-10, ICD-11 and clinical guidelines. True adrenal insufficiency is rare and dangerous, confirmed by morning cortisol, ACTH stimulation testing and antibodies – not by «salivary cortisol» from a private lab. Taking DHEA with preserved adrenal function raises testosterone and estradiol via peripheral conversion – this is not «balancing», this is iatrogenic hormone manipulation with risks of acne, hirsutism and gynecomastia. Fatigue, libido or mood complaints require labs and an endocrinologist or general practitioner visit, not DHEA self-prescription.

Sources

NIH ODS: Dehydroepiandrosterone (DHEA) fact sheet (2022)

Anti-aging and longevity

Not recommended

DHEA is the flagship of biohacker «youth hormone» protocols. The two-year Mayo Clinic DHEA Aging Trial (NEJM 2006) in men and women aged 60–88: DHEA 75 mg/day did not improve body composition, muscle strength, bone density, insulin sensitivity or quality of life vs placebo. Cochrane 2003 on DHEA for cognition in older adults found no effect. The Endocrine Society 2014 states that routine DHEA use «for ageing» in people without adrenal insufficiency is not justified. AEMPS and have not registered the drug as a geroprotector. Adverse effects in women include acne, scalp hair loss and hirsutism; in men – gynecomastia and accelerated BPH growth.

Sources

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Safety

Contraindications

Pregnancy and lactation
Hormone-dependent tumours: breast, endometrial, prostate and ovarian cancer
Vaginal bleeding of unknown origin
Severe hepatic impairment
Age under 18 years
History of severe thromboembolic events

Serious adverse effects

Growth of hormone-dependent tumours (breast, endometrial, prostate cancer)
Thromboembolic events from peripheral conversion to estradiol
Acute drug-induced liver injury (DILI) with high doses
Adrenal crisis on abrupt withdrawal in patients with Addison disease

Common adverse effects

Acne and oily skin
Androgenic hair loss in women
Hirsutism in women
Gynecomastia and reduced libido in men
Insomnia, irritability, anxiety
Raised ALT and AST

PregnancyFDA X

FDA Category X. DHEA is contraindicated in pregnancy: the drug converts to androgens and can cause virilisation of a female fetus. AEMPS explicitly prohibits Intrarosa and systemic prasterone in gestation.

Breastfeeding

Incompatible. Hale L5. DHEA passes into breast milk and may theoretically affect infant hormonal status. AEMPS does not recommend use during lactation.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Dehydroepiandrosterone (DHEA, prasterone) used for?

Dehydroepiandrosterone (DHEA, prasterone) is evaluated for the following indications with varying evidence strength: Adrenal insufficiency (evidence tier B), Low ovarian reserve in assisted reproduction (evidence tier C), Menopausal symptoms (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Dehydroepiandrosterone (DHEA, prasterone)?

Common side effects of Dehydroepiandrosterone (DHEA, prasterone) (≥ 1 in 100): Acne and oily skin, Androgenic hair loss in women, Hirsutism in women, Gynecomastia and reduced libido in men, Insomnia, irritability, anxiety, Raised ALT and AST. See the Safety section for uncommon and serious reactions.

Is Dehydroepiandrosterone (DHEA, prasterone) safe during pregnancy?

FDA category X. FDA Category X. DHEA is contraindicated in pregnancy: the drug converts to androgens and can cause virilisation of a female fetus. AEMPS explicitly prohibits Intrarosa and systemic prasterone in gestation.

Is Dehydroepiandrosterone (DHEA, prasterone) compatible with breastfeeding?

Incompatible. Hale L5. DHEA passes into breast milk and may theoretically affect infant hormonal status. AEMPS does not recommend use during lactation.

Who should not take Dehydroepiandrosterone (DHEA, prasterone)?

Dehydroepiandrosterone (DHEA, prasterone) is contraindicated in: Pregnancy and lactation; Hormone-dependent tumours: breast, endometrial, prostate and ovarian cancer; Vaginal bleeding of unknown origin; Severe hepatic impairment; Age under 18 years. Full list in the Safety section.

Mechanism of action

Indications

Adrenal insufficiency

Adjunct

Sources

AEMPS: Ficha técnica de Prasterona (DHEA) (2022)

Low ovarian reserve in assisted reproduction

Adjunct

Sources

Safety

Contraindications

Pregnancy and lactation
Hormone-dependent tumours: breast, endometrial, prostate and ovarian cancer
Vaginal bleeding of unknown origin
Severe hepatic impairment
Age under 18 years
History of severe thromboembolic events

Serious adverse effects

Growth of hormone-dependent tumours (breast, endometrial, prostate cancer)
Thromboembolic events from peripheral conversion to estradiol
Acute drug-induced liver injury (DILI) with high doses
Adrenal crisis on abrupt withdrawal in patients with Addison disease

Common adverse effects

Acne and oily skin
Androgenic hair loss in women
Hirsutism in women
Gynecomastia and reduced libido in men
Insomnia, irritability, anxiety
Raised ALT and AST

PregnancyFDA X

Breastfeeding

Incompatible. Hale L5. DHEA passes into breast milk and may theoretically affect infant hormonal status. AEMPS does not recommend use during lactation.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Dehydroepiandrosterone (DHEA, prasterone) used for?

What are the side effects of Dehydroepiandrosterone (DHEA, prasterone)?

Is Dehydroepiandrosterone (DHEA, prasterone) safe during pregnancy?

Is Dehydroepiandrosterone (DHEA, prasterone) compatible with breastfeeding?

Incompatible. Hale L5. DHEA passes into breast milk and may theoretically affect infant hormonal status. AEMPS does not recommend use during lactation.

Who should not take Dehydroepiandrosterone (DHEA, prasterone)?