The physiological role of
dehydroepiandrosterone (
DHEA) and
DHEA sulphate (DHEAS) is poorly understood. It depends in a large part on their transformation into
testosterone and
estradiol. The capacity of
DHEA as a
neurosteroid, the recent discovery of putative specific
DHEA receptors on endothelial and vascular smooth muscle cells, the steady decrease of
DHEA production from the 40s on, together with certain human epidemiologic data as well as various beneficial effects of DHA supplementation in rodents have suggested the possibility that this
steroid is involved in cognitive and memory, metabolic and vascular, immune and sexual functions and in their aging. However, epidemiologic studies are conflicting, and no well-designed clinical trials have definitely substantiated the role of
DHEA in these functions in humans, or the utility and safety of
DHEA supplementation. However, beneficial effects seem plausible in women with several conditions according to the results of double-blind placebo-controlled trials: the dose of 30 to 50 mg seems beneficial to the mood, sense of well being and sexual desire and activity of women with
adrenal insufficiency. The only long-term trial of supplementation devoted to women over 60 reported significant increases in bone mineral density and, in the 70-79-year-old subgroup, in sexual desire, arousal, activity and satisfaction. The dose of 200 mg also proved to decrease disease activity in
systemic lupus erythematosus. Lastly, high
DHEA doses have improved mood in various groups of patients of any age and gender with depressive symptoms. The use of
DHEA therapy may also be discussed in women of any age when a trial of
androgen supplementation seems justified because of the existence of an inhibited sexual desire or a
sexual arousal disorder associated with documented
androgen deficiency. The rather weak conversion of
DHEA into
testosterone protects from the risk of overdosing associated with
testosterone preparations. However, it must be realized that
DHEA is also converted into
estradiol, which may be a risk factor for breast or
endometrial cancer in postmenopausal women. Unlike women, no consistent beneficial effect has been found for men in the placebo-controlled trials. The present data do not exclude a role of
DHEA in other conditions, but this remains to be properly established. This paper includes practical considerations on dosage to be used,
contraindications and follow-up.