DHEA for menopause: what vaginal, oral and cream DHEA each show in trials. | Reddit

Vaginal, oral and cream DHEA, side by side

Vaginal DHEA: the FDA-approved form

Prasterone is DHEA in a 6.5 mg vaginal insert, used once a day at bedtime with an applicator. Its label approves it for moderate to severe painful sex (dyspareunia) caused by vaginal atrophy from menopause.

• The trials. In the larger of two 12-week placebo-controlled trials, 558 women were randomized. Pain severity scores fell from 2.54 to 1.13 on prasterone, a drop of about 56%, and from 2.56 to 1.50 on placebo, about 41%. Vaginal dryness also improved more than on placebo.
• Side effects. Vaginal discharge, from the insert melting at body temperature, was reported by 5.71% of women on prasterone and 3.66% on placebo in the 12-week trials. In a 52-week study, 14.2% reported discharge and 2.1% had an abnormal Pap smear.
• Hormones and the uterus. Over 12 weeks, trough blood levels of estradiol rose 19% and testosterone 21% from baseline, and the 2025 urology and gynecology guideline describes the estradiol rise as remaining “within the normal menopausal range.” Endometrial biopsies after up to 52 weeks of use found atrophic or inactive lining in every woman sampled.
• What the guidelines say. The Menopause Society lists vaginal DHEA among the effective treatments for genitourinary syndrome of menopause, and the 2025 AUA/SUFU/AUGS guideline says clinicians should offer it for vaginal dryness and painful sex.
• Breast cancer. Estrogen is one of the hormones prasterone turns into, and the insert has not been studied in women with a history of breast cancer, so its label advises caution there.

A compounded vaginal DHEA is a different product. In a trial of 464 postmenopausal cancer survivors, a compounded vaginal DHEA at 3.25 or 6.5 mg did no better than a plain moisturizer on dryness or pain at 12 weeks, though the 6.5 mg dose improved sexual function scores.

Oral DHEA: what the trials found

The 2015 Cochrane review is the most complete look at DHEA taken by mouth or applied to the skin in menopause. It covered 28 trials and 1,273 women, only 66 of them perimenopausal, and most trials used 50 mg a day or less.

• Quality of life. “There is no evidence that DHEA improves quality of life.”
• Menopause symptoms. “There is uncertainty whether DHEA decreases menopausal symptoms,” because trial results were inconsistent and could not be pooled.
• Sexual function. A small improvement, which the authors translated to about 2.3 points on a scale running from 0 to 84, and which may not be clinically meaningful.
• Side effects. Androgenic effects, mainly acne, had nearly four times the odds seen on placebo (odds ratio 3.77). No serious side effects were reported at doses up to 1,600 mg a day for up to a year.

The professional societies read that evidence the same way. The Endocrine Society’s 2014 guideline, written with ACOG, the American Society for Reproductive Medicine and two international societies, recommends against routine use of DHEA. A 2019 global consensus statement from menopause and sexual medicine societies says systemic DHEA cannot be recommended for low sexual desire. For hot flashes specifically, one small uncontrolled pilot reported improvement, and a placebo-controlled trial completed in 2007 has posted no results; The Menopause Society’s 2023 statement on non-hormone treatments for hot flashes does not include DHEA, and calls hormone therapy the most effective treatment.

A 2022 review in the Endocrine Society’s journal summarizes where that leaves a clinician: for healthy women “there are few data to support the administration of DHEA for sexual, cognitive, mood, or overall wellbeing.” Where DHEA is tried, the reviewers suggest 25 mg a day after menopause and a short trial, weighed against effects on breast, bone and heart, because DHEA converts to testosterone and estradiol. A 2025 meta-analysis of 21 trials confirmed that conversion: DHEA supplementation raised testosterone and estradiol, mainly at 50 mg a day or more.

DHEA cream on the skin

Cream is how DHEA is most often compounded for systemic use, and it has the thinnest evidence. The Cochrane review found three skin-application trials and no trial of any non-oral route that measured menopause symptoms.

• Labrie 1997. Fourteen women aged 60 to 70 applied a 10% DHEA cream daily for 12 months. Vaginal tissue matured in 8 of the 10 women who started with none, the uterine lining stayed atrophic in all of them, and hip bone density rose slightly, from 0.744 to 0.759 g/cm². The study was not blinded.
• Labrie 2008. In 150 women aged 60 to 65 using a skin emulsion for 12 months, blood DHEA rose 203% while estrogen changes were small and mostly not significant. The authors found the rise in blood DHEA overstated real androgen formation by 186%, so a DHEA blood level is a poor guide to what a cream is doing.
• Skin effects. Oily skin increased in the skin trials, and acne or other skin effects were reported in all three.

PepScribe’s pharmacy makes DHEA cream at 50, 75 and 100 mg per mL. Its labels typically direct 0.25 to 1 mL once a day on the inner thigh, inner arm or abdomen, and the prescription sets the strength and amount.

DHEA-S levels by age

DHEA-S is the form a clinician measures. It comes almost entirely from the adrenal glands, and because it lasts about a day in the blood, one test gives a stable reading. Levels fall steadily with age in everyone, so a value that looks low against a young adult’s range can be normal for your age.

Labcorp and other labs publish different bands, so compare your result with the range printed on your own report. A clearly low DHEA-S can come from adrenal insufficiency, a pituitary problem or steroid medicines such as prednisone. A high one can point to polycystic ovary syndrome or an adrenal condition. Labcorp asks patients to stop biotin supplements at least 72 hours before the test. The Endocrine Society advises against diagnosing “androgen deficiency” in healthy women from hormone levels alone, so the number is read alongside your symptoms and history.

Prescription DHEA and supplements

DHEA has been sold in the US as a dietary supplement since 1994, without FDA oversight of potency. In a 2000 laboratory analysis of 45 supplement products, DHEA content ranged from 0% to 109.5% of the amount on the label. A prescription DHEA is compounded by a licensed 503A pharmacy for one patient at the strength the clinician writes.

Neither is FDA-approved. The Menopause Society lists DHEA among the hormones used in compounded bioidentical therapy and says compounding should be considered only when an approved therapy cannot be used, for reasons such as an ingredient allergy or a dose that is not available.

Athletes should know that DHEA and 7-keto DHEA are on the World Anti-Doping Agency’s prohibited list at all times, and drug tests detect DHEA use.

7-keto DHEA

7-keto DHEA is a compound the body makes from DHEA, sold as a supplement and compounded by prescription. In one small study in men it left sex hormones unchanged, and in another, a gel lowered testosterone and estradiol. We found no trial of 7-keto DHEA in menopause, and a 2023 systematic review of its effect on body weight found too little evidence to recommend it for therapeutic use. PepScribe’s pharmacy lists it as a 10 mg capsule.

Side effects and who should avoid DHEA

• Androgenic effects. Acne, oily skin and unwanted facial or body hair are the most common, and they rise with the dose.
• Hormone changes. In a year-long study of 50 mg a day in women aged 60 to 79, 21% of testosterone and estradiol values at 6 months were outside the normal premenopausal range.
• Breast cancer. The 2022 Endocrine Society journal review calls DHEA contraindicated in women with a history of breast cancer, because it converts to estradiol and testosterone.
• Medicines. Tell your clinician about blood thinners, estrogen or progestin hormones, and diabetes medicines, which are among the interactions listed for DHEA.
• Cholesterol. In one cream study, HDL cholesterol fell 8% with no change in the HDL-to-total cholesterol ratio; a 2014 meta-analysis found no significant effect on blood lipids.

How to get DHEA through PepScribe

1. Start the free online visit at /book/hrt and answer questions about your symptoms and health history.
2. A licensed clinician reviews your answers and, where indicated, your DHEA-S level, and decides with you whether DHEA belongs in your plan, and in which form.
3. If DHEA is prescribed, it is compounded in the USA by a licensed 503A pharmacy and shipped to you, and the form or dose is adjusted over time.

Plan details are on the DHEA page. For other options, see alternatives to HRT for menopause and testosterone for women.

Frequently asked questions