Is DHEA safe to take?

Why DHEA isn't 'just a supplement'

Your adrenal glands make DHEA, and levels decline gradually with age. The body uses it as raw material to make androgens such as testosterone and estrogens such as estradiol. That's why it's often marketed for energy, libido and 'healthy aging.'

In the U.S., DHEA is legal to sell over the counter as a dietary supplement. The U.S. Anti-Doping Agency notes that most other countries treat it as a controlled anabolic steroid, and the World Anti-Doping Agency prohibits it at all times, even with a prescription. That gap reflects regulatory history more than anything about its biology.

Effects that follow from the conversion

Because DHEA becomes androgens and estrogens, its side effects look like those of too much of either hormone. USADA describes androgen effects including facial hair growth, scalp hair loss, acne, a deeper voice and higher blood pressure, and notes they may be more pronounced in women.

• Women: acne, oily skin, unwanted facial or body hair, scalp hair thinning and, with sustained high levels, voice changes that may not fully reverse.
• Men: some DHEA converts to estrogen, which can contribute to breast tenderness or tissue growth.
• Both: changes in mood or sleep are reported, in either direction.

Same dose, different results

How much DHEA turns into testosterone versus estrogen differs widely from person to person, and depends on age, sex, body fat and other medicines. So a dose that's uneventful for one person can push another into side effects. This is one reason guessing a dose from a supplement label is risky.

Who should avoid DHEA

• Anyone with a current or past hormone-sensitive cancer, such as breast, ovarian, endometrial or prostate cancer, unless their oncologist specifically advises it. USADA notes the potential for higher risk of these cancers because DHEA can convert to estrogen.
• People who are pregnant or breastfeeding.
• People with liver disease.
• Women with polycystic ovary syndrome or existing signs of androgen excess.
• Athletes in tested sport.
• Anyone on testosterone therapy, menopausal hormone therapy or an aromatase inhibitor, unless the prescriber knows and agrees.

The product-quality problem

FDA's position on dietary supplements is that manufacturers are responsible for evaluating safety and labeling before marketing, with FDA able to act after a product is on the market. In other words, there's no FDA approval step confirming that a DHEA bottle contains what it says.

USADA reports that DHEA is the most common prohibited anabolic agent it finds in supplements and that it sometimes turns up in products where you wouldn't expect it, such as a multivitamin pack. Third-party testing seals help confirm content, but they don't show that a product works.

Where DHEA is a legitimate medicine

There is an FDA-approved DHEA product: prasterone vaginal inserts (Intrarosa), approved for moderate to severe painful intercourse caused by menopausal vaginal changes. Used locally, it works in vaginal tissue. Its label notes that it hasn't been studied in women with a history of breast cancer.

DHEA is also used by endocrinologists in selected people with adrenal insufficiency. For low sexual desire, the 2019 global consensus statement on testosterone for women recommends against systemic or vaginal DHEA for that purpose because evidence is lacking. Evidence for DHEA as a general energy or anti-aging supplement is weak.

If you're already taking DHEA

Many people start DHEA on their own after reading about it. If that's you, don't panic, but do take stock. Note the dose and brand, how long you've used it, and any changes you've noticed in skin, hair, mood, sleep or periods.

Tell any clinician who orders hormone tests, because DHEA can raise testosterone and estrogen levels and make results harder to interpret. Watch for warning signs such as new facial hair, worsening acne, voice changes or breast tenderness, and stop and seek advice if they appear. If you have a personal or strong family history of hormone-sensitive cancer, talk to your doctor before continuing.

How HealifyMD handles DHEA

DHEA appears in one HealifyMD product, the compounded Enclomiphene / DHEA / Boron / Pregnenolone ODT for men (listed from $129/month), prescribed only after a clinician reviews your history and labs. Compounded medications are not FDA-approved, aren't reviewed by FDA for safety, effectiveness or quality, and aren't equivalent to branded products. If you already take DHEA on your own, tell your clinician, because it can affect hormone test results and other treatment decisions. Lab testing is priced separately; the comprehensive lab panel is listed at $199.