The Pro-Hormone DHEA and Sexual Health

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Studies suggest DHEA supports improved libido, fertility, and more

To say DHEA (dehydroepiandrosterone) is a pro-hormone simply implies that it is a precursor hormone to the hormones that we more often speak of: estrogen and testosterone. However, this is not its only hormonal “job” in the body; DHEA and its sulfated form, DHEA-S, interact with numerous receptors, exerting hormonal actions throughout the body as well as neurosteroid activity in the brain.^[1] In fact, due to its abundance in the body and plethora of anti-aging actions, DHEA has even been referred to as a “superhormone.”^[2]

Clinical research with DHEA is not much different than that for which we would consider its hormone metabolites, estrogen and testosterone. Much like estrogen and testosterone, levels of DHEA and DHEA-S decrease with age and are approximately 25% of their peak by age 70.^[3],[4] Thus, we see substantial research surrounding concerns with aging: libido, the health of the skin, bone strength, and body composition. As a hormone that in some ways balances the action of cortisol, we also see research in the settings of stress and glucocorticoid-related bone loss. Herein, we take a deep dive into the data surrounding DHEA and sexual health, while elsewhere, its effects on brain and bone health are discussed.

DHEA and age-related hormonal decline

Human studies have shown DHEA improves libido, bone health, and skin thickness and moisture levels in elderly women, with some of these benefits also being seen in elderly men.

In 280 elderly men and women ranging from 60 to 79 years of age, long-term supplementation of 50 mg of DHEA for a period of a year was shown to restore DHEA-S to “normal youthful levels” in both sexes.^[4] In men, there was no significant increase in testosterone, while in women, there was, with levels exceeding the normal testosterone range for menstruating women in 10% of subjects. There was a trend of increasing estradiol levels in men, while in women, this increase was significant, with levels falling within normal ranges of the early follicular phase of menstruating women. No adverse effects associated with DHEA supplementation were noted, and there was no significant change in the prostate specific antigen (PSA) levels in the men.

DHEA supplementation significantly improved most parameters related to libido in the elderly women over age 70. In this group, it also positively affected bone health, decreasing bone turnover. In all participants taking DHEA, significant changes were seen in the health of the skin: hydration and sebum levels increased, and facial yellowness decreased. Skin thickness on the back of the hand also significantly increased in individuals having the lowest DHEA levels initially. The findings with DHEA as a supplement for helping protect against many of the changes with aging were summarized in the conclusions: “A number of biological indices confirmed the lack of harmful consequences of this 50 mg/day DHEA administration over one year, also indicating that this kind of replacement therapy normalized some effects of aging.”

DHEA and sexual health in women

DHEA supports healthy libido in women after menopause as well as women with a diminished sex drive related to oral contraceptive use.

DHEA has also been shown to support libido and sexual health in younger women in a variety of settings. In post-menopausal women age 50 to 60, DHEA at a dose of only 10 mg a day for 12 months was shown to significantly improve sexual function and frequency compared to the control intervention (400 IU of vitamin D).^[5] In a population of men and women with hypoactive sexual desire disorder, at a dose of 100 mg/day for six weeks, treatment with DHEA significantly improved sexual arousal and satisfaction in women, however, no improvements were seen in the men.^[6]

It is not uncommon for women to have sexual side effects from oral contraceptive (OC) use, with a small but still substantial percentage having a decline in libido.^[7] In women taking OCs who had a decline in libido after initiating the medication, the addition of 50 mg of DHEA daily significantly improved numerous markers of sexual function.^[8] The women who had higher free testosterone levels during DHEA administration were found to experience greater effects of DHEA on sexual arousal and desire.

In women, DHEA conversion to testosterone by the adrenals is the primary source of testosterone; hence, with adrenal insufficiency, women often experience a decline in libido, while in men, sexual function and testosterone levels are largely preserved.^[9] Multiple studies have shown that 50 mg of DHEA is a suitable dose for women with adrenal insufficiency,^{[10],[11],,[12]} supporting improvements in hormone levels, metabolic parameters, well-being, anxiety and depression, and frequency of sexual thoughts and interest. DHEA also has been shown to improve alertness, stamina, and sexual interest or activity in women with hypopituitarism when added to other indicated hormone replacement therapies.^[13]

DHEA and erectile dysfunction

DHEA isn’t a primary intervention for erectile dysfunction, but one small study showed it may be of benefit to men who have not yet used other forms of treatment.

Multiple population studies have shown an inverse relationship between DHEA levels and the incidence of erectile dysfunction (ED).^[14],[15] In addition to being a testosterone precursor, DHEA’s demonstrated anti-inflammatory effects and action of enhancing vasodilation further suggest it may be useful for the treatment of ED.^[16]

There is not a preponderance of evidence for DHEA as a tool for the treatment of ED, although two studies have demonstrated a positive impact. In one small prospective study without placebo, supplementation with 50 mg of DHEA for six months was shown to improve ED in men who had not yet undergone any form of hormone-replacement therapy or treatment for ED.^[17] Both the men with hypertension and those having ED without organic etiology saw significant improvements in multiple International Index of Erectile Function (IIEF) sub scores after treatment, while those with diabetes mellitus and neurological disorders did not see any change.

In a randomized, double-blind, placebo-controlled trial of men with ED without sub-classification of etiology, treatment with 50 mg of DHEA/day for six months was associated with significantly higher scores on all IIEF domains compared to placebo.^[18] However, this study had a fairly high dropout rate especially in the placebo group due to an insufficient response to treatment.

DHEA and infertility

Multiple studies have shown that DHEA may improve IVF outcomes for women with diminished ovarian reserve, with one study also showing that micronized DHEA increased the amount of women who became pregnant spontaneously.

Most research with DHEA concerning fertility is concentrated in the arena of female infertility due to diminished ovarian reserve. Studies in rats suggest that DHEA reduces follicular atresia, that is, the process by which follicles not selected for maturation involute and become part of the parenchyma.^[19] By doing so, the total number of follicles that later can potentially grow into a larger, mature oocyte that is viable for fertilization increases.

Human studies have similar findings. In women who were poor responders to in vitro fertilization (IVF), the majority of whom were of advanced age or diagnosed with low ovarian reserve, supplementation of DHEA at a dose of 75 mg/day for three months prior to ovarian stimulation led to a highly significant improvement in four of the five oocyte parameters assessed.^[20] With IVF, there was a 31% rate of clinical pregnancies, and a live birth rate of 19%. Additional subgroup analysis found that there was a significant increase in high quality embryos in the patients less than 38 years of age and in those who became pregnant following DHEA treatment.

In a randomized, placebo-controlled study of women who previously had a poor response to ovarian stimulation, DHEA was also provided at 75 mg a day for a period of six weeks prior to ovulation induction and IVF procedures.^[21] Those receiving DHEA were observed to have significantly improved embryo quality as well as a significantly higher live birth rate versus controls (23.1 vs 4%).

In addition to the positive findings seen with reproductive assistance, one study reports of the positive impact DHEA had on spontaneous pregnancy. The women were enrolled in a study with a design much like the others previously described, however, after taking 75 mg of micronized DHEA daily for a period of time, a substantial amount of the women spontaneously became pregnant.^[22] In fact, of the women taking DHEA, in the 39 women under age 40 who previously had been poor responders to IVF, there was 10 spontaneous pregnancies, while in women age 40 and older, 21% of those taking DHEA became pregnant. There was not a control group for comparison with the women under age 40, but in those over 40, the women in the control group not receiving DHEA only had a spontaneous pregnancy rate of 13%.

Many other clinical studies have also assessed the impact of DHEA on female infertility due to diminished ovarian reserve, with most having positive findings.^{[23],[24],[25],[26]} Clearly, this represents yet another category of anti-aging effects that this prohormone that will increasingly be investigated for, particularly as maternal age continues to rise.

Although a restoration to youth is, of course, elusive, there are many nutritional tools that help us maintain health and function with increasing age. DHEA and pregnenolone are two of these pro-hormone tools, while the fat-soluble antioxidants astaxanthin and CoQ10 additionally support us in our anti-aging endeavors. Many other basic nutrients also have evidence they support us not only in longevity, but in maintaining health through our lifespan.

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