Understanding DHEA and Age-Related Decline
Dehydroepiandrosterone (DHEA) is a hormone produced primarily by the adrenal glands that acts as a precursor to other sex hormones, including estrogen and testosterone. As a woman enters her late 30s and beyond, her DHEA production naturally begins to decrease, and by her 60s, it may be a fraction of what it was in her younger years. This age-related decline has led to interest in DHEA supplementation for a variety of purposes, from addressing menopausal symptoms to supporting bone density. However, DHEA supplements are not a one-size-fits-all solution, and their use requires careful consideration, especially for older women.
Oral DHEA Considerations for Women Over 60
For postmenopausal women, oral DHEA supplementation has been explored in numerous clinical trials, with various daily amounts studied. The effects, however, are inconsistent across different studies and women.
- Starting low is advised: Many experts recommend starting with a lower amount, and adjusting only under a doctor's guidance. This approach helps minimize potential androgenic side effects.
- Higher amounts: Some studies have used larger amounts, particularly when targeting specific conditions like bone mineral density, but these also carry an increased risk of side effects. A recent meta-analysis of postmenopausal women aged 60 and older found that larger amounts significantly elevated both testosterone and estradiol levels.
- Testing is key: Before starting any supplementation, it is critical for a woman over 60 to have her DHEA-S levels tested to establish a baseline. Regular monitoring is then necessary to ensure levels remain within a safe range, reflecting youthful levels without causing adverse effects.
Different Approaches: Oral vs. Vaginal DHEA
For women seeking relief from specific symptoms like vaginal dryness, the route of administration is a critical factor. The FDA has approved a prescription vaginal insert containing the synthetic form of DHEA, called prasterone, for treating painful intercourse associated with menopause.
- Oral DHEA: Provides systemic effects throughout the body. Once ingested, it is converted into androgens and estrogens in various tissues. This can result in widespread benefits, but also increases the risk of systemic side effects.
- Vaginal DHEA (Intrarosa): Applied daily at bedtime, it produces a localized effect on genitourinary tissues. This targeted approach significantly improves symptoms of vaginal dryness and painful sex with minimal absorption into the bloodstream, thereby reducing the likelihood of systemic side effects.
Oral vs. Vaginal DHEA Comparison
| Feature | Oral DHEA Supplement | Vaginal DHEA (Intrarosa) |
|---|---|---|
| Typical Administration | Daily in clinical studies | Vaginal insert nightly |
| Regulation | Unregulated dietary supplement by the FDA | FDA-approved prescription medication |
| Primary Purpose | Systemic effects for potential benefits on bone density, libido, and mood | Localized treatment for painful sex due to menopause |
| Side Effects | Higher risk of systemic androgenic side effects (acne, hair growth), changes in cholesterol | Minimal systemic effects; main side effect is vaginal discharge |
| Absorption | Absorbed through the digestive system; undergoes significant liver metabolism | Absorbed locally by vaginal tissues with minimal systemic absorption |
Potential Risks and Side Effects for Older Women
For women over 60, considering DHEA supplementation involves weighing potential benefits against significant risks, especially regarding long-term use.
- Androgenic Side Effects: DHEA is converted to androgens (like testosterone), which can cause side effects such as oily skin, acne, and hirsutism (unwanted facial hair growth). The risk of these side effects increases with higher amounts.
- Hormone-Sensitive Cancers: Because DHEA is converted into estrogen and testosterone, it may increase the risk of hormone-sensitive cancers, including breast and ovarian cancer. Women with a history or high risk of these cancers should avoid DHEA supplementation.
- Cardiovascular Health: DHEA may decrease levels of protective HDL ("good") cholesterol. This is a concern for older women already at risk for cardiovascular disease.
- Mental Health: DHEA might worsen psychiatric disorders, including mood disorders, and increase the risk of mania.
- Unregulated Supplements: Over-the-counter DHEA supplements lack FDA regulation and may have inconsistent potency and purity, adding an element of risk.
The Critical Role of Medical Supervision
Given the varied study results, potential risks, and unregulated nature of supplements, taking DHEA should always be done under the supervision of a qualified healthcare provider. An expert can:
- Assess need: Determine if DHEA supplementation is appropriate based on individual health history, symptoms, and potential risks.
- Test hormone levels: Order blood tests to check baseline DHEA-S levels and monitor them throughout supplementation.
- Recommend appropriate form: Advise on the best route of administration (oral vs. vaginal) based on a woman's specific health goals.
- Monitor side effects: Watch for signs of androgenic or other side effects and adjust administration accordingly.
Conclusion
While some clinical studies show potential benefits for older women using DHEA, particularly regarding bone density and sexual health, the evidence is not conclusive and risks are present. For localized symptoms like painful intercourse, the FDA-approved vaginal insert provides a safer, targeted approach. Ultimately, a 60-year-old woman should not self-prescribe DHEA. Working with a healthcare provider to test DHEA-S levels, weigh the pros and cons, and closely monitor any treatment is the safest and most responsible course of action.
Potential Benefits and Safety of DHEA
As discussed in a recent article from the Center for Human Reproduction, DHEA supplementation has shown some promise for improving sexual function in postmenopausal women, especially when administered vaginally for issues related to genitourinary syndrome of menopause. However, they also emphasize that oral DHEA has less conclusive evidence regarding its benefits. This highlights the importance of choosing the right form of DHEA for specific health concerns.
