DHEA (dehydroepiandrosterone) is a steroid precursor produced by the adrenal glands. The body converts it to estrogen and testosterone. DHEA levels decline with age.
The two product categories
Vaginal DHEA (prasterone / Intrarosa):
- FDA-approved for moderate-to-severe dyspareunia due to GSM.
- Acts locally; converted to hormones within vaginal tissue.
- Minimal systemic hormone elevation at standard dosing.
- Competes with vaginal estrogen as a local GSM treatment; choice often comes down to insurance coverage and patient preference.
Oral DHEA:
- Sold as a dietary supplement in the US — not FDA-regulated as a drug.
- Potency and purity of OTC products vary substantially.
- The Menopause Society does not recommend oral DHEA for routine menopause symptom management due to insufficient evidence.
- Some providers use it off-label in specific contexts (low-dose androgen supplementation, adrenal support).
When vaginal DHEA makes sense
- Moderate-to-severe painful intercourse due to GSM.
- Patient preference for a non-estrogen local therapy.
- Contraindication or hesitation about vaginal estrogen that can be addressed by a different molecule.