DHEA is a hormone precursor produced mainly by the adrenal glands and is close to inactive on its own. Vulvar and vaginal tissue converts it into active androgens and estrogens inside its own cells. Circulating DHEA falls by roughly 60% by the postmenopausal years. Oral, intravaginal and topical vulvar administration are different exposures, and evidence for one does not transfer to another.
Key points
● DHEA is a precursor, not an active hormone.
● Vulvar and vaginal tissue convert it locally into androgens and some estrogens — and cannot make DHEA itself.
● Circulating DHEA declines from around age 30.
● Oral, intravaginal and topical vulvar routes are not equivalent and their evidence does not transfer.
What is DHEA?
DHEA (dehydroepiandrosterone) is a hormone precursor produced mainly by the adrenal glands, and is close to biologically inactive on its own.[1] Its significance is entirely what tissues make from it.
Levels peak in the twenties and fall from around age 30, reaching roughly 40% of young-adult levels by around the time of menopause and continuing to decline with age.[1] After ovarian production ends, DHEA becomes the principal source of sex steroids for peripheral tissue.[2]
Is DHEA a hormone?
It is a steroid but a precursor rather than an active hormone. It becomes active only when tissue converts it into testosterone, DHT or estrogens. Its effects therefore depend entirely on the receiving tissue's enzymes.
How does vulvar tissue use DHEA?
It converts DHEA into active androgens inside its own cells, where they act and are then inactivated without re-entering circulation.[1,2]
In human vaginal tissue this has been demonstrated directly, and the tissue is configured to produce androgens rather than estrogens — the enzyme making estradiol is almost undetectable there. Critically, the tissue cannot manufacture DHEA itself and depends entirely on circulating supply.[1] → Intracrine Hormone Signaling
Is oral DHEA the same as vaginal or topical?
No. These are three different exposures, and evidence for one does not transfer to another.
|
|
Oral DHEA |
Intravaginal (prasterone) |
Topical vulvar |
|
Route |
Swallowed; hepatic first pass |
Inserted vaginally |
Applied to external vulva |
|
Reaches |
Every tissue in the body |
Vaginal tissue |
Vulvar tissue |
|
Regulatory status |
Supplement (varies by country) |
Prescription drug |
Cosmetic |
|
Trial evidence |
Separate literature |
Randomised trials[3] |
None for this category |
|
Predictability |
Systemic, tissue-dependent |
Studied and characterised |
Not characterized |
This is the most useful distinction on this page. When you meet a claim about "DHEA," the first question is: by what route, and to which tissue?
What does the evidence support?
|
Tier |
Claim |
|
Established |
DHEA is a precursor to androgens and estrogens[1,2] |
|
Established |
Human vulvovaginal tissue carries the conversion enzymes and performs conversion[1] |
|
Established |
The tissue cannot synthesise DHEA de novo[1] |
|
Established |
Circulating DHEA declines substantially with age[1] |
|
Established |
Intravaginal prasterone improves dyspareunia and vaginal dryness in randomised trials[3] |
|
Established |
In those trials, serum steroid concentrations stayed within normal postmenopausal values[4] |
|
Inferred |
That local conversion capacity meaningfully contributes to tissue state in an individual woman |
|
Not established |
Any predictive relationship between an individual's DHEA level and her symptoms |
|
Not established |
Equivalence between topical vulvar application and studied intravaginal formulations |
That last point applies to us. Restore has no clinical trials of its own. The prasterone research is good evidence that local DHEA conversion is a real mechanism. It is not evidence about our product, and we will not present it as though it were.
What is Restore, and what is it not?
Restore Liposomal DHEA Vulvar Cream is a cosmetic vulvar moisturizer for external application. It is not hormone replacement therapy, not a prescription product, and not intended to diagnose, treat, cure or prevent any condition.
DHEA is fat-soluble and vulvar tissue is sensitive, so delivery is a genuine formulation problem. Restore uses a liposomal system — DHEA carried in phospholipid spheres, the same class of molecule making up cell membranes. It contains no added estrogen or testosterone, no synthetic fragrance, and no parabens or phenoxyethanol.
Who should speak to a clinician first?
Anyone with a hormone-sensitive medical history — including a personal history of breast, uterine or ovarian cancer — and anyone pregnant or breastfeeding, because DHEA is a hormone precursor.
Unexplained bleeding after menopause always warrants evaluation and is never a symptom to manage with a topical product.
In trials of intravaginal prasterone the most common adverse event was application-site discharge, and serum steroid metabolites remained within normal postmenopausal ranges over 52 weeks.[4] That is reassuring about that product by that route. Vulvar application is different because vulvar tissue is less absorbent. This means less is absorbed, so dosage is not equivalent between the vagina and the vulva.
Frequently asked questions
Is DHEA a hormone or a supplement? Biologically it is a steroid precursor. Its regulatory status varies by country and by route — prescription as intravaginal prasterone, a supplement or cosmetic ingredient elsewhere.
Will topical DHEA raise my blood hormone levels? Intravaginal prasterone trials found serum steroids remained within normal postmenopausal values.[4] Those findings describe that product by that route; they are not measurements of a cosmetic vulvar cream. We can preliminarily state that because of the differing tissue types the absorption will be lower in the vulvar tissue.
Does DHEA work for everyone? No. There is no predictive relationship between an individual's DHEA level and her symptoms, and no test of tissue-level conversion capacity.
Is topical DHEA safe with a history of breast cancer? That is a decision for your oncology team. Speak with your doctors before using any DHEA-containing product.
How long before anything changes? Tissue change is slow. Trials of intravaginal prasterone assessed outcomes over 12 weeks.[3] Think in months rather than days.
Educational note: For educational purposes only; not intended to diagnose, treat, cure or prevent any medical condition.
By Laura Kelly, DAOM, L.Ac., Dipl. OM
ORCID 0000-0001-6586-7308.
References
1. Cellai I, Di Stasi V, Comeglio P, et al. Insight on the intracrinology of menopause: androgen production within the human vagina. Endocrinology. 2021;162(2):bqaa219. doi:10.1210/endocr/bqaa219
2. Labrie F. Intracrinology and menopause. Menopause. 2019;26(2):220–224. doi:10.1097/GME.0000000000001177
3. Labrie F, Archer DF, Koltun W, et al; VVA Prasterone Research Group. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness. Menopause. 2018;25(11):1339–1353. doi:10.1097/GME.0000000000001238
4. Martel C, Labrie F, Archer DF, et al. Serum steroid concentrations remain within normal postmenopausal values in women receiving daily 6.5 mg intravaginal prasterone for 12 weeks. J Steroid Biochem Mol Biol. 2016;159:142–153. doi:10.1016/j.jsbmb.2016.03.016
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