Should I take DHEA?

Our read is that DHEA supplementation is well supported for specific applications, particularly in women's health and hormonal balance, but carries notable caveats.

For women, DHEA, especially in vaginal forms, shows strong efficacy for conditions like UTIs, dyspareunia, and restoring testosterone levels. However, oral DHEA for men lacks demonstrated utility and may cause estrogen spikes, and for women, it carries a worse risk-to-reward ratio due to side effects like acne.

The cortisol to DHEA ratio is highlighted as a predictor of overall stress, morbidity, and mortality, with DHEA potentially offering metabolic and mental benefits.

For DHEA supplementation, a typical study dose is 25-50mg, though it is advisable to start lower due to potential androgenic side effects, as noted by Rhonda Patrick. Paul Saladino suggests taking 25-50mg of DHEA in the morning to suppress the stress response and normalize blood sugar during stressful activities. Paul Saladino also notes that measuring cortisol and DHEA in the afternoon may be the best time to assess the ratio for optimal health.

• 01The cortisol to DHEA ratio is a predictor of overall stress, morbidity, and mortality (Paul Saladino).
• 02Vaginal estrogen or DHEA can substantially reduce the risk of urinary tract infections (UTIs) (Peter Attia).
• 03Intrarosa (DHEA) suppositories have good efficacy and safety data for treating postmenopausal dyspareunia with minimal systemic absorption (Peter Attia, Andrew Huberman).
• 04DHEA supplementation is being tested for PTSD in males and may help rebalance the endocrine framework (Paul Saladino).
• 05In women, DHEA supplementation can increase total testosterone levels by approximately 4-fold, restoring levels to baseline while on suppressive oral contraceptives (Peter Attia, Rhonda Patrick).
• 06A triple treatment of DHEA, metformin, and growth hormone rebuilt the thymus and reversed biological age by two and a half years in a study (David Sinclair).
• 07Anti-catabolic hormones like DHEA and testosterone have numerous metabolic and mental benefits for both males and females, contributing to overall health and longevity (Paul Saladino).
• 08Vaginal DHEA is converted by vaginal enzymes into both estrogen and androgens, which may explain its benefits (Peter Attia).
• 09Elevated homocysteine and low DHEA/DHA levels are common and often unrecognized (Peter Attia).
• 10Topical DHEA, compounded with estrogen (0.01%) and testosterone (0.1%), can be used to treat pain with sex, UTI symptoms, and interstitial cystitis in women (Peter Attia).
• 11Intravaginal DHEA can be used for vaginal pain, and compounded testosterone cream for sexual desire in women (Peter Attia).

Our read is that DHEA supplementation carries a worse risk-to-reward ratio for women due to the common side effect of acne, as noted by Peter Attia. Peter Attia also states that oral DHEA has no discernible utility or effect on testosterone levels in males and may cause a spike in estrogen. Furthermore, Peter Attia indicates that oral DHEA is not recommended for hypoactive sexual desire disorder due to lack of demonstrated efficacy and insufficient safety data.

Our read is that the verdict would change with further robust studies demonstrating efficacy and safety for oral DHEA in men, or for hypoactive sexual desire disorder, or if new data emerged regarding the long-term systemic effects and side effect profiles, particularly for women.