Dehydroepiandrosterone (DHEA) is a mild male hormone, which in the process of steroidogenesis (the body’s chemical process of steroid hormone production), is converted into the quintessential female hormone, estradiol, and the essential male hormone, testosterone. DHEA, thus, serves as the precursor of two hormones of major importance for the female. Estradiol is the hormone that women lack, once they go into menopause. Its deficiency has been associated with many of the standard menopausal symptoms, such as hot flashes, dryness of the vagina and the development of osteoporosis. Testosterone, on the other hand, while a strong male hormone, is also found in females, and has, in many studies, been statistically correlated to the female sex drive. Testosterone, like estradiol, declines in menopause and is substituted by many investigators in attempts to improve the declining sexual interest many women experience after menopause.

DHEA also declines significantly as women age. Indeed, since DHEA serves as substrate for the production of estradiol and testosterone, it appears likely that at least one reason for the declines in estradiol and testosterone levels may be the decline in DHEA. Indeed, investigators at our sister organization, the Center for Human Reproduction (CHR) were able to demonstrate conclusively that DHEA substitution in women with aging ovaries, to a significant degree “rejuvenates” ovarian function (for detail, see www.centerforhumanreproduction.com).

DHEA would, therefore, also appear to represent an almost ideal hormone replacement regiment for the woman in early perimenopause, in need of hormone substitution. Indeed, by administering DHEA to postmenopausal women, their need for estradiol and testosterone substitution can be met with a single drug. One can, therefore, in addition, make the argument that this kind of hormone substitution is more physiological in nature than the direct administration of either estrogen or testosterone since it mimics the natural process of steroidogenesis (i.e., the production of estradiol and testosterone by the adrenal glands and the ovaries) and allows the body to find its own balance in the production of these two hormones from DHEA. In other words, it seems reasonable to assume that the body will adjust the balance in hormone production based on the specific needs of the moment. The rigid administration of hormones, according to preset schedules, of course, cannot achieve such a goal!

Surprisingly, DHEA has not been widely used for hormone replacement in postmenopausal women. The rational of such treatment has, however, been recognized recently, and a number of formal investigations are currently underway. MRI has been using DHEA in postmenopausal women for some time and is, indeed, one of the centers which is accumulating data on its use. (For additional information on DHEA, see also the section on Alternative Treatment)