DHEA Supplementation Guidelines for Female Sexual Dysfunction and Adrenal Insufficiency

Primary Clinical Indications

The American College of Obstetricians and Gynecologists recommends vaginal DHEA for postmenopausal women with sexual dysfunction, as it significantly improves sexual desire, arousal, pain, and overall sexual function, including in cancer survivors 4, 5, 1
A randomized controlled trial demonstrated significant improvements in sexual function domains in 464 breast and gynecologic cancer survivors, with benefits also seen with plain moisturizer 4, 5
Vaginal DHEA is effective for vaginal dryness and dyspareunia in postmenopausal women, with the National Comprehensive Cancer Network supporting its use 4, 1, 2

The Endocrine Society recommends starting with 25 mg orally as a single daily morning dose, with adjustments between 10-50 mg based on clinical response and laboratory monitoring 1, 2, 3

Implement a 6-month trial period before determining long-term use, evaluating treatment effect after 3-6 months based on subjective improvement in target symptoms 1, 2, 3
Continue therapy only if the patient reports clinical benefit in libido, energy, or sexual function, with consideration of limiting therapy to 24 months due to limited long-term safety data 1, 2, 3

DHEA should be used with extreme caution in survivors receiving aromatase inhibitor therapy, as it may impact AI activity, according to the Journal of the National Comprehensive Cancer Network 4, 5, 2
DHEA is generally contraindicated in breast cancer survivors due to potential risks of hormone-dependent cancers, with the American Cancer Society recommending alternative treatments 2, 3

Improvements in sexual desire, arousal, lubrication, orgasm, and reduction in dyspareunia can be expected, as supported by the National Comprehensive Cancer Network and the American College of Obstetricians and Gynecologists 4, 5, 1
Enhanced vaginal health and function in women with vulvovaginal atrophy can also be expected, with benefits seen in vaginal moisturizers and lubricants 4

Pelvic physical therapy, vaginal moisturizers, and lubricants can help alleviate vaginal dryness and sexual pain, as recommended by the National Comprehensive Cancer Network and the American College of Obstetricians and Gynecologists 4, 5, 1
Flibanserin and bremelanotide are FDA-approved alternatives for premenopausal women with low sexual desire, with statistically significant increases in sexual desire and reduction in distress 4, 5, 1

Do not prescribe DHEA without establishing baseline hormone levels, as this prevents appropriate dose titration, according to the Endocrine Society 2, 3
Do not ignore signs of virilization, as these indicate excessive androgen exposure requiring immediate dose adjustment, with monitoring for hirsutism, voice deepening, or clitoral enlargement 2, 3