DHEA for Erectile Dysfunction

Probably not for most men. Small trials from one research group reported benefit, but an independent placebo-controlled trial and a meta-analysis of 25 trials found no effect on sexual function [5][6]. DHEA (dehydroepiandrosterone) is an adrenal hormone that the body converts into testosterone and estrogen. The case for it in erectile dysfunction started with an observation: in the Massachusetts Male Aging Study, men with lower serum DHEA were more likely to report impotence, after allowing for age [1]. One research group then ran small trials and reported that 50 mg of DHEA a day improved scores on the International Index of Erectile Function (IIEF, the standard ED questionnaire) [2][3].

Those results have not held up outside that group. An independent double-blind trial gave 86 men with low androgen levels DHEA, oral testosterone or placebo and found no difference in erectile function [5]. A meta-analysis of 25 placebo-controlled trials in 1,353 older men found no effect of DHEA on sexual function [6], and an international expert review concluded that controlled trials show DHEA is not useful for improving male sexual function [7]. So the verdict is mixed, leaning negative, and the evidence is limited.

DHEA is made by the adrenal glands and works as a building block for other hormones, including testosterone and estrogen; natural levels peak in early adulthood and then slowly fall [11]. Blood levels of its sulfated form, DHEAS, fall with age [10], and several studies have found lower DHEAS in men with ED. In one comparison of 309 men with ED and 133 healthy volunteers, DHEAS was lower in the ED group up to age 60 [4]; a smaller 2021 study found 6.43 vs 9.48 µmol/L (P < .001) [8].

The idea was that topping up a falling hormone would restore erectile function. Testosterone does matter for desire and erection, and expert recommendations support testosterone therapy for men who are genuinely hypogonadal [9]. DHEA, though, is a weak, indirect route to testosterone: in the positive ED trial, 6 months of DHEA did not change mean serum testosterone [2].

A low DHEAS level in men with ED does not mean DHEA causes ED. A small study (40 men with ED, 17 controls) that compared men within the same age band found no difference in DHEAS between men with ED and controls, and concluded the decline is an age-related process rather than a cause [10]. Age is also the strongest single predictor of ED, and after age it is linked to heart disease, high blood pressure and diabetes, several of them risk factors for vascular disease [1].

That is why the biology doesn't rescue the trials: a hormone that tracks age will look linked to almost every age-related problem, and the trials that tested supplementation directly mostly found nothing.

Every ED trial used oral DHEA. The two positive placebo-controlled trials gave 50 mg once a day [2][3], for 6 months in the first one [2], and so did the uncontrolled follow-up study [12]. The independent trial that found no benefit used a higher dose, 50 mg twice a day, and confirmed that blood DHEA rose, so poor absorption is an unlikely explanation for the null result [5].

Mayo Clinic notes that studies have often found the quality control of DHEA supplements to be low, so product quality varies [11]. Because DHEA is a hormone, have your clinician check DHEAS, testosterone and PSA before you start rather than self-dosing.

In the first trial, Reiter and colleagues randomised 40 men with ED, low DHEAS (below 1.5 µmol/L) and normal testosterone to 50 mg of DHEA or placebo for 6 months. The DHEA group had higher mean scores in all five IIEF domains, but the authors themselves wrote that the patient database was too small for relevant statistical analysis and called the result a trend that justified larger studies [2].

A short report from the same group described 50 elderly men with ED randomised 25 to 25 (the abstract gives no treatment length or DHEAS criterion), with a statistically significant increase in all IIEF domains on DHEA and not on placebo, again with the same caveat about sample size [3]. Their 2001 follow-up treated 85 men with 50 mg a day for 6 months without a placebo group: erection scores improved from baseline in men with high blood pressure or no organic cause, but not in men with diabetes or neurological disease [12].

The only independent placebo-controlled trial focused on sexual function, by Morales and colleagues, enrolled 86 men with sexual dysfunction and low testosterone and/or DHEA. They received DHEA 50 mg twice daily, oral testosterone undecanoate or placebo; 79 completed. There were no significant differences on the IIEF or three other questionnaires for sexual interest or erectile function, even though blood DHEA rose clearly [5].

A 2013 meta-analysis pooled 25 double-blind, placebo-controlled trials in 1,353 older men followed for a mean of 36 weeks. DHEA slightly reduced fat mass but had no effect versus placebo on sexual function or quality of life [6]. A 2-year NEJM trial in older men with low DHEAS likewise found no improvement in quality of life [13].

No ED trial has selected men with normal DHEA levels (trials in older men in general found no effect on sexual function [6]), compared DHEA with an approved ED medicine, or tried it as an add-on to one. The positive data come from a few dozen men in one clinic, and a 2018 review of DHEA and erectile function concluded that large, well-designed prospective studies are still needed [14].

The American Urological Association guideline asks clinicians to inform every man with ED of all treatments that aren't contraindicated as potential first-line options, through shared decision-making [16], and the 2025 European Association of Urology guidelines say patients should be fully counselled about all available treatment modalities [17]. Because ED shares risk factors with heart disease and diabetes [1], a medical check comes first. If low testosterone is confirmed, testosterone therapy has meta-analytic support for improving ED in hypogonadal men [9].

Among supplements, L-arginine and Korean ginseng carry a "likely" verdict for ED on this site, against "mixed" for DHEA; their pages set out the trials.

In the first ED trial, 50 mg a day did not change PSA (prostate-specific antigen), prostate volume or testosterone [2]; PSA also stayed stable at 100 mg a day [5]; and the 2-year NEJM trial in older men reported no major adverse effects [13]. Those studies were small and lasted 2 years at most. Mayo Clinic's overall advice is to avoid DHEA, because its use can cause serious side effects [11]. It warns that high doses or long-term use might raise the risk of hormone-sensitive cancers such as prostate and breast cancer (more research is needed), and says not to use DHEA if you have one. It suggests considering avoiding DHEA if you have high cholesterol or ischaemic heart disease, because it might lower HDL cholesterol; notes that it might worsen mental health conditions and raise the risk of mania in people with mood disorders; and lists oily skin and acne as side effects [11].

The Merck Manual adds headache, mood changes and breast enlargement in men as possible effects, while noting these have not been substantiated, and says DHEA supplements are usually not recommended because the claimed benefits have not been proven and harmful side effects and several drug interactions are possible [15]. DHEA is banned by many sports organisations, including the NCAA [11][15].

DHEA's interactions come from its hormone effects. The ones that matter most for men with ED are other hormone treatments and some mental-health drugs [11][15].