DHEA: Available Forms and Which to Choose

On shelves and in online stores DHEA is available in dozens of variants: capsules, tablets, "micronized" powder, sublingual lozenges, creams, as well as related products such as 7-keto-DHEA or wild yam extract. The editorial team has sorted out how these forms differ from a pharmacological standpoint, which of them have been studied, and what to pay attention to in order not to buy a product that does not contain what is declared.

Oral capsules and tablets

The vast majority of clinical data on DHEA has been obtained precisely with oral forms: capsules or tablets taken once a day. After absorption in the intestine, a significant part of DHEA passes through the liver, where it is quickly sulfated to DHEA-S. Therefore oral intake effectively raises the level of DHEA-S in the blood.

This "first-pass effect" has a downside as well: part of the substance in the liver is converted into other steroids, and the profile of metabolites may differ from natural adrenal secretion. However, it was with this profile that studies were conducted, so the oral form remains the benchmark for comparison.

Manufacturers often emphasize that their DHEA is "micronized," that is, has smaller particles. In theory this improves the dissolution and absorption of a poorly soluble substance, and some pharmacokinetic works did use micronized DHEA specifically. Nevertheless, there is little convincing comparative research that would show a clinical advantage of micronization over ordinary powder.

Slow-release tablets are advertised as "more physiological," but there is no reliable data on their advantage. For most people, what matters is not the type of capsule but the accuracy of the active substance content and consistency from batch to batch.

Sublingual forms and creams

Sublingual tablets and lozenges are designed for absorption through the mucous membrane of the mouth, bypassing the liver. In that case the ratio between DHEA and DHEA-S in the blood may be different than after swallowing a capsule. However, there are far fewer clinical studies with sublingual DHEA, and there is virtually no standard data on its efficacy and safety.

Transdermal creams and gels with DHEA are most often made in compounding pharmacies or sold as cosmetics. The skin contains enzymes capable of converting DHEA into androgens and estrogens locally, so such forms can cause local effects, for example acne or hair growth in the application area.

The main problem with creams is the unpredictability of the dose. The amount of product applied, the area of skin, its thickness, and its degree of hydration substantially change absorption. In addition, there is a risk of transferring the hormone to other people through skin contact, as described for testosterone gels.

Cosmetic products "with DHEA" for the face usually contain small amounts of the substance, but their effectiveness for the skin is confirmed mainly by manufacturers' studies. The editorial team advises not to regard such products as an alternative to systemic use and not to combine several forms at once.

Vaginal prasterone — a medicinal product

Vaginal prasterone stands apart (prasterone is the international nonproprietary name for DHEA). This is a registered medicinal product in the form of vaginal suppositories of 6.5 mg, approved by the FDA in 2016 and by the European Medicines Agency (trade name Intrarosa) for the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women.

The logic of this form lies in local action: DHEA is converted into estrogens and androgens in the cells of the vagina, while systemic sex hormone levels change minimally and remain within postmenopausal values, as stated in the instructions. In other words, this is not a way to "raise hormones" throughout the whole body.

Prasterone is dispensed by prescription and has clear indications, contraindications, and a list of warnings, including hormone-dependent tumors and unexplained bleeding. This is an example of how DHEA looks in the role of a full-fledged medicinal product with proven efficacy for a specific problem.

Using vaginal suppositories for a purpose other than that stated in the instructions, or considering them equivalent to capsules, is inappropriate: this is a different form, a different dose, and a different distribution profile in the body.

7-keto-DHEA and wild yam: not to be confused

7-keto-DHEA is a metabolite of DHEA that, according to available data, is not substantially converted into testosterone or estrogens. It is advertised for "speeding up metabolism" and weight loss, but the evidence base is limited to small studies. It is important to understand: this is a different molecule with different expected effects, not an "improved DHEA."

Wild yam extracts (Dioscorea) are sold as a "natural source of DHEA." They contain diosgenin — a plant steroid from which steroid hormones are synthesized chemically in industry. However, in the human body diosgenin is not converted into DHEA, so such products cannot replace real DHEA.

Sometimes labels display combinations of "DHEA + pregnenolone" or "DHEA + plant boosters." Such mixtures complicate the assessment of effect and adverse reactions, and the content of each component is often not confirmed by independent analyses.

Athletes should remember that both DHEA and its metabolite 7-keto-DHEA (7-oxo-DHEA) are mentioned on the WADA Prohibited List as endogenous anabolic agents, so changing the form does not make the product permissible for competition.

How to assess product quality

An independent check of commercial DHEA supplements, published in JAMA, found that in some products the actual content was significantly lower or higher than declared, and in some — almost absent. The market has changed since then, but the problem of inaccurate labeling of supplements remains relevant.

The most reliable guide is certification by independent laboratories (for example, programs like USP Verified or NSF), which confirms the content and the absence of impurities. For athletes, even certification "for sport" does not save them, because DHEA itself is banned.

• choose products with an exact indication of the amount of DHEA in one capsule;
• look for an independent analysis or a certificate of batch conformity;
• avoid "proprietary blends" without disclosure of doses;
• do not buy "DHEA from wild yam" as a substitute for real DHEA;
• check the expiration date and storage conditions.

Even the best product does not replace laboratory monitoring. The only way to find out how a particular form works for you is to measure DHEA-S and other hormones before and after starting use together with a doctor.

Editorial conclusions

The most research has been conducted with oral DHEA, so it is precisely capsules and tablets that give the most predictable picture. Sublingual forms and creams are studied far worse.

Vaginal prasterone is a separate prescription medicinal product with local action, while 7-keto-DHEA and wild yam are products with different pharmacology that should not be confused with DHEA.

When choosing, more important than the form is the confirmed content of the active substance and laboratory monitoring.

We also recommend reviewing our materials "How to Take DHEA: Dosage, Timing, Duration," "Side Effects of DHEA," and "What to Combine DHEA With."

References

1. Kroboth PD, Salek FS, Pittenger AL, et al. DHEA and DHEA-S: a review. J Clin Pharmacol. 1999;39(4):327–348.
2. Legrain S, Massien C, Lahlou N, et al. Dehydroepiandrosterone replacement administration: pharmacokinetic and pharmacodynamic studies in healthy elderly subjects. J Clin Endocrinol Metab. 2000;85(9):3208–3217.
3. Parasrampuria J, Schwartz K, Petesch R. Quality control of dehydroepiandrosterone dietary supplement products. JAMA. 1998;280(18):1565.
4. U.S. Food and Drug Administration. Intrarosa (prasterone) vaginal inserts: prescribing information. 2016.
5. European Medicines Agency. Intrarosa (prasterone): European public assessment report. 2018.
6. Webb SJ, Geoghegan TE, Prough RA, Michael Miller KK. The biological actions of dehydroepiandrosterone involves multiple receptors. Drug Metab Rev. 2006;38(1-2):89–116.
7. World Anti-Doping Agency. Prohibited List. Montreal: WADA; чинна редакція.