What are DHEA’s effects in older women?

During the perimenopausal period, there are large reductions in estrogens and progesterones. By the time menopause begins, DHEA and testosterone levels have also reduced by 55%–60%.^[1] DHEA has been studied as a potential therapeutic for postmenopausal women. A systematic review found that in postmenopausal women, supplementation with vaginal DHEA, testosterone, and estrogen were all associated, in a dose-response manner, with improvements in genitourinary complaints such as vaginal atrophy and sexual function.^[2] Like other androgens, DHEA supplementation increases testosterone in postmenopausal women, but it is unique among supplemental androgens in also increasing estrogens.^[1]

In addition, another systematic review found that in older women without health conditions, DHEA supplementation may have small benefits for bone mineral density; however, the benefits did not extend to men.^[3] Although that meta-analysis did not evaluate fracture risk, one Mendelian randomization study found that women with genes predicting higher DHEA-S serum levels had higher bone mineral density and less risk of lower back and forearm fractures (but not hip or femoral fractures).^[4]