When the “pink pill” for women came to market late this past year I had a number of women asking me for it. This reminded me to look into the different options for libido. Without going into too much about the new medication, it is only approved for use in premenopausal women and most of the requests came from my postmenopausal patients. Overall, the literature also seems to suggest it carries a number of significant risks with minimal gain. Maybe I’ll do a little reassessment of this drug in the future but for now trying to see if any more “natural” remedies were available to suggest my patients. So, one of the first things on my topic list is to evaluate is DHEA.
What is DHEA ?
Keeping it simple – DHEA, also known as dehydroepiandrosterone (but we’ll just stick with DHEA), is a steroid. It is primarily made the adrenal gland but also is produced in small amounts in the brain (Strous 2006). As part of the cholesterol biochemical pathway, DHEA goes through multiple transformations leading to increased levels of testosterone and estrogen. (Callahan et al, 2004).
Do androgens matter for libido?
Studies have shown that women need a certain amount of estrogen and testosterone to maintain libido and sexual response (Clayton 2010, Davis 2005) and women with supplemented hormones show improvement in sexual functioning (Davis 2008). In premenopausal women with low scores of sexual response and arousal, lower DHEA levels were found (Turna 2005) but correlation doesn’t necessarily mean a cause.
My next question is:
What do the studies suggest about DHEA supplementation in libido improvement?
There are only a handful of studies that reviewed DHEA specifically and the results are mixed. Two small studies with higher DHEA doses [100mg] administered showed improvement in sexual function (Hackert & Heiman 2002; Schmidt 2005) but other studies with lower doses of DHEA [50mg] and more women included didn’t show a difference (Kritz-Silverstein 2008; Panjari et al 2009). A more recent study (Bloch 2013) conducted a randomized, double blind trial of 100mg DHEA supplementation for postmenopausal women. After 6 weeks the women supplemented with DHEA showed improvement in sexual arousal and satisfaction.
So, while the results are mixed and there are only a few studies, this may be something that could potentially help some of my patients.
What is the appropriate dose of DHEA?
This is a good question. Most supplements suggest 25mg daily, however, the studies used a minimum of 50mg and many of those that noted significant effects used more, 100mg. It is possible that for some women the smallest amount would be effective but with increasing doses come increasing side effects and risks.
Who should avoid DHEA?
As with any medications or supplements, there are potential side effects and risks. Individuals with any contraindication to other steroids should avoid DHEA. For instance, women with any estrogen positive cancers, individuals with liver dysfunction, insulin resistance could be worsened for those with diabetes and it may have central nervous system effects so those with psychiatric disorders may want to avoid DHEA. It also seems that women with elevated testosterone as a result of polycystic ovary syndrome would be harmed more than helped by DHEA. Those already on any hormone replacement should avoid additional hormones.
What are potential side effects?
As with any increasing androgens, the potential side effects are oily skin, acne, hot flashes and increased hair growth in a male pattern. In high enough doses or potentially if someone is very sensitive other significant risks are deepening of the voice, clitoral enlargement, and breast size reduction to name a few. Interestingly enough, in the Bloch et al (2013) paper the side effects were similar in the DHEA as in the placebo groups with short-term use.
Who might be helped by DHEA?
The studies seem to suggest that postmenopausal and potentially peri-menopausal woman, or any woman with low hormone levels as the cause of low libido, could benefit by DHEA supplementation.
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REFERENCES:
Bloch M, Meiboom H, Zaig I, Schreiber S, Abramov L (2012). The use of dehydroepiandrosterone in the treatment of hypoactive sexual desire disorder: A report of gender differences. European Neuropharmcology, 1-9.
Callahan T., Caughey A., Heffner L (2004) Blueprints, Obstetrics and Gynecology. Pages 202-204.
Clayton AH, (2010). The pathophysiology of hypoactive sexual desire disorder in women. Int J. Gynecol.Obstet. 110, 7-11.
Davis SR, Davison SL, Donath S, Bell RJ et al (2005). Circulating androgen levels and self-reported sexual function in women. JAMA 294, 91-96.
Davis SR, Moreau M, Kroll R, Bouchard, C, Panay N, Gass M, Braunstein et al (2008). Testosterone for low libido in postmenopausal women not taking estrogen. NEJM. 359, 2005-2017.
Genazzani AR, Stomati M, Valentino V, Pluchino N, Poti E, Casarosa e, Merlini S, Giannini A, Luisi M. (2011). Effect of 1-year, low dose DHEA therapy on climacteric symptoms and female sexuality. Climacteric 14, 661-668.
Hackert L, Heiman JR (2002). Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. J Womens Health Gender Based Medicine 11, 155-162.
Kritz-Silverstein D, Von Muhlen D, Laughlin GA, Bettencourt R (2008). Effects of dehydroepiandrosterone supplementation on cognitive funtion and quality of life: The DHEA and wellness (DAWN) trial. J Am Geriatric Society 56, 1292-1298.
Morales AJ, Haubrich RH, Hwang JY, Asakura H, Yen SSC (1998). The effect of six months treatment with a 100mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle screnght in age-advanced men and women. Clin Endocrinol. (Oxf), 49, 421-432.
Munarriz R, Talakoub L, Flaherty E, Giola M, Hoag L, Kim NN, Traish A, Goldstein I, Guay A, Spark R (2002). Androgen replacement therapy with dehydroepiandrosterone for androgen insufficiency and female sexual dysfunction: Androgen insufficiency and female sexual dysfunction: Androgen and questionnaire results. J Sex Marital Ther 28, 165-173.
Panjari M, Bell RJ, Jane F, Wolfe R, Adams J, Morrow C, Davis SR (2009). A randomized trial of oral DHEA treatment for sexual function, well-being and menopausal symptoms in postmenopsual women with low libido. J Sex Med 6, 2579-2590.
Schmidt PJ, Daly RC, Bloch M, Smith MJ, Danaceau MA, Simpson St Clair L, Murphy JH, Haq N, Rubinow DR (2005). Dehydroepiandrosterone manotherapy in midlife onset major and minor depression. Arch Gen Psychiatry 62, 154-162.
Shifren JL, Baunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, Burki RE, Ginsburg ES, Rosen RC, Leiblum SR, Caramelli KE, Jones KP, Daugherty CA, Mazer NA (2000). Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. NEJM 343, 682-688.
Simon J, Braunstein G, Nachtigall L, Utian W, Katz M, Miller S, Waldbaum A, Bouchard C, Derzko C, Buch A, Rodenberg C, Lucas J, Davis S (2005). Testosterone patch increases sexual activity and desire in surgically menopsual women with hypoactive sexual desire disorder. J Clin Endocrinol Met 90, 5226-5233.
Strous RD, Maayan R, Weizman A (2006). The relevance of neurosteroids to clinical psychiatry: from the laboratory to the bedside. Eur Neuropsychopharmacol. 16, 155-169.
Turna B, Apaydin E, Semerci B, Altay B, Cikili N, Nazli O (2005). Women with low libido: Correlation of decreased androgen levels with female sexual function index. Int J Impot Res 17, 148-153.
*You should consult with a qualified healthcare provider regarding your specific health risks/benefits before making decisions about therapies and/or health conditions.
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