DHEA & skin

DHEA is sometimes used to treat the symptoms of menopause. Dr Haran Sivapalan explains what it is and what it does to you and your skin.

DHEA stands for dehydroepiandosterone. It is sometimes known as ‘prasterone.’ It is a hormone naturally produced by the body’s adrenal glands. More accurately, it is classified as a ‘precursor hormone’  because it is converted by the body’s tissues (including the ovary, skeleton and breast tissue) into other hormones – oestrogens and testosterone.

Your body’s natural production reaches a peak at around age 25. It then declines gradually – reaching as low as 30% of the peak level by the time you reach menopause.

What is it used for?

Synthetically produced DHEA is sometimes used as a treatment for symptoms of menopause, which include hot flushes, night sweats, vaginal dryness and decreased libido.

It is not currently licensed for use in the UK, where the current first line treatment for menopausal symptoms is conventional HRT (Hormone Replacement Therapy). Doctors may sometimes prescribe DHEA “off-label” as an alternative to HRT for loss of libido.

In the USA, DHEA may be purchased without a prescription. It is licensed for the treatment of vaginal atrophy and painful intercourse that result from menopause.

DHEA may be taken orally, via skin patches, or vaginally as a cream or pessary.

Why might it be useful in menopause?

Symptoms of menopause arise from reduced production of progesterone and oestrogen hormones by the ovaries. Lower levels of oestrogens (which include estrone, estriol and estradiol) may cause thinning and dryness of the vagina and pain during sexual intercourse (dyspareunia).

Once in the body, DHEA gets converted into oestrogen (estrone and estradiol). DHEA may therefore help to increase levels of circulating oestrogen and thereby help symptoms of vaginal dryness and painful intercourse.

Women in menopause may also experience reduced libido. This may be due to reduced levels of the hormone testosterone. DHEA also gets converted into testosterone and therefore may restore sexual desire by increasing levels of testosterone in the body.

What does the evidence say?

A Cochrane Review, widely considered to be the gold standard for assessing the effectiveness of a treatment, found that DHEA slightly improved sexual function, libido and sexual satisfaction compared to placebo. DHEA was not found to be better than conventional HRT in this regard.

Despite collating and analysing results for 1,273 menopausal women across 28 clinical trials, there was insufficient data to conclude whether or not DHEA could relieve other symptoms of menopause (such as flushing, night sweats and vaginal dryness).

The Cochrane Review found that using DHEA did not significantly improve measures of quality of life or well-being in menopausal women.

Currently, the evidence suggests that HRT is the best first-line treatment for menopausal symptoms. Anti-depressants are also sometimes prescribed for hot flushes and night sweats. More studies are required to fully assess the benefits of DHEA.

DHEA and the skin

The 2015 Cochrane Review revealed that about 15% of women taking DHEA developed acne. Acne is likely due to the increased levels of testosterone brought about by DHEA.

More positively, there is early research suggesting topically-applied DHEA may help with the rejuvenation aged skin. These results, however, are preliminary and more rigorous research is needed.