Scientific framework by Dr. Laura Kelly, DAOM — published researcher in midlife female sexual physiology.

What the Restore Protocol Is

The Restore Protocol is a structured approach to supporting vulvar and vaginal tissue health in midlife women using topical liposomal DHEA applied to the vulvar surface. It is based on the principle that tissue function is governed locally — by the availability of hormonal substrate within individual cells, not by circulating hormone levels alone.

Restore delivers DHEA — a natural precursor molecule — directly to vulvar tissue via a liposomal delivery system. Within the tissue, cells convert DHEA locally into the estrogens and androgens they require. This process, called intracrine conversion, allows hormone activity to be regulated at the cellular level without systemic hormone exposure.

The protocol consists of a restoration phase using Restore at 30mg per dose, applied three times weekly, and then maintenance to continue indefinitely. 

What the Restoration Phase Involves

Duration: 8–12 weeks

Dose: 23mg per application — one pump of Restore

Frequency: For the first 1-2 weeks use Restore daily, in the morning.  After the initial period, use Restore daily, or a minimum of 2 days per week.  It is important to note that each woman will find her own rhythm. 

Application site: Vulvar tissue — labia majora, labia minora, vestibule, and clitoral hood as appropriate

What to expect: Tissue response is gradual. Intracrine conversion supports epithelial thickness, collagen synthesis, barrier integrity, lubrication capacity, and sensory function — processes that develop over weeks rather than days. Some women notice changes in tissue comfort and moisture right away. Broader functional changes typically emerge over 4-8 weeks of consistent use.

Who This Protocol Is Designed For

The Restore Protocol is designed for postmenopausal and perimenopausal women experiencing changes in vulvovaginal tissue comfort, lubrication, sensory response, or sexual function associated with declining DHEA and sex steroid substrate availability.

It is appropriate for women who:

• Prefer to avoid systemic hormone therapy
• Have been told they are not candidates for estrogen therapy
• Have tried lower-dose or standard cream DHEA formulations without adequate response
• Want to support vulvovaginal tissue health as part of a broader midlife wellness approach

Women with hormone-sensitive conditions, those taking aromatase inhibitors, or those with complex hormonal histories should discuss use with their healthcare provider. Because Restore supports local intracrine conversion rather than delivering active hormones systemically, it presents a different risk profile than systemic hormone therapy — but individual assessment remains appropriate.

Why Androgens Matter — Not Just Estrogen

Most vulvovaginal therapies address the surface epithelial layer of tissue, where estrogen receptors predominate. But vulvar and vaginal tissue has distinct layers — and the deeper layers, including smooth muscle, stroma, and vascular endothelium, are richly populated with androgen receptors.

Research has established that androgens regulate functions estrogen cannot fully address: smooth muscle tone, nerve fiber density, vasodilatation, and structural collagen integrity. Vulvar tissue also expresses 5α-reductase, which converts testosterone into dihydrotestosterone — the most potent androgen — amplifying local androgen signaling within the tissue itself.

When DHEA undergoes intracrine conversion, the tissue routes substrate toward androgens in the deeper structural layers and toward estrogens at the surface — in proportions determined by each cell's own enzyme expression. Neither pathway is sacrificed for the other.

For women who have tried estrogen therapy and found it incomplete, the androgen pathway is likely the explanation. For women who cannot use estrogen, DHEA's intracrine mechanism offers a different route entirely.

→ [The full science: Why vulvovaginal tissue needs androgens, not just estrogen]

Frequently Asked Questions

Is 23mg of DHEA safe for topical vulvar use?

DHEA has been studied for topical and intravaginal use across a wide dose range. Published pharmacokinetic research has tested intravaginal doses up to 23.4mg daily and found serum sex steroid concentrations remaining within normal postmenopausal values at all doses studied. Restore's 23mg dose is applied to vulvar skin via liposomal delivery that preferentially supports local tissue uptake rather than systemic absorption. Serum sex steroids remain within normal postmenopausal range consistent with the intracrine model.

How is Restore different from other DHEA creams?

Most topical DHEA products use standard cream bases that rely on passive diffusion for absorption. Restore uses a liposomal delivery system in which microscopic lipid carriers fuse directly with skin cell membranes, depositing DHEA intracellularly where intracrine conversion occurs. Additionally, Restore is formulated for vulvar application specifically — not intravaginal use — which presents a different absorption profile and a different relationship between dose and systemic exposure.

Why is Restore applied to the vulva rather than vaginally?

Vulvar skin retains a stratum corneum that, combined with liposomal delivery, allows preferential local tissue uptake. Intravaginal application bypasses this barrier entirely, producing more direct systemic exposure. Vulvar liposomal application supports intracrine conversion within vulvar epithelial cells while maintaining sex steroid levels within normal postmenopausal range — a distinction that may be clinically relevant for women with hormone-sensitive conditions.

How long does one bottle last?

The 23ml Restore bottle contains approximately 130 doses at one pump per application. At three applications per week, this represents approximately 10 months of use. The 10ml bottle contains approximately 41 doses — approximately 6 weeks at three times weekly.

When will I notice results?

Intracrine tissue restoration is a gradual biological process. Tissue comfort and moisture changes may be noticeable within 2-4 weeks. Broader changes in sensory response and function typically emerge over 8 weeks of consistent use. Individual response varies based on baseline tissue state, duration of postmenopause, and underlying tissue capacity.

Can Restore be used alongside hormone therapy?

Restore supports local intracrine conversion rather than delivering active hormones systemically. Many women use it alongside systemic hormone therapy. Women taking aromatase inhibitors or with hormone-sensitive conditions should discuss use with their healthcare provider, as DHEA can be converted into estrogens and androgens locally within tissue.

Is this appropriate for women who cannot take estrogen?

Because Restore delivers DHEA as a precursor rather than active estrogen, and because intracrine conversion produces hormones locally within cells rather than systemically, it presents a different profile than systemic estrogen therapy. Women who have been advised to avoid systemic estrogen should discuss Restore with their healthcare provider, who can assess individual appropriateness based on their specific situation.

 

The Science This Protocol Is Built On

The Restore Protocol draws on the following published research:

Labrie F. Intracrinology. Annals of the New York Academy of Sciences. 1995;774:16–28.

Labrie F, et al. Effect of intravaginal dehydroepiandrosterone on libido and sexual dysfunction in postmenopausal women. Menopause. 2009;16(5):923–931. PubMed

Martel C, Labrie F, et al. Serum steroid concentrations remain within normal postmenopausal values in women receiving daily 6.5mg intravaginal prasterone for 12 weeks. Journal of Steroid Biochemistry and Molecular Biology. 2016;159:142–153. PubMed

Labrie F, et al. A low dose of intravaginal DHEA permits a strictly local action while maintaining all serum estrogens or androgens within normal postmenopausal values. Hormone and Molecular Biology and Clinical Investigation. 2017;29(2):39–60. PubMed

Physiology of the skin of the vulva: new aspects.(in German) PubMed

Elsner P, Wilhelm D, Maibach HI. "The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures." Contact Dermatitis. 2004. PMID: 15500670. PubMed 

Kelly L. Drive–Capacity Model of Midlife Female Sexual Function, Research Connections, 2026  Oxford Open Access

Why Delivery Mechanism Matters

Most discussions of topical DHEA focus on dose. The more important variable is how the dose reaches the tissue.

Standard cream formulations deposit DHEA on the skin surface. Absorption depends on passive diffusion through the stratum corneum — the skin's outer barrier layer. Much of the compound remains at the surface or diffuses inconsistently into deeper tissue.

Liposomal delivery works differently. Liposomes are microscopic lipid-based carriers whose membrane structure is compatible with skin cell membranes. Rather than sitting on the skin surface, liposomes fuse directly with epithelial cell membranes and deposit their payload intracellularly — inside the cells where intracrine conversion occurs.

The practical result: more DHEA reaches the tissue where it is used, and less escapes into systemic circulation before local conversion can occur.

Vulvar vs. Intravaginal Delivery — A Critical Distinction

Intravaginal DHEA formulations — including the FDA-approved prescription product prasterone — are delivered to vaginal mucosa, which has no functional stratum corneum barrier. Absorption is rapid and poorly selective between local tissue and systemic circulation. Independent clinical trials have shown measurable systemic estradiol increases at 6.5mg daily intravaginal dose, even though levels remain within normal postmenopausal range.

Vulvar skin retains a reduced but functional stratum corneum. Even though vulvar skin is significantly more permeable than general body skin — research characterizes it as having reduced stratum corneum barrier function and elevated basal blood flow compared to other skin sites — it is not equivalent to mucosal tissue.

The stratum corneum lipid architecture of vulvar skin is specifically compatible with liposomal fusion. This means liposomal carriers preferentially deposit DHEA within epithelial cells rather than allowing free diffusion into systemic vasculature.

This structural difference has an observable consequence: vulvar liposomal DHEA at 30mg applied three times weekly produces measurable serum DHEA elevation without the systemic sex steroid changes observed with intravaginal delivery at a fraction of the dose. Sex steroid levels remain within normal postmenopausal range — consistent with the intracrine model, in which locally converted hormones are utilized and inactivated within the same cells that produced them.

What Intracrine Conversion Means in Practice

Intracrine conversion is the process by which cells convert precursor molecules — in this case DHEA — into active hormones locally, using those hormones within the same cell, without releasing them into systemic circulation.

Vulvar and vaginal tissue cells express the enzymatic machinery required for this conversion, including 3β-hydroxysteroid dehydrogenase, 17β-hydroxysteroid dehydrogenase, aromatase, and 5α-reductase. These enzymes convert DHEA first into androstenedione, then into testosterone, dihydrotestosterone, and estrogens — in proportions determined by each cell's own enzyme expression profile.

Because the resulting hormones are utilized intracellularly, systemic sex steroid levels do not reflect local tissue hormone activity. A woman using Restore may have unchanged serum estradiol and testosterone while experiencing meaningful local tissue effects — because the hormonal activity is occurring within her cells, not in her bloodstream.

This is the mechanism Fernand Labrie's intracrinology research has described since 1991, and it is the scientific basis on which Restore is formulated. [Reference: Labrie F. Intracrinology. Annals of the New York Academy of Sciences. 1995;774:16–28.]

Dosage

Restore delivers 30mg of DHEA per application via liposomal carrier in 0.23ml per pump.

This dose reflects the following reasoning:

Labrie's dose-response research demonstrated meaningful tissue benefit climbing from 6.5mg to 13mg intravaginal daily. Vulvar skin, despite being highly permeable, retains a stratum corneum that limits absorption compared to vaginal mucosa. Liposomal delivery enhances local tissue uptake relative to standard cream formulations, but the delivery route still differs fundamentally from intravaginal mucosal delivery.

A higher single dose applied less frequently — three times weekly rather than daily — produces higher peak local tissue concentrations at each application, maximizing substrate availability for intracrine conversion at each dose. Research on steroid receptor signaling indicates that pulsatile rather than continuous hormone exposure preferentially activates non-genomic signaling pathways, which may support more dynamic tissue response. This intermittent pattern also more closely reflects physiological signaling than flat daily dosing. Systemic sex steroid exposure remains within normal postmenopausal range consistent with the intracrine model.

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This page is provided for educational purposes and does not constitute medical advice. Individual responses vary. Consult a qualified healthcare provider for personal guidance.

Scientific framework by Dr. Laura Kelly, DAOM. DrLauraKelly.com