Menopause can make your body feel unfamiliar. Sleep may change. Energy can drop. Sex may become uncomfortable. Strength and body composition may shift.
Most women know that estrogen and progesterone change during this transition. Fewer have heard much about dehydroepiandrosterone, better known as DHEA.
DHEA is a hormone made primarily by the adrenal glands. It serves as a building block that tissues can use to produce androgens and estrogens. Its production naturally declines with age, so lower levels become more common in midlife and beyond.
That has led to growing interest in DHEA deficiency in menopausal women. It has also created confusion. A low DHEA-S result does not automatically explain fatigue, low libido, brain fog, or every other menopausal symptom. It is one piece of a larger health picture.
In my practice, I want women to understand both sides of this conversation. DHEA can be relevant. It should not become a catch-all diagnosis or an automatic reason to start a supplement.
Key Takeaways
- DHEA is produced mainly by the adrenal glands and can be converted within tissues into androgens and estrogens.
- DHEA and DHEA-S levels decline naturally with age, independent of menopause.
- There is no single DHEA-S cutoff that defines androgen deficiency in all menopausal women.
- Symptoms linked with low DHEA overlap with many other common medical and menopausal concerns.
- DHEA-S testing can be helpful when it is interpreted in the context of age, symptoms, medications, medical history, and other laboratory results.
- Oral DHEA has mixed evidence for general menopausal symptoms and can cause androgenic side effects.
- Prescription vaginal prasterone is different from over-the-counter oral DHEA and is used for a specific menopausal concern.
1. What is DHEA?
DHEA stands for dehydroepiandrosterone. DHEA-S is its sulfated form, dehydroepiandrosterone sulfate.
The adrenal glands produce most circulating DHEA-S. Smaller amounts of DHEA are made by the ovaries and other tissues. Their importance comes largely from their role as precursors. Individual tissues can convert them into more active androgens or estrogens.
This does not mean DHEA simply “becomes testosterone or estrogen” in a predictable amount. Conversion varies from one person and tissue to another. That is one reason supplementation can affect women differently.
The National Library of Medicine’s DHEA-S testing guide explains that DHEA-S is made mostly in the adrenal glands and contributes to the production of testosterone and estrogen. A detailed Endotext review of adrenal androgens and aging describes DHEA and DHEA-S as precursor hormones whose clinical and therapeutic roles in aging remain controversial and, in many areas, inconclusive.
2. Why do DHEA levels decline?
DHEA production rises during development, peaks in early adulthood, and then gradually declines. According to the Endotext review, circulating DHEA and DHEA-S may decrease by roughly 2% to 5% per year after the third decade of life. By menopause, DHEA may be substantially lower than it was at its peak.
This age-related change is sometimes called “adrenopause.” The term can be misleading. It does not mean the adrenal glands suddenly stop working when menopause begins. DHEA decline is gradual, occurs in men and women, and is independent of the ovarian changes that define menopause.
For that reason, DHEA deficiency in menopausal women needs careful wording. A lower value may reflect expected aging. Medications, pituitary function, adrenal disease, glucocorticoid use, and individual biology may also affect it.
Chronic stress is often blamed for “draining” DHEA. That explanation is too simple. Stress, sleep, illness, and overall health can interact with hormone physiology, but a low result should not automatically be labeled “adrenal fatigue.” If the value is unexpectedly low or symptoms raise concern for adrenal or pituitary disease, the evaluation should look beyond lifestyle alone.
3. What symptoms can overlap with low DHEA?
Patients often ask me whether fatigue, low mood, brain fog, lower libido, vaginal dryness, or loss of strength means their DHEA is low. These symptoms can occur alongside lower DHEA-S, but they are not specific to it. They may also relate to changing estrogen levels, poor sleep, thyroid disease, iron deficiency, depression, medications, nutrition, insulin resistance, or chronic illness.
Symptoms sometimes discussed in connection with DHEA deficiency in menopausal women include:
- Lower sexual desire
- Vaginal tissue thinning or dryness
- Reduced energy
- Lower mood or reduced sense of well-being
- Changes in muscle mass or strength
- Changes in bone density
Association is not causation. A woman can have low DHEA-S without symptoms. Another can have several symptoms with a result appropriate for her age. If we assume one hormone explains everything, we can miss a more treatable cause.
When symptoms need a broader evaluation?
Very low DHEA-S can occur with adrenal insufficiency or reduced pituitary signaling. Those conditions usually require a broader medical evaluation, not DHEA supplementation alone.
The National Library of Medicine notes that low DHEA-S related to adrenal disease may occur with unexplained weight loss, nausea, vomiting, dizziness, dehydration, or salt craving. Those symptoms are different from the more gradual, nonspecific concerns many women notice in menopause.
4. How is DHEA-S tested and interpreted?
A blood test typically measures DHEA-S rather than DHEA. DHEA-S circulates at higher concentrations, has a longer half-life, and remains more stable throughout the day. This makes it more practical for assessing adrenal androgen production.
The blood draw generally requires no special preparation. Interpretation is the more important part. A result should be compared with the laboratory’s age- and sex-specific range. Levels vary among healthy people, and no universally accepted threshold proves clinically meaningful androgen deficiency in a menopausal woman.
When I evaluate possible DHEA deficiency in menopausal women, I do not look at the number in isolation. I consider:
- The woman’s age and menopausal stage
- Her specific symptoms and when they began
- Prescription medications and supplements
- Glucocorticoid exposure
- Estrogen and androgen therapy
- Thyroid function and other relevant laboratory results
- Sleep, nutrition, exercise, stress, and recovery
- Signs that could suggest adrenal or pituitary disease
Depending on the question, DHEA-S may be reviewed alongside testosterone, sex hormone-binding globulin, estradiol, thyroid markers, blood counts, iron studies, or metabolic markers. Cortisol testing may be appropriate when the history raises a specific concern, but it is not automatically required.
That is what I mean when I say evaluating DHEA deficiency in menopausal women at RMRM starts with context. The goal is not to chase a single “optimal” number. It is to understand what the result may mean for the whole person.
You can learn more about our broader approach through the Thrive Women’s Health Program and our hormone therapy services.
5. Does oral DHEA supplementation help?
DHEA supplements are sold over the counter in the United States. Easy access can make them seem low risk. They are still hormonally active.
Oral DHEA can raise DHEA-S and change androgen and estrogen exposure. Potential side effects include:
- Acne or oily skin
- Increased facial or body hair
- Scalp hair thinning
- Mood changes
- Changes in other hormone levels
Product quality and dose consistency may vary. DHEA may not be appropriate with a hormone-sensitive condition or when other hormones or medications are involved.
The evidence is also more restrained than supplement marketing often suggests. A Cochrane review of DHEA in peri- and postmenopausal women found no evidence that DHEA improves quality of life and noted uncertainty around menopausal symptoms and sexual function. It also found an association with androgenic side effects, especially acne.
Oral DHEA may still have a role. Treatment should have a clear reason, an appropriate dose, and a monitoring plan. Treating DHEA deficiency in menopausal women should not mean giving the same supplement to every woman with a low-normal result.
6. How is vaginal prasterone different?
Vaginal prasterone is a prescription form of DHEA used locally. It is not the same as taking an oral DHEA supplement for energy, mood, or general anti-aging purposes.
Prasterone, sold as Intrarosa, is FDA approved for moderate to severe pain with sexual activity due to vulvar and vaginal atrophy associated with menopause. It acts within vaginal tissues.
The FDA prescribing information for Intrarosa identifies vaginal discharge and an abnormal cervical Pap smear as adverse reactions reported more often than with placebo in clinical studies. The label also states that women with postmenopausal bleeding that has not been evaluated should be assessed before treatment.
Vaginal dryness, irritation, urinary symptoms, and painful sex may be part of genitourinary syndrome of menopause, or GSM. Options include nonhormonal moisturizers and lubricants, vaginal estrogen, vaginal prasterone, or other therapies based on medical history.
The key point is simple. Evidence for a local prescription treatment addressing a specific tissue problem should not be used as proof that oral DHEA treats every symptom attributed to DHEA deficiency in menopausal women.
7. What supports healthy hormones in midlife?
No lifestyle strategy can prevent every age-related hormonal change. Healthy routines can still improve many of the same outcomes women hope to address when they ask about DHEA.
Resistance and aerobic exercise
Adequate nutrition
Sleep and recovery
Stress support
These foundations are not a substitute for appropriate treatment. They are part of it. A thoughtful plan for DHEA deficiency in menopausal women should support muscle, bone, metabolic health, sleep, sexual health, and quality of life rather than focusing only on a laboratory value.
A more useful way to think about DHEA
DHEA matters. So does precision.
Levels decline with age. Lower DHEA-S may be relevant, but it is not a stand-alone explanation for menopausal symptoms. Testing can help when there is a clear clinical question and the result is interpreted in context.
If supplementation is considered, it should be purposeful. The potential benefit should be weighed against androgenic side effects, interactions, medical history, and the limits of the evidence.
At RMRM, my approach to DHEA deficiency in menopausal women starts with the complete picture. I listen, review symptoms and history, select relevant labs, and discuss evidence-based options. Sometimes DHEA is part of that conversation. Often, the most important finding is somewhere else.
