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
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.
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
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
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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