Detailed definition
Dehydroepiandrosterone (DHEA) and its sulfate ester (DHEA-S) are produced predominantly by the zona reticularis of the adrenal cortex and to a smaller extent by the ovaries and brain. DHEA is the most abundant circulating steroid in humans and serves as a metabolic precursor: it can be converted to androstenedione, then to testosterone and estradiol, in target tissues including ovary, fat, brain, breast, and skin. Serum DHEA-S declines progressively from a peak around age 25 to roughly 10–20% of peak levels by age 70, a decline often called "adrenopause." Oral DHEA is sold as a dietary supplement in the United States, but supplement quality is unregulated and clinical evidence for systemic benefit is mixed. The FDA has approved one prescription DHEA product: prasterone (Intrarosa), a daily 6.5 mg intravaginal insert that delivers DHEA locally where vaginal cells convert it to small amounts of estrogen and testosterone, treating moderate-to-severe dyspareunia from genitourinary syndrome of menopause without raising serum estrogen.
Why it matters in menopause
The intravaginal DHEA product (prasterone) is one of the few FDA-approved options for vaginal atrophy that does not deliver estrogen as the active ingredient. That makes it useful for women who want to avoid even the very low systemic exposure of vaginal estrogen, including some breast cancer survivors after consultation with their oncology team. Oral DHEA supplementation is a separate question — the evidence for systemic oral DHEA improving energy, mood, or libido in healthy postmenopausal women is unimpressive.