The adrenal prohormone that declines with age — OTC in the US, prescription elsewhere, and the hormone replacement most people try first.
Dehydroepiandrosterone (DHEA) is an adrenal-produced steroid hormone that serves as a precursor to both testosterone and estradiol. Levels peak in the mid-20s and decline steadily with age — by 70, most people have 10–20% of their peak levels.
DHEA is over-the-counter in the US as a dietary supplement, but prescription-only in Canada, Australia, and most of Europe. The WADA also bans it for athletes. Quality of OTC product varies significantly; pharmaceutical-grade or compounded DHEA is more reliable.
OTC in US; Rx in most other countries. WADA prohibited. Despite OTC status, DHEA is hormonally active and deserves the same thoughtfulness as a prescription hormone.
DHEA is converted in peripheral tissues to androstenedione, testosterone, and estradiol. Amount of conversion varies by tissue, age, and sex. Women convert proportionally more to androgens; men more to estrogens.
DHEA and its sulfate (DHEA-S) cross the blood-brain barrier and have independent neurosteroid effects — modulating GABA, NMDA, and serotonin receptors. Some of the mood benefit appears to be receptor-mediated, not just downstream hormonal.
Unlike many hormone replacements, DHEA supplementation is mostly aimed at restoring youthful levels rather than replacing deficiency. The benefits are correspondingly subtler than TRT or menopausal HRT.
| Benefit | Evidence |
|---|---|
| Adrenal insufficiency (Addison’s) | Weaker than we previously said. A meta-analysis of placebo-controlled RCTs (Alkatib 2009, PMID 19773400) concluded DHEA "may improve, in a small and perhaps trivial manner" quality of life and depression — with no significant effect on anxiety or sexual well-being — and that the evidence is "insufficient to support the routine use of DHEA in women with adrenal insufficiency" |
| Female libido | Vaginal DHEA (prasterone, Intrarosa) is FDA approved for menopausal dyspareunia and is the best-supported use of this molecule. Oral DHEA for libido is a different claim with much weaker backing — the adrenal-insufficiency meta-analysis found no significant sexual-well-being effect |
| Bone density | Modest improvements in older adults |
| Mood | Mild antidepressant effect in some studies; stronger in women |
| Muscle / body comp | Minimal effect in healthy men; small improvements in women with low baseline levels |
| Ovarian reserve / IVF | Widely used, poorly supported. The most recent meta-analysis (Zhang 2023, PMID 37361534, 32 studies) found that in the RCT-only subgroup there was no significant difference in oocytes retrieved, embryos transferred, clinical pregnancy or live birth. Higher pregnancy and live-birth rates appeared only in the non-randomised studies, which the authors caution are prone to bias. Intermediate markers did improve — antral follicle count, gonadotropin dose, stimulation days and miscarriage rate |
What the guideline says. The Endocrine Society's reappraisal of androgen therapy in women (Wierman 2014, PMID 25279570) recommends against the routine use of DHEA, citing limited data on effectiveness and safety both in healthy women and in those with adrenal insufficiency. It likewise recommends against routinely prescribing it for low androgen levels arising from hypopituitarism, adrenal insufficiency, surgical menopause or glucocorticoid use, on the grounds that improvement in signs and symptoms is poorly supported and long-term risk is unstudied.
That is a stronger negative than most DHEA write-ups convey, this guide included until now. DHEA is cheap, over-the-counter in the US, and hormonally active — a combination that generates far more enthusiasm than the trial record supports. The one clearly established use is the vaginal preparation for dyspareunia.
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Start Tracking FreeNot medical advice. These are prescription medications. The figures below describe established clinical practice and labelled prescribing information — they are not a recommendation, they do not account for your labs, history, or other medications, and safe use depends on monitoring a page cannot do. Work with a qualified healthcare provider.
Check DHEA-S, total T, free T, estradiol, SHBG at baseline and 6–8 weeks after starting. Women especially should monitor androgen levels to avoid unwanted virilization.
FDA approved for menopausal dyspareunia. 6.5 mg vaginal insert daily; minimal systemic absorption.
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DHEA is widely available as a dietary supplement. You don’t need a specialty source to get a quality product — mainstream pharmacies, health retailers, and online retailers all carry it.
StackTrax does not sell supplements and does not earn a commission on supplement purchases.
Build your protocol, log every dose, monitor your body's response, and get reminders so you never miss a dose.
Start Tracking FreeOral DHEA is sold over-the-counter in the US as a dietary supplement, not as an FDA-approved drug. The vaginal form (prasterone, brand Intrarosa) is FDA approved specifically for menopausal dyspareunia at 6.5 mg daily. In Canada, Australia, and most of Europe, DHEA is prescription-only. Quality of OTC product varies significantly; pharmaceutical-grade or compounded DHEA is more reliable.
DHEA is an adrenal-produced steroid hormone that serves as a precursor to both testosterone and estradiol. It is converted in peripheral tissues to androstenedione, testosterone, and estradiol, with women converting proportionally more to androgens and men more to estrogens. DHEA and its sulfate also cross the blood-brain barrier and have independent neurosteroid effects, modulating GABA, NMDA, and serotonin receptors, which appears to be part of the mood benefit.
Not really. Unlike many hormone replacements, DHEA supplementation is mostly aimed at restoring youthful levels rather than replacing deficiency, and the benefits are correspondingly subtler than TRT or menopausal HRT. The strongest evidence is for adrenal insufficiency (Addison's), female libido (especially with low adrenal androgens), modest bone density improvements in older adults, and mild antidepressant effect in some studies. Effects on muscle and body composition in healthy men are minimal.
General adult replacement is 10 to 25 mg/day for women (commonly 25 mg) and 25 to 50 mg/day for men, taken as an oral capsule in the morning. The target is DHEA-S in the mid-to-upper reference range for ages 25 to 35. Vaginal prasterone (Intrarosa) is dosed at 6.5 mg as a daily vaginal insert with minimal systemic absorption.
Check DHEA-S, total testosterone, free testosterone, estradiol, and SHBG at baseline and again 6 to 8 weeks after starting. Women especially should monitor androgen levels to avoid unwanted virilization. Target DHEA-S in the mid-to-upper reference range for age 25 to 35.
Dose-dependent side effects include acne, oily skin, hair thinning in those susceptible to androgenetic alopecia, mild jitteriness or irritability, and insomnia if dosed late in the day. In women, voice deepening, facial hair, and clitoral changes at higher doses are a stop-immediately signal. Use caution in PCOS (androgenic effects worsen), active acne, and male pattern baldness history.
Do not use DHEA with hormone-sensitive cancers (breast, prostate, endometrial, ovarian), in pregnancy or breastfeeding, or under age 18 unless treating congenital adrenal hyperplasia under specialist care. DHEA is also WADA prohibited for athletes. Despite OTC status, DHEA is hormonally active and deserves the same thoughtfulness as a prescription hormone.
Disclaimer: This guide is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. The compounds discussed are not FDA approved for human use. Always consult a qualified healthcare provider before starting any new supplement or peptide protocol. StackTrax does not sell peptides or supplements directly — purchase links go to third-party vendors. StackTrax is not responsible for the products, quality, or business practices of any third-party vendor.
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StackTrax guides cover peptides and compounds that are not FDA-approved for the uses discussed. The dosing, reconstitution, and safety information is compiled from published research and community protocols for educational purposes only.
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