DHEA for Decreased Sex Drive

DHEA is sold as a hormone that declines with age and as a fix for low sex drive, but the trials don't back it up. A meta-analysis of 23 randomised trials in 1,188 postmenopausal women found no significant improvement in libido or sexual function, and rated its confidence low (Elraiyah 2014). The biggest oral trial in women who actually had low desire gave 50 mg a day and found no difference from placebo after 26 weeks (Panjari 2009).

The Cochrane review did find a slight overall improvement in sexual function, but oral DHEA on its own had no significant effect; the strongest single result came from a vaginal DHEA trial (Scheffers 2015). In older men, 25 placebo-controlled trials showed no effect on sexual function (Corona 2013). The Endocrine Society recommends against routine DHEA use (Wierman 2014).

DHEA is one of the body's main precursors of androgens, which are in turn converted into testosterone and estrogens (Scheffers 2015). Its levels fall with age, and researchers had linked low levels of its sulfate form, DHEAS, with lower sexual function in women (Panjari 2009). The idea was simple: top up the precursor, raise testosterone, and restore desire.

In women, DHEA does raise androgens. In women with adrenal insufficiency, 50 mg a day lifted DHEA, androstenedione and testosterone from low to normal (Arlt 1999), and in a trial of people with low desire, 100 mg a day raised bioavailable testosterone in women but not in men (Bloch 2013).

Raising a hormone level is not the same as raising desire. Almost all women with adrenal failure who took 25 mg a day reached normal androgen levels, yet their sexuality scores changed no more than on placebo (Løvås 2003). In postmenopausal women with low desire, 50 mg a day, given with the aim of restoring youthful DHEA levels, did not improve sexual function either (Panjari 2009).

Even with testosterone itself, the Endocrine Society guideline notes that a woman's own testosterone level did not predict whether treatment helped her desire (Wierman 2014). Low sex drive usually has several causes at once, and a hormone precursor addresses at most one of them.

There is no evidence-based dose of DHEA for low libido. Oral trials used 50 mg a day in postmenopausal women (Panjari 2009), 100 mg a day in women and men with hypoactive sexual desire disorder (Bloch 2013), and 50 mg twice daily in men with sexual dysfunction (Morales 2009). None produced a consistent improvement in desire.

Androgenic side effects are common even at modest doses. In the 26-week trial, more women on 50 mg had acne and extra hair growth than on placebo (Panjari 2009), and at 25 mg a day 89% of women with adrenal failure reported side effects (Løvås 2003). The vaginal product that did work in trials is a prescription insert, not a supplement dose (Labrie 2009).

Elraiyah and colleagues pooled 23 randomised trials of systemic DHEA in 1,188 postmenopausal women with normal adrenal function. Libido and sexual function did not improve significantly (SMD 0.35, 95% CI -0.02 to 0.73, P = 0.06), the trials disagreed with each other (I² = 62%), and the authors rated the evidence low confidence because of imprecision and risk of bias (Elraiyah 2014).

The Cochrane review of 28 trials (1,273 women) found DHEA slightly improved sexual function overall (SMD 0.31, 95% CI 0.07 to 0.55; 5 studies, 261 women) but did not improve quality of life. Split by route, oral DHEA showed no significant effect (SMD 0.11, 95% CI -0.13 to 0.35; 5 studies, 340 women), while one intravaginal trial of 218 women did (SMD 0.42, 95% CI 0.03 to 0.81). The review's test for a difference between the oral and vaginal results was not significant (P = 0.18), so the split is a pattern, not proof (Scheffers 2015).

Panjari and colleagues enrolled 93 postmenopausal women with low sexual desire who were not on estrogen and gave 50 mg DHEA or placebo daily. After 26 weeks there was no difference in satisfying sexual events or in a sexual self-rating scale, nor in well-being or menopause symptoms (Panjari 2009).

A smaller trial gave 100 mg a day for 6 weeks to 27 postmenopausal women and 21 men with hypoactive sexual desire disorder. Women on DHEA reported better arousal (P = 0.001 at 6 weeks) and satisfaction, while men showed no benefit (Bloch 2013). The groups were tiny and short-term, and the abstract does not report an improvement in desire itself.

A meta-analysis of 25 double-blind, placebo-controlled trials in 1,353 older men (mean follow-up 36 weeks) found no effect of DHEA on sexual function or quality of life (Corona 2013). In 86 men with sexual dysfunction and low testosterone or DHEA, 50 mg DHEA twice daily did no better than placebo for sexual interest or erectile function (Morales 2009).

An older trial in 40 men with erectile dysfunction and low DHEAS reported higher scores in all five domains of the erectile function questionnaire after 6 months on 50 mg a day, but its authors said the sample was too small for relevant statistical analysis (Reiter 1999).

Adrenal insufficiency leads to DHEA deficiency, so the question there is replacement rather than a boost (Arlt 1999). In a crossover trial of 24 such women, 50 mg a day increased sexual thoughts (P = 0.006) and sexual interest (P = 0.002) compared with placebo (Arlt 1999). A 9-month trial of 25 mg a day in 39 women found no benefit (Løvås 2003), and a meta-analysis of 10 trials found the effect on sexual well-being small and not significant (Alkatib 2009). See DHEA in Addison's disease for the full picture.

DHEA causes androgenic side effects. In the Cochrane review, women on DHEA were more likely than those on placebo to have them, mainly acne (odds ratio 3.77, 95% CI 1.36 to 10.4) (Scheffers 2015). In the 26-week trial, acne and increased hair growth were more common on 50 mg a day (Panjari 2009), and 89% of women with adrenal failure on 25 mg reported side effects, especially stronger sweat odour and scalp itching (Løvås 2003).

Serious adverse effects were not more common in the pooled trials of postmenopausal women (Elraiyah 2014), and PSA stayed stable in men taking 100 mg a day (Morales 2009). These trials ran for months, not years, so long-term safety is not established, and the Endocrine Society cites limited safety data as one reason to avoid routine use (Wierman 2014).

No formal drug-interaction studies of DHEA were found. Because it is converted into testosterone and estrogens (Scheffers 2015), it adds to hormone therapy and can work against treatments that block those hormones. DHEA (prasterone) is also on the World Anti-Doping Agency's prohibited list as an anabolic agent, so athletes in tested sport should not take it (WADA 2026).