Talking to Your Patients About OTC DHEA

CLINICAL ACTIONS:

Patient complaints regarding sexual functioning, either lowered levels of desire, or difficulty becoming aroused, are common. Currently, there are drugs, such as testosterone, that are being used ‘off label’ for this purpose. A patient may request a trial of a ‘more natural’ alternative, available over the counter (OTC) such as Dehydroepiandrosterone (DHEA). In this setting, consider discussing the following

• Because DHEA converts into testosterone, ongoing use of DHEA may result in side effects associated with testosterone use
• Side effects of DHEA are generally less severe than testosterone, although patients may experience some hair growth, oily skin or acne
• In very high doses, more than 1600 milligrams daily, DHEA can have the same significant side effects as testosterone: hair growth, hair loss on the head, voice deepening and clitoral enlargement

SYNOPSIS:

Data support the positive role of androgens in female sexual function and ovarian physiology. However, the availability of approved testosterone formulations remains limited, particularly in the US. Therefore, patients may opt to obtain DHEA, the precursor hormone, in its stead.  There is no positive guidance regarding the use of DHEA in women for sexual dysfunction because currently there remains a lack of well-designed studies demonstrating consistent clinical improvement.

KEY POINTS:

• DHEA will convert into estrogen as well as testosterone and therefore extra caution to avoid this hormone may be reasonable in women with a history of breast or uterine cancer
• DHEA is not FDA approved as a drug and therefore what is packaged may not be reliably indicated on the bottle
• In a small but well-designed pilot study that studied sleep patterns in healthy postmenopausal women, DHEA supplementation can cause sleep stimulation or inhibition
• ACOG states

Systemic DHEA has been tested but has not shown efficacy in postmenopausal women for treatment of sexual interest and arousal disorders and, therefore, is not recommended for use

Learn More – Primary Sources:

Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction

ACOG Practice Bulletin 213: Female Sexual Dysfunction

DHEA therapy for women: effect on sexual function and wellbeing

Effects of a 3-week dehydroepiandrosterone administration on sleep, sex steroids and multiple 24-h hormonal profiles in postmenopausal women: a pilot study