title: Testosterone for low libido in postmenopausal women not taking estrogen. [Does dehydroepiandrosterone improve well-being?]. Endocrine, neuroendocrine and behavioral effects of oral dehydroepiandrosterone sulfate supplementation in postmenopausal women. Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in postmenopausal women. Delivery of dehydroepiandrosterone to premenopausal women: effects of micronization and nonoral administration. Lack of influence of dyspareunia on the beneficial effect of intravaginal prasterone (dehydroepiandrosterone, DHEA) on sexual dysfunction in postmenopausal women. Acute Dehydroepiandrosterone Effects on Sexual Arousal in Premenopausal Women Replacement of dehydroepiandrosterone enhances T-lymphocyte insulin binding in postmenopausal women. Oral dehydroepiandrosterone in physiologic doses modulates immune function in postmenopausal women. A randomized controlled trial of dehydroepiandrosterone in postmenopausal women with fibromyalgia. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial The effect of dehydroepiandrosterone on lumbar spine bone mineral density in patients with quiescent systemic lupus erythematosus. Postmenopausal dehydroepiandrosterone administration increases free insulin-like growth factor-I and decreases high-density lipoprotein: a six-month trial. The use of dehydroepiandrosterone in the treatment of hypoactive sexual desire disorder: A report of gender differences Postmenopausal steroid replacement with micronized dehydroepiandrosterone: preliminary oral bioavailability and dose proportionality studies. Supplementation with DHEA: effect on muscle size, strength, quality of life, and lipids. Intravaginal dehydroepiandrosterone (prasterone), a highly efficient treatment of dyspareunia Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women Dehydroepiandrosterone for the treatment of hot flashes: a pilot study. Effects of dehydroepiandrosterone supplementation on cognitive function and quality of life: the DHEA and Well-Ness (DAWN) Trial. Effects of prasterone on bone mineral density in women with active systemic lupus erythematosus receiving chronic glucocorticoid therapy. Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. The effect of dehydroepiandrosterone (DHEA) on recognition memory decision processes and discrimination in postmenopausal women Dehydroepiandrosterone-sulphate replacement improves the human plasma fatty acid profile in plasma of obese women Low serum levels of sex steroids are associated with disease characteristics in primary Sjogren's syndrome; supplementation with dehydroepiandrosterone restores the concentrations. Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial. The safety of 52 weeks of oral DHEA therapy for postmenopausal women. Lack of dehydroepiandrosterone effect on a combined endurance and resistance exercise program in postmenopausal women. Changes in hormones, lipids and symptoms after the administration of a commercial preparation with dehydroepiandrosterone in postmenopausal women. Pangenomic changes induced by DHEA in the skin of postmenopausal women Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality Serum steroid levels during 12-week intravaginal dehydroepiandrosterone administration Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy A randomized trial of oral DHEA treatment for sexual function, well-being, and menopausal symptoms in postmenopausal women with low libido. High internal consistency and efficacy of intravaginal DHEA for vaginal atrophy
abstract: BACKGROUND The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy  are unknown . METHODS We conducted a double-blind , placebo-controlled , 52-week trial in which 814 women with hypoactive sexual desire disorder were r and omly assigned to receive a patch delivering 150 or 300 microg of testosterone per day or placebo .  Efficacy was measured to week 24 ; safety was evaluated over a period of 52 weeks , with a subgroup of participants followed for an additional year . The primary end point was the change from baseline to week 24 in the 4-week frequency of satisfying sexual episodes . RESULTS At 24 weeks , the increase in the 4-week frequency of satisfying sexual episodes was significantly greater in the group receiving 300 microg of testosterone per day than in the placebo group ( an increase of 2.1 episodes vs. 0.7 , P<0.001 ) but not in the group receiving 150 microg per day ( 1.2 episodes , P=0.11 ) . As compared with placebo , both doses of testosterone were associated with significant increases in desire ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) and decreases in distress ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) . The rate of and rogenic adverse events - primarily unwanted hair growth - was higher in the group receiving 300 microg of testosterone per day than in the placebo group ( 30.0 % vs. 23.1 % ) . Breast cancer was diagnosed in four women who received testosterone ( as compared with none who received placebo ) ; one of the four received the diagnosis in the first 4 months of the study period , and one , in retrospect , had symptoms before undergoing r and omization . CONCLUSIONS In postmenopausal women not receiving estrogen therapy  , treatment with a patch delivering 300 microg of testosterone per day result ed in a modest but meaningful improvement in sexual function . The long-term effects of testosterone , including effects on the breast , remain uncertain . ( Clinical Trials.gov number , NCT00131495 . OBJECTIFS : Le role physiologique de la dehydro-epi and rosterone ( DHEA ) chez l'etre humain reste incertain . L'insuffisance surrenale entraine un deficit en DHEA . L'administration de DHEA a des sujets âges en bonne sante entraine une augmentation de la densite osseuse , de la force musculaire , de la sensation de bien-etre et des concentrations du facteur de croissance « insuline-like » ( IGF-I ) . Mais ces etudes n'ont pas utilise de question naires valides de bien-etre et la plupart etaient ouvertes sans comparaison au placebo . L'objectif de l'essai est d'evaluer les effets de la supplementation en DHEA chez des patientes ayant une insuffisance surrenale sur le bien-etre et la sexualite . METHOD ES : Vingt quatre femmes ayant une insuffisance surrenale , ont ete incluses dans un essai croise , en double insu , et ont recu 50 mg de DHEA per os chaque matin pendant 4 mois et le placebo chaque matin pendant 4 mois , l'ordre des traitements etant attribue par la r and omisation . Une periode de 1 mois sans traitement separait les 2 periodes de traitement . Ont ete mesures les hormones steroides seriques , l'IGF-I , les lipides et l'hormone « sex-binding globulin » ( SBG ) . Ont egalement ete evaluees la sensation de bien-etre et la sexualite , a l'aide de question naires psychologiques valides et d'echelles visuelles analogiques . Les femmes ont ete evaluees avant le debut du traitement , apres 1 mois et 4 mois de traitement par DHEA , apres 1 mois et 4 mois de traitement par placebo , et 1 mois apres la fin de la deuxieme periode de traitement . PATIENTS : L'âge moyen des 24 femmes est de 42 ± 9 ans , l'anciennete de l'insuffisance surrenale est de 9 ± 2 ans . L'insuffisance surrenale est primitive pour 14 femmes et secondaire pour 10 femmes . Toutes les femmes prenaient une dose reguliere de glucocorticoides et 14 prenaient egalement des mineralocorticoides .  Sept femmes etaient menopausees , 3 avaient un hypogonadisme primitif et 7 un hypogonadisme secondaire . Parmi ces 17 femmes , 13 recevaient un traitement hormonal substitutif par estroprogestatifs . RESULT ATS : Le traitement par DHEA augmente les taux seriques initiaux bas de sulfate de DHEA , d ' and rostenedione et de testosterone jusqu'a des taux normaux . Les concentrations seriques de SBG , de cholesterol total , de lipoproteines de haute densite diminuent significativement . La DHEA ameliore significativement le score global de bien-etre , de meme que les scores de depression et d'anxiete . Ainsi , le score global s'ameliore de -0,18 ± 0,29 par rapport au debut du traitement dans le groupe DHEA , contre 0,03 ± 0,29 dans le groupe placebo ( p = 0,02 ) . Comparee au placebo , la DHEA augmente significativement la frequence des pensees sexuelles ( p = 0,006 ) , de l'interet sexuel ( p = 0,002 ) et la satisfaction avec la sexualite ( p = 0,02 ) . CONCLUSION : La DHEA ameliore le bien-etre et la sexualite chez des femmes ayant une insuffisance surrenale Aging in women and men is characterized by a progressive decline of circulating dehydroepi and rosterone ( DHEA ) levels and its sulfate ester ( DHEAS ) . The improvement of wellbeing described in postmenopausal women treated with DHEA  suggests that this steroid may exert specific actions on the central nervous system ( CNS ) . The postmenopausal period is associated with several neuroendocrine modifications . The decrease of circulating levels of beta-endorphin is considered a hormonal marker of those changes . The aim of the present study was to investigate neuroendocrine and behavioral effects of three months of DHEAS supplementation in postmenopausal women . Postmenopausal women ( n = 22 ) were divided in three groups : the first group was treated with oral DHEAS ( n = 8) ( 50 mg/day ) , the second treated with the same dose of oral DHEAS + transdermal estradiol ( n = 8) ( DHEAS ) 50 mg/day , estradiol 50 micrograms/patch ) and the third with transdermal estradiol alone ( n = 6 ) ( 50 micrograms/day ) . Before and after 1 , 2 and 3 months of therapy , the following circulating steroid and protein hormone levels were evaluated : DHEA , DHEAS , and rostenedione , testosterone , estrone , estradiol , 17-hydroxyprogesterone , sex hormone-binding globulin ( SHBG ) , follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LH ) , beta-endorphin , growth hormone ( GH ) and cortisol , and a Kupperman score was performed . Before and after treatments , plasma beta-endorphin levels were evaluated in response to three neuroendocrine tests : ( a ) clonidine , an alpha 2-presynaptic adrenergic agonist ( 1.25 mg i.v . ) ( b ) naloxone , an opioid receptor antagonist ( 4 mg i.v . ) and ( c ) fluoxetine , a serotonin selective reuptake inhibitor ( 30 mg p.o . ) . In both groups of women treated with  DHEAS  , mean basal serum DHEA , DHEAS , and rostenedione , and testosterone levels significantly increased after treatment , while no changes were shown in the group receiving estradiol alone . Serum estradiol , estrone , GH and plasma beta-endorphin levels significantly increased progressively for the three months of treatment , with higher levels for estrone and estradiol in subjects receiving estradiol alone or plus DHEAS . Serum SHBG , cortisol , and 17-hydroxyprogesterone did not show significant variations under any treatment . Serum LH and FSH levels showed a significant decrease in groups treated with estradiol alone or plus DHEAS at the second and third months . The Kupperman score showed that all treatments were associated with similar and progressive improvement . Before therapy clonidine , naloxone and fluoxetine stimuli failed to modify circulating beta-endorphin levels . After each of the treatments , the beta-endorphin response was completely restored and was similar , independent of the kind of therapy . Restoration of the beta-endorphin response to specific stimuli suggests that DHEAS and /or its active metabolites modulates the neuroendocrine control of pituitary beta-endorphin secretion , which may support the therapeutic efficacy of the DHEAS on behavioral symptoms Menopause is associated with decreased lean body mass and increased fat due to aging and declining hormone secretion . Estrogens or estrogen-progestins have been used to alleviate vasomotor symptoms . However , estrogen- and rogen ( E/A ) therapy is also used for vasomotor symptom relief and has been shown to increase lean body mass while decreasing fat mass . The objective of this 16-wk , double-blind , r and omized , parallel group clinical trial was to compare esterified estrogen plus methyltestosterone ( 1.25 mg estrogen + 2.5 mg methyltestosterone/d ; E/A group ) vs. esterified estrogen alone ( 1.25 mg/d ; E group ) on body composition . Forty postmenopausal women ( mean age , 57 yr ) participated . Compared with estrogen treatment alone , women in the E/A group increased their total lean body mass and reduced their percentage fat for all body parts ( P < 0.05 ) . After E/A treatment , there were statistically significant increases in lean body mass by 1.232 kg [ 0.181 + /- 0.004 , 0.81 + /- 0.057 , and 0.24 + /- 0.009 kg in the upper body ( P = 0.021 ) , trunk ( P = 0.001 ) , and lower body ( P = 0.047 ) , respectively ] . In the E group , the increase was 0.31 + /- 0.004 , 0.021 + /- 0.03 , and 0.056 + /- 0.05 kg in the upper body , trunk , and lower body , respectively . In the E/A group , body fat was reduced by 0.90 kg ( P = 0.18 for the trunk only ) , and percentage body fat declined by 7.4 % ( P < or = 0.05 for all body parts ) . Lower body strength increased by 23.1 kg ( 51 lb ) in the E/A group vs. only 11 kg ( 24.25 lb ) in the E group ( P = 0.002 between groups ) . A statistically significant increase in weight ( 2.7 + /- 5.1 vs. 0.1 + /- 4.6 lb ; P < 0.05 ) was observed in the E/A group compared with the E group . When subjects were given self-reporting question naires , more improvement was noted in sexual functioning and quality of life in the  E/A  group when compared with patients receiving E alone . There were no noteworthy side effects . In conclusion , E/A replacement therapy can improve body composition , lower-body muscle strength , quality of life , and sexual functioning in postmenopausal women OBJECTIVES This single-dose study compares three dehydroepi and rosterone delivery methods  ( oral crystalline steroid , micronized steroid , and vaginal administration ) to ascertain whether physiologic levels of circulating dehydroepi and rosterone and dehydroepi and rosterone sulfate can be obtained while increases in testosterone are minimized . STUDY DESIGN Two r and omized , double-blind , placebo-controlled single-dose comparisons were made . For oral micronized versus crystalline dehydroepi and rosterone 300 mg doses of micronized or crystalline dehydroepi and rosterone were administered , followed by 6 hours of blood sampling ( n=7 ) . Serum dehydroepi and rosterone , dehydroepi and rosterone sulfate , and testosterone levels were measured ; areas under the curve and mean peak values were analyzed by Student-Newman-Keuls tests . For oral versus vaginal micronized dehydroepi and rosterone 150 mg oral or vaginal doses of micronized dehydroepi and rosterone were administered , followed by blood sampling over 12 hours ( n=5 ) . Data analysis was as described . RESULTS Oral micronized and unmicronized dehydroepi and rosterone result ed in increases in serum dehydroepi and rosterone , dehydroepi and rosterone sulfate , and testosterone . Micronization increased the area-under-the-curve ratios for dehydroepi and rosterone sulfate/dehydroepi and rosterone and dehydroepi and rosterone sulfate/testosterone . Vaginal administration provided equivalent serum dehydroepi and rosterone ; however , it failed to increase dehydroepi and rosterone sulfate or testosterone over placebo . CONCLUSION Micronization of oral dehydroepi and rosterone diminishes bioconversion to testosterone . Vaginal dehydroepi and rosterone delivers equivalent dehydroepi and rosterone but substantially diminishes dehydroepi and rosterone bioconversion INTRODUCTION We have previously observed that intravaginal prasterone ( dehydroepi and rosterone , DHEA ) improved all domains of female sexual dysfunction ( FSD ) . AIM Investigate the influence of moderate/severe pain at sexual activity ( dyspareunia ) ( MSD ) at baseline on FSD following prasterone administration . METHODS The effect of daily administration of prasterone ( 0 , 3.25 mg , 6.5 mg or 13 mg ) for 12 weeks on FSD in 215 postmenopausal women with or without MSD at baseline was evaluated in a prospect i ve , r and omized , double-blind , and placebo-controlled phase III clinical trial . MAIN OUTCOME MEASURES Differences were examined on desire , arousal and orgasm . RESULTS Comparable benefits were observed in women not having MSD ( n = 56 ) vs. those having MSD ( n = 159 ) . The benefits over placebo in prasterone-treated women for desire , avoiding intimacy and vaginal dryness as well as for the total sexual domain of the MENQOL ( Menopause Specific Quality of Life ) question naire , ranged between 18.0 % and 38.2 % with P values of < 0.05 or < 0.01 except in one out of 12 subgroups . For the arousal/sensation , arousal/lubrication and summary score of the ASF ( Abbreviated Sexual Function ) question naire , in the MSD+ group , improvements of 64.2 % ( P = 0.01 ) , 118 % ( P = 0.001 ) and 31.1 % ( P = 0.03 ) were observed over placebo , respectively , while similar differences ( 58.0 % , 67.6 % and 32.1 % ) did not reach statistical significance in the MSD- group having up to only 44 prasterone-treated women compared with 119 in the MSD+ group . CONCLUSIONS No MSD at baseline does not apparently affect the effects of intravaginal prasterone on sexual dysfunction . Knowing the absence of significant effects of estrogens on FSD , the present data suggest that vulvovaginal atrophy ( VVA ) and vulvovaginal sexual dysfunction ( VVSD ) are two different consequences of sex steroid deficiency at menopause which can respond independently . In addition , the present data seriously question the justification of pain being part of FSD as well as the separation of FSD into separate domains The present investigation was design ed to provide the first empirical examination of the effects of acute dehydroepi and rosterone ( DHEA ) administration on subjective and physiological sexual arousal in women . The primary purpose was to assess whether DHEA influences vaginal blood flow response in sexually functional women .  Subjective ( self-report ) and physiological ( vaginal photoplethysmograph ) sexual responses to erotic stimuli were measured following DHEA ( 300 mg ) and placebo administration in 12 sexually functional , premenopausal women , using a single-blind protocol . Acute DHEA significantly increased blood levels of dehydroepi and rosterone sulfate ( DHEA-S ) 30 min following drug administration but had no significant effect on either vaginal pulse amplitude responses or subjective responses to the erotic films . Acute DHEA does not appear to substantially influence sexual responding among sexually functional , premenopausal women OBJECTIVE To demonstrate bioavailability of 3 weeks of oral micronized DHEA and to delineate changes induced on insulin sensitivity , morphometric indexes , and lipoprotein profiles . DESIGN Oral micronized DHEa ( 50 mg/d ) was administered in 3-week treatments to 11 postmenopausal women in a prospect i ve , placebo-controlled , r and omized , blinded , crossover trial with an interarm washout . After dose ( 23 hour ) serum DHEA , DHEAS , T , and cortisol levels were measured , as were fasting lipoproteins , oral glucose tolerance tests ( OGTT ) , T-lymphocyte insulin binding and degradation , and urine collagen cross-links . Morphometric changes were determined by hydrostatic weighing . RESULTS Dehydroepi and rosterone sulfate , DHEA , T , and free T increased up to two times premenopausal levels with treatment . Fasting triglycerides declined ; no change in collagen cross-links or morphometric indexes was noted . Oral glucose tolerance test parameters did not change , but both T-lymphocyte insulin binding and degradation increased with DHEA . CONCLUSION Fifty milligrams per day of oral DHEA gives suprahysiologic and rogen levels ; 25 mg/d may be more appropriate . Dehydroepi and rosterone enhanced tissue insulin sensitivity and lowered serum triglycerides . Rationale is provided for postmenopausal replacement therapy with this and rogen OBJECTIVE This study tests the hypothesis that dehydroepi and rosterone or its metabolic products are immunomodulatory in postmenopausal women with relative adrenal and rogen deficiency . STUDY DESIGN A prospect i ve , r and omized , double-blind , crossover study of 11 subjects with 3-week treatment arms separated by a 2-week washout period was performed . Immunologic evaluation at the beginning and end of the treatment arms consisted of flow cytometry to delineate T-cell population s , in vitro T-cell mitogenic response and cytokine production , and natural killer cell cytotoxicity . Statistical analysis was based on a split-plot design with analysis of variance with repeated measures . RESULTS Dehydroepi and rosterone supplementation decreased CD4 + ( helper ) T cells and increased CD8+/CD56 + ( natural killer ) cells . Although T-cell mitogenic and interleukin-6 responses were inhibited , natural killer cell cytotoxicity increased dramatically . CONCLUSIONS These data provide the first in vivo evidence in human for an immunomodulatory effect of dehydroepi and rosterone . The salutary immune changes could account for clinical and experimental evidence of antioncogenic effects of this steroid . This study provides a strong rationale for further clinical studies on dehydroepi and rosterone supplementation in adrenal and rogen-deficient states OBJECTIVE Patients with fibromyalgia ( FM ) consistently have adrenal hyporesponsiveness and low dehydroepi and rosterone ( DHEA ) levels . DHEA is promoted for and used by patients with FM . We tested the efficacy and safety of DHEA supplementation in ameliorating the symptoms of FM . METHODS In a double-blind crossover study , postmenopausal women with FM were r and omized to DHEA supplementation  ( 50 mg/day ) or placebo for 3 months , with a one-month washout period in between . Patients were assessed monthly for well-being and pain and by medical evaluations at the beginning and the end of each treatment period . The primary outcome was well being ; secondary outcomes were pain , fatigue , cognition , sexuality , functional impairment , depression , and anxiety . RESULTS A total of 52 patients were r and omized , 47 patients completed the  DHEA  treatment period , and 45 the placebo treatment period . After 3 months of treatment with 50 mg of DHEA , median DHEA sulfate blood levels had tripled , but there was no improvement in well-being , pain , fatigue , cognitive dysfunction , functional impairment , depression , or anxiety , nor in objective measurements made by physicians . And rogenic side effects ( greasy skin , acne , and increased growth of body hair ) were more common during the DHEA treatment period ( p = 0.02 ) . CONCLUSION DHEA does not improve quality of life , pain , fatigue , cognitive function , mood , or functional impairment in FM CONTEXT Despite decades of accumulated observational evidence , the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain . OBJECTIVE To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States . DESIGN Estrogen plus progestin component of the Women 's Health Initiative , a r and omized controlled primary prevention trial ( planned duration , 8.5 years ) in which 16608 postmenopausal women aged 50 - 79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993 - 1998 . INTERVENTIONS Participants received conjugated equine estrogens , 0.625 mg/d , plus medroxyprogesterone acetate , 2.5 mg/d , in 1 tablet ( n = 8506 ) or placebo ( n = 8102 ) . MAIN OUTCOMES MEASURES The primary outcome was coronary heart disease ( CHD ) ( nonfatal myocardial infa rct ion and CHD death ) , with invasive breast cancer as the primary adverse outcome . A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke , pulmonary embolism ( PE ) , endometrial cancer , colorectal cancer , hip fracture , and death due to other causes . RESULTS On May 31 , 2002 , after a mean of 5.2 years of follow-up , the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits . This report includes data on the major clinical outcomes through April 30 , 2002 . Estimated hazard ratios ( HRs ) ( nominal 95 % confidence intervals [ CIs ] ) were as follows : CHD , 1.29 ( 1.02 - 1.63 ) with 286 cases ; breast cancer , 1.26 ( 1.00 - 1.59 ) with 290 cases ; stroke , 1.41 ( 1.07 - 1.85 ) with 212 cases ; PE , 2.13 ( 1.39 - 3.25 ) with 101 cases ; colorectal cancer , 0.63 ( 0.43 - 0.92 ) with 112 cases ; endometrial cancer , 0.83 ( 0.47 - 1.47 ) with 47 cases ; hip fracture , 0.66 ( 0.45 - 0.98 ) with 106 cases ; and death due to other causes , 0.92 ( 0.74 - 1.14 ) with 331 cases . Corresponding HRs ( nominal 95 % CIs ) for composite outcomes were 1.22 ( 1.09 - 1.36 ) for total cardiovascular disease ( arterial and venous disease ) , 1.03 ( 0.90 - 1.17 ) for total cancer , 0.76 ( 0.69 - 0.85 ) for combined fractures , 0.98 ( 0.82 - 1.18 ) for total mortality , and 1.15 ( 1.03 - 1.28 ) for the global index . Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events , 8 more strokes , 8 more PEs , and 8 more invasive breast cancers , while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures . The absolute excess risk of events included in the global index was 19 per 10 000 person-years . CONCLUSIONS Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women .  All-cause mortality was not affected during the trial . The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases , and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD OBJECTIVE Because dehydroepi and rosterone ( DHEA ) is an adrenal steroid hormone with weak intrinsic and rogenic properties that can be converted in peripheral tissues into more potent sex hormones , one might expect a positive effect of DHEA on bone mineral density ( BMD ) . We evaluated the effects on lumbar BMD of oral DHEA , 200 mg/day , for 1 year in female patients with quiescent systemic lupus erythematosus ( SLE ) . METHODS The study subjects were 60 women with SLE . All participants gave informed consent to participate in a double-blind , placebo-controlled study on the effects of DHEA on fatigue and general well-being . BMD was measured with dual-energy x-ray absorptiometry ( DEXA ) at baseline and after 12 months . RESULTS Fifty-eight patients ( mean age 42.6 years ) could be evaluated ; 2 patients ( both in the DHEA group ) refused to undergo DEXA a second time . In premenopausal women , DHEA did not influence BMD significantly . There was a significant increase in BMD with use of DHEA in postmenopausal women who were not receiving bisphosphonates or estrogen-containing medications . This increase was not observed in the group receiving placebo . CONCLUSION In premenopausal women with quiescent SLE , use of DHEA does not have a significant effect on BMD .  DHEA may increase BMD in postmenopausal SLE patients if they are not already protected from bone loss by use of estrogens or bisphosphonates . Small numbers , due to the absence of stratification for menopausal status , and the use of antiresorptive agents at r and omization preclude firmer conclusions based on the results of this study OBJECTIVE To determine the effect of administering 6 months of oral postmenopausal DHEA therapy on serum DHEA , DHEAS , and T levels and on physiologic endpoints including lipoproteins and insulin-like growth factor-I ( IGF-I ) . DESIGN R and omized , double-blind , parallel trial . SETTING Academic referral practice . PATIENT(S ) Thirteen normal-weight or overweight , healthy , nonsmoking , postmenopausal women . INTERVENTION(S ) Administration of oral micronized DHEA ( 25 mg/d ) . MAIN OUTCOME MEASURE(S ) Monthly fasting 23 hours postdose levels of serum DHEA , DHEAS , T , lipoproteins , IGF-I , IGF binding protein-3 ( IGFBP-3 ) , and liver function tests . Morphometric indices by dual-energy x-ray absorptiometry scan ( percent body fat ; lean body mass ) , immune indices , and insulin sensitivity . RESULT ( S ) Levels of DHEA , DHEAS , and T all rose into premenopausal ranges , but after 6 months , levels of DHEA and T did not differ from baseline or placebo . At 3 months , the ratio of IGF-I to IGFBP-3 rose by 36.1 % + /- 12.7 % , but it fell to placebo values by 6 months . High-density lipoprotein and apolipoprotein A1 levels declined . CONCLUSION ( S ) Patients appeared to tolerate 6 months of DHEA therapy well . Given the small study size , no statistically significant differences in morphometric indices , immune indices , or insulin-sensitizing properties were observed , but significant attenuation of bioavailability occurred . Supplementation with DHEA increased IGF-I/IGFBP-3 levels at 3 months and decreased high-density lipoprotein and apolipoprotein A1 levels at 6 months Data regarding the efficacy of dehydroepi and rosterone ( DHEA ) in the treatment of hypoactive sexual desire disorder ( HSDD ) are scarce and inconsistent . We aim ed to determine possible gender differences in the efficacy of DHEA as a treatment for HDSS . Postmenopausal women ( n=27 ) , and men ( n=21 ) with HSDD , were r and omized to receive either DHEA 100 mg daily or placebo for 6 weeks in a controlled , double blind study . Primary outcome measures were sexual function question naires . Hormone serum levels of DHEAS , total and bioavailable testosterone , estradiol , and urine levels of DHEA and and rosterone were also measured . Participants on active treatment showed a significant increase in circulating serum levels of DHEAS , while bioavailable testosterone levels increased in women only . In women only , significant interaction effects were observed for sexual arousal ( p<0.05 ) , satisfaction ( p<0.05 ) , and cognition ( trend ; p=0.06 ) . For arousal , a significant improvement was observed for the DHEA treated group at 6 weeks ( p=0.001 ) . Significant correlations were observed between bioavailable T and sexual cognitions , arousal and orgasm , while DHEAS was correlated with satisfaction . In the men , significant correlations were observed between testosterone and arousal ( r=.45 ) , sexual drive ( r=.50 ) and orgasm ( r=.55 ) . In women with HSDD , DHEA treatment had a significant beneficial effect on arousal , whereas no efficacy was demonstrated in men , indicating a possible gender difference . This improvement seems to be mediated via DHEA 's metabolism to testosterone . Our positive results suggest that the neurosteroid DHEA may be effective as a treatment for women with HSDD if administered at a dose of at least 100 mg per day OBJECTIVES Because dehydroepi and rosterone may protect against neoplasia , osteoporosis , and cardiac disease , we investigated the bioavailability of oral micronized dehydroepi and rosterone , anticipating its adjunctive use in postmenopausal steroid replacement . STUDY DESIGN Eight postmenopausal women r and omly received either a placebo or 150 or 300 mg of oral micronized dehydroepi and rosterone in a lipid matrix . Serum dehydroepi and rosterone , dehydroepi and rosterone sulfate , testosterone , and estradiol were measured periodically over the 12 hours after each dose . All treatments , all doses , and mean serum dehydroepi and rosterone , dehydroepi and rosterone sulfate , and testosterone were compared with analysis of variance for repeated measures and Newman-Keuls a posteriori test of statistical significance . RESULTS Mean peak steroid concentrations after 150 mg ( 300 mg ) doses were dehydroepi and rosterone 1617 ( 2639 ) ng/dl , 7 (11.5)-fold above placebo ; dehydroepi and rosterone S 1185 ( 1688 ) micrograms/dl , 14 (20)-fold above placebo ; and testosterone 183 ( 311 ) ng/dl , 4 (7)-fold above placebo . Estradiol concentrations remained less than 20 pg/ml , but and rogen concentrations rose by 1 hour and remained elevated through the twelfth hour . Peak and rogen concentrations and areas under the curves exhibited proportionality with both doses . A testosterone radioimmunoassay with celite chromatography revealed a 300 % overestimation for testosterone in the direct-assay method used in this study . Thus after appropriate readjustment maximum testosterone concentrations were observed consistently within physiologic premenopausal ranges after the 150 mg dose . CONCLUSIONS Micronized dehydroepi and rosterone may provide a steroidal postmenopausal replacement that is adjunctive to estrogens and worthy of further investigation OBJECTIVE To evaluate the effects of combination estrogen/ and rogen therapy on muscle mass , strength and endurance , serum hormone and lipid profiles , and quality of life measures in postmenopausal women . METHODS Prospect i ve , r and omized , placebo-controlled pilot study at a tertiary care medical center . Fifty postmenopausal women were r and omized to a 12-week course of ( 1 ) dehydroepi and rostenedione ( DHEA ) 50 mg daily , ( 2 ) conjugated equine estrogen ( CEE ) 0.625 mg daily , ( 3 ) DHEA 50 mg+CEE 0.625 mg daily , or ( 4 ) placebo . Main outcome measures of lower extremity muscle ( calf ) mass , functional muscle parameters , serum hormone and lipid levels , and quality of life ( QOL ) were obtained at baseline and after treatment . Statistical analysis compared percent change from baseline values and treatment differences among outcomes . RESULTS Significant increases in mean DHEA , DHEA sulfate ( DHEA-S ) , testosterone , and and rostenedione levels were noted with DHEA alone or combined DHEA/CEE treatments when compared with placebo . Compared with no hormone therapy , none of the supplemental hormone groups caused significant changes in muscle mass , muscle strength , muscle endurance , feelings of well-being , sleep , or sexual function . CONCLUSIONS And rogen replacement therapy , with DHEA , to menopausal women increases serum and rogen levels without any appreciable effect on muscle cross-sectional area , muscle strength , muscle function , or improvement in health-related QOL Objective To examine the effect of intravaginal dehydroepi and rosterone ( DHEA ) on pain at sexual activity ( dyspareunia ) identified as the most bothersome symptom of vaginal atrophy in postmenopausal women at both screening and day 1 . Methods This prospect i ve , r and omized , double-blind and placebo-controlled phase III clinical trial studied the effect of prasterone ( DHEA ) applied locally in the vagina on the severity of dyspareunia in 114 postmenopausal women who had identified dyspareunia as their most bothersome symptom of vaginal atrophy , while meeting the criteria for superficial cells ≤ 5 % and pH > 5.0 at both screening and day 1 . Results At the st and ard duration of 12 weeks of treatment , increasing doses of 0.25 % , 0.5 % and 1.0 % DHEA decreased the percentage of parabasal cells by 48.6 ± 6.78 % , 42.4 ± 7.36 % and 54.9 ± 6.60 % ( p < 0.0001 vs. placebo for all ) with no change with placebo ( p = 0.769 ) . The effects on superficial cells and pH were also highly significant compared to placebo at all DHEA doses . The severity score of pain at sexual activity decreased by 0.5 , 1.4 , 1.6 and 1.4 units in the placebo and 0.25 % , 0.5 % and 1.0 % DHEA groups , respectively , with the p value of differences from placebo ranging from 0.0017 to < 0.0001 . Conclusions Intravaginal DHEA , through local estrogen and and rogen formation , causes a rapid and highly efficient effect on pain at sexual activity without systemic exposure of the other tissues , thus avoiding the recently reported systemic effects of estrogens Objective : The objective of this study was to provide evidence that the transformation of DHEA into both and rogens and /or estrogens locally in cells of the three layers of the vagina ( epithelium , lamina propria , and muscularis ) would have effects of greater impact , including effects on sexual function , than only effects on superficial epithelial cells as achieved with estrogens . Methods : This prospect i ve , r and omized , double-blind , and placebo-controlled phase III clinical trial has evaluated the effect of daily local intravaginal application of Prasterone ( dehydroepi and rosterone ; DHEA ) for 12 weeks on the domains of sexual dysfunction , namely , desire/interest , arousal , orgasm , and pain at sexual activity , in 216 postmenopausal women with moderate to severe symptoms of vaginal atrophy . Results : A time- and dose-dependent improvement of the four domains of sexual function was observed . At the 12-week time interval , the 1.0 % DHEA dose led , compared with placebo , to 49 % ( P = 0.0061 ) and 23 % ( P = 0.0257 ) improvements of the desire domains in the Menopause Specific Quality of Life and Abbreviated Sex Function question naires , respectively . Compared with placebo , the Abbreviated Sex Function arousal/sensation domain was improved by 68 % ( P = 0.006 ) , the arousal/lubrication domain by 39 % ( P = 0.0014 ) , orgasm by 75 % ( P = 0.047 ) , and dryness during intercourse by 57 % ( P = 0.0001 ) . Conclusions : By a local action in the vagina , DHEA applied daily at doses at which serum steroids remain well within normal postmenopausal values exerts relatively potent beneficial effects on all four aspects of sexual dysfunction . Such data indicate that combined and rogenic/estrogenic stimulation in the three layers of the vagina exerts important beneficial effects on sexual function in women without systemic action on the brain and other extravaginal tissues BACKGROUND Published data regarding the negative risk-benefit ratio of traditional estrogen/progesterone hormone replacement therapy for menopausal symptoms have indicated the need for alternative treatments . Dietary supplements and herbal products are popularly used for menopausal control without a large evidence base . Therefore , a prospect i ve pilot trial using 50 mg of dehydroepi and rosterone ( DHEA ) once daily for 4 weeks following a baseline week was developed to explore whether DHEA has any efficacy in reducing hot flashes . Safety issues were also evaluated . PATIENTS AND METHODS Twenty-eight women were enrolled in this study , 22 of whom are evaluable . The primary outcome was the reduction in hot flash score ( frequency multiplied by average severity ) from baseline as measured by vali date d self-report daily hot flash diaries . RESULTS The mean hot flash score decreased 50 % from baseline , and there were no side effects that were significantly worse compared with baseline . Quality of life related to hot flashes showed statistically significant improvement after 4 weeks of DHEA therapy . CONCLUSION This pilot study provides data supporting the hypothesis that DHEA is well tolerated and can reduce hot flashes . Dehydroepi and rosterone should be studied further in a larger , placebo-controlled trial OBJECTIVES To examine the effects of dehydroepi and rosterone ( DHEA ) supplementation on cognitive function and quality of life in healthy older adults . DESIGN Double-blind , r and omized , controlled clinical trial . SETTING Clinical research facility . PARTICIPANTS One hundred ten men and 115 women aged 55 to 85 ( mean + /- st and ard deviation 68 + /- 8) . INTERVENTION Fifty milligrams daily oral DHEA versus placebo for 1 year . MEASUREMENTS Six cognitive function tests at baseline and 12 months , the Beck Depression Inventory ( BDI ) , the Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) , the Life Satisfaction Index-Z , the Satisfaction with Life Scale , the Female Sexual Function Index ( in women ) , and the 15-item International Index of Erectile Function ( in men ) at baseline and 3 , 6 , and 12 months . RESULTS There were no differences between the DHEA and placebo groups in change over time in cognitive function ( P>.10 ) . Over time , BDI scores decreased for men ( P=.006 ) and women ( P=.02 ) , and Satisfaction with Life Scale scores increased for women ( P=.004 ) , but there were no differences between the DHEA and placebo groups over time on these measures or the SF-36 , Life Satisfaction Index-Z scale , or sexual function scales ( P>.10 ) . CONCLUSION DHEA supplementation has no benefit on cognitive performance or well-being in healthy older adults , and it should not be recommended for that purpose in the general population OBJECTIVE To assess prevention of bone mineral density ( BMD ) loss and durability of the response during treatment with prasterone in women with systemic lupus erythematosus ( SLE ) receiving chronic glucocorticoids . METHODS 155 patients with SLE received 200 mg/day prasterone or placebo for 6 months in a double-blind phase . Subsequently , 114 patients were re-r and omized to receive 200 or 100 mg/day prasterone for 12 months in an open-label phase . Primary efficacy endpoints were changes in BMD at the lumbar spine ( L-spine ) from baseline to Month 6 and maintenance of BMD from Month 6 to 18 for patients who received prasterone during the double-blind phase . RESULTS In the double-blind phase , there was a trend for a small gain in BMD at the L-spine for patients who received 200 mg/day prasterone for 6 months versus a loss in the placebo group ( mean + /- SD , 0.003 + /- 0.035 vs -0.005 + /- 0.053 g/cm(2 ) , respectively ; p = 0.293 between groups ) . In the open-label phase , there was dose-dependent increase in BMD at the L-spine at Month 18 between patients who received 200 versus 100 mg/day prasterone ( p = 0.021 ) . For patients who received 200 mg/day prasterone for 18 months , the L-spine BMD gain was 1.083 + /- 0.512 % ( p = 0.042 ) . There was no overall change in BMD at the total hip over 18 months with 200 mg/day prasterone treatment . The safety profile reflected the weak and rogenic properties of prasterone . CONCLUSION This study suggests prasterone 200 mg/day may offer mild protection against bone loss in women with SLE receiving glucocorticoids . ( Clinical Trials.gov Identifiers NCT00053560 and NCT00082511 ) BACKGROUND The age-related decline of dehydroepi and rosterone ( DHEA ) has prompted research on its experimental replacement in women . Although no relationship to sexual functioning in healthy women has been shown to date , DHEA replacement has potential for affecting sexual response . METHODS To investigate DHEA effects , 16 sexually functional postmenopausal women participated in a r and omized , double-blind , crossover protocol in which oral administration of DHEA ( 300 mg ) or placebo occurred 60 minutes before the presentation of an erotic video segment . Blood DHEA sulfate ( DHEAS ) changes , subjective and physiological sexual responses , as well as affective responses were measured in response to videotaped neutral and erotic video segments . RESULTS The concentration of DHEAS increased 2 - 5-fold following DHEA administration in all 16 women . Subjective ratings across DHEA and placebo conditions showed significantly greater mental ( p < 0.016 ) and physical ( p < 0.036 ) sexual arousal to the erotic video with DHEA vs. placebo .  Positive affect also increased during the erotic video across drug conditions . Vaginal pulse amplitude ( VPA ) and vaginal blood volume ( VBV ) demonstrated a significant increase ( p < 0.001 ) between neutral and erotic film segments within both conditions ( DHEA and placebo ) but did not differentiate drug conditions . CONCLUSION In sum , increases in mental and physical sexual arousal ratings significantly increased in response to an acute dose of DHEA in postmenopausal women In this article , the theoretical distinction between recognition memory decision and discrimination processes is used to explore the effect of dehydroepi and rosterone ( DHEA ) in postmenopausal women .  DHEA is an adrenal steroid that diminishes with aging . It has enhanced memory in laboratory animals . An 8-week placebo-controlled , double-blind experiment in which 30 women ( ages 39–70 ) received a 50-mg/day oral dose of DHEA for 4 weeks demonstrated that DHEA made subjects more conservative ( i.e. , less likely to call test items “ old ” ) in their recognition memory decisions and enhanced recognition memory discrimination for items presented briefly . The former result may reflect an empirical regularity ( Hirshman , 1995 ) in whichrecent strong memory experiences make participants more conservative . The latter result may reflect the effect of DHEA on visual perception , with consequent effects on memory . These results suggest the method ological importance of focusing on decision processes when examining the effects of hormones on memory DHEA-S treatment is used as an anti-aging and anti-obesity hormone therapy in adults ; however , it mechanisms of action are not clearly eluci date d. The objective of the present work was to analyze the effect of a replacement therapy , which included a daily single oral dose of DHEA-S for three months , on the composition of human plasma fatty acids ( FAs ) in obese women . In the first study , a r and omized , double-blind , placebo-controlled trial was conducted involving 61 postmenopausal women , who were assigned to receive 100mg/day of DHEA-S ( n = 41 ) or placebo ( n = 20 ) orally for 3 months . In a second study , the effect of DHEA-S treatment on postmenopausal obese women ( n = 41 ) was compared to that in premenopausal obese women ( n = 20 ) . Blood sample s were collected at the beginning and at the end of the treatment . Plasma FAs were analyzed by gas chromatography . DHEA-S treatment produced significant changes in plasma FAs of both post- and premenopausal women with a reduction of total saturated FAs ( SFA ) as well as an increase in n-6 polyunsaturated FA ( PUFA ) . Particularly , in premenopausal women the DHEA-S treatment also increased the plasma n-3 PUFA percentage . Regarding estimation of desaturase activity , our data showed that Δ6-desaturase was significantly decreased in postmenopausal women after DHEA-S treatment , whereas Δ5-desaturase was increased in the premenopausal group . In conclusion , DHEA-S treatment in obese women  modifies plasma FA composition towards a potentially better metabolic profile , mainly by decreasing SFA and increasing n-6 PUFA in both postmenopausal and premenopausal women CONTEXT Serum levels of the sex steroid prohormones dehydroepi and rosterone ( DHEA ) and DHEA sulfate ( DHEA-S ) decline upon aging and are reduced in primary Sjogren 's syndrome . OBJECTIVE Our aim was to investigate : 1 ) effects of 50 mg oral DHEA/day on changes in serum levels of DHEA and 12 of its metabolites ; 2 ) relationships between steroid levels and disease characteristics ; and 3 ) whether these parameters were influenced by DHEA . DESIGN Twenty-three postmenopausal women with primary Sjogren 's syndrome and subnormal levels of DHEA-S were included in a r and omized , 9-month , controlled , double blind crossover study . Liquid chromatography/mass spectrometry (MS)/MS and gas chromatography/MS were used to measure the sex steroids . Anti-SS-A/Ro and /or anti-SS-B/La , salivary gl and focus score , salivary flow rates , dry mouth and eye symptoms , and routine laboratory tests were assessed . RESULTS Baseline erythrocyte sedimentation rate was inversely correlated with testosterone ( Testo ) , dihydrotestosterone , and DHEA-S ( rs = -0.42 , -0.45 , and -0.58 , respectively ) . Dry mouth symptoms correlated with low Testo and and rostenedione , whereas dry eyes correlated with low estrogens , most strongly estrone ( rs = -0.63 ) . Presence of anti-SS-A and /or anti-SS-B was independently associated with low estradiol ( area under the receiver operating characteristic curve , 0.82 ) . All metabolites increased during DHEA but not during placebo . The relative increases were less for estrogens and Testo compared to dihydrotestosterone and glucuroni date d and rogen metabolites . Dry mouth symptoms decreased during DHEA therapy . CONCLUSIONS Disease manifestations in primary Sjogren 's syndrome were associated with low sex hormone levels , dry mouth symptoms with low and rogens , and dry eyes with low estrogens . Exogenous DHEA was preferentially transformed into and rogens rather than into estrogens The physiological role of dehydroepi and rosterone ( DHEA ) is not well understood , but studies suggest positive effects on subjective health and bone metabolism . We have conducted a clinical trial with DHEA replacement in adrenal failure with the primary aim of evaluating effects on subjective health status and sexuality .  Thirty-nine women with adrenal failure were r and omized to 9 months of treatment with 25 mg DHEA ( n = 19 ) or placebo ( n = 20 ) . Treatment effects were assessed by vali date d question naires of subjective health and sexuality .  DHEA replacement yielded a wide variation of effects on the subjective health scales , which were not different from the effects of placebo . Almost all patients receiving DHEA obtained normal and rogen levels . Eighty-nine percent of the patients receiving DHEA experienced side-effects , in particular increased sweat odor and scalp itching .  DHEA replacement did not significantly change the levels of blood lipids , IGF-I , and markers of bone metabolism . In conclusion , we do not find evidence of beneficial effects of DHEA on subjective health status and sexuality in adrenal failure . However , DHEA may be beneficial for subgroups of patients with adrenal failure , but these remain to be identified . Premenopausal and rogen levels can be restored with 25 mg DHEA daily in most female patients , but side-effects are frequent OBJECTIVE The aim of this study was to evaluate the safety of 52 weeks of DHEA 50 mg daily oral dose given to postmenopausal women with low libido to improve sexual function . METHOD 93 postmenopausal women were enrolled in a 52-week r and omised , double-blind , placebo-controlled trial and received either DHEA 50 mg or placebo ( PL ) daily . The effects of DHEA versus placebo on lipid profile , insulin-glucose homeostasis and the endomentrium were assessed over 52 weeks . RESULTS Oral DHEA , 50mg/day , was not associated with any effects on blood lipids or insulin resistance . The pattern of breakthrough bleeding did not substantially differ between the DHEA and PL groups and no significant adverse endometrial effects were apparent . CONCLUSIONS The use of 50 mg oral DHEA did not significantly alter lipid profile , insulin sensitivity or adversely affect the endometrium in postmenopausal women CONTEXT Recent studies disputed the widely promoted anti-aging effect of dehydroepi and rosterone ( DHEA ) supplementation ; however , conflicting data exist on whether physiological DHEA supplementation enhances exercise training effects on body composition , physical performance , and cardiometabolic risk in healthy postmenopausal women . OBJECTIVE The aim of this study was to determine whether 12 wk of DHEA supplementation ( 50 mg/d ) in postmenopausal women enhances exercise-related changes in body composition , physical performance , and cardiometabolic risk . DESIGN AND SETTING This study was a 12-wk r and omized double-blind , placebo-controlled trial and took place at the Mayo Clinic General Clinical Research Center ( Rochester , MN ) . PARTICIPANTS Thirty-one sedentary , postmenopausal , Caucasian women ( mean + /- sem age 64.6 + /- 1.0 yr ) completed the study . INTERVENTION Participants were r and omized to one of two 12-wk interventions : 1 ) exercise training plus 50 mg/d of DHEA ( n = 17 ) , or 2 ) exercise training plus placebo ( n = 14 ) . The exercise intervention consisted of both endurance ( 4 d/wk ) and resistance ( 3 d/wk ) exercise components . MAIN OUTCOME MEASURES The main outcomes were measures of body composition , physical performance , and measures of cardiometabolic risk . RESULTS DHEA treatment with exercise result ed in increases in circulating sulfated DHEA ( 650 % ) , total testosterone ( 100 % ) , estradiol ( 165 % ) , estrone ( 85 % ) , and IGF-I ( 30 % ) ( all P < or = 0.05 , for all within and between treatment comparisons ) . Although exercise training alone significantly improved physical performance , body composition , and insulin sensitivity , administration of DHEA provided no additional benefits . CONCLUSIONS Twelve weeks of combined endurance and resistance training significantly improved body composition , physical performance , insulin sensitivity , and low-density lipoprotein cholesterol particle number and size , whereas DHEA had no additional benefits Dehydroepi and rosterone ( DHEA ) is an adrenal and rogen precursor of sex steroids with effects on a variety of physiological events [ 1 ] . DHEA and its sulfate ( DHEAS ) , as well as and rostendione , have minimal and rogenic activity [ 2 ] . It has been reported that serum levels of DHEA and DHEA-S substantially decrease with age , and experimental studies have demonstrated benefit with DHEA substitution at physiologic doses [ 3 ] . DHEA and DHEA-S are abundant in the circulation . DHEA-S accounts for more than 99 % of the steroid in the serum , with less than 1 % of free DHEA . Their main actions have been related to cellular control , immunoregulation , obesity and lipid metabolism [ 2 ] . Estrogen and and rogen replacement therapy date s to 1941 , when Geist and Salmon used and rogen therapy to treat climacteric symptoms [ 4 ] . DHEA has also been used as part of hormone therapy . In a study in which women from 60 to 70 years age received  DHEA  , a significant increase was observed in bone mineral density at the hip . This was followed by an increase in serum osteocalcin ( a bone formation marker ) , which was supposed to be due to DHEA and rogenic action . These results suggest that DHEA can be useful in the prevention and treatment of osteoporosis [ 5 ] . In another study , DHEA was given in a dose of 50 mg/day for 6 months to men and women aged 40 to 70 years . No changes were observed in estrone ( E ) and estradiol ( E2 ) serum levels in either sex . In women , there was a decrease in high-density lipoprotein cholesterol ( HDL-C ) levels without changes in the other lipids . Insulin sensitivity and mean body fat were not modified , and an increase in subjective physical well-being was cl aim ed in 67 % of men and in 84 % of women [ 6 ] . When DHEA was applied percutaneously in women from 60 to 70 years age for 12 months , no changes were observed in body weight . However , there was a 3.8 % decrease of body fat and an increase of 3.5 % in the muscular mass at the femoral level . HDL-C levels decreased 8 % , but the HDL-C/total cholesterol ratio did not change due to a parallel decrease of total cholesterol [ 7 ] . It then appears that the literature is controversial about DHEA effects . Commercial DHEA formulations are frequently used in Mexico , as in other countries . Therefore , the objective of this study was to evaluate a formulation of DHEA ( Siscelar plus  ) , commercially available in Mexico , on hormone and lipid levels and on climacteric symptoms after administration to postmenopausal women The objective of this study was to explore , for the first time , the changes in the pangenomic profile induced in human skin in women treated with dehydroepi and rosterone ( DHEA ) applied locally . Sixty postmenopausal women participated in this phase II prospect i ve , r and omized , double-blind and placebo-controlled  study . Women were r and omized to the twice daily local application of 0 % ( placebo ) , 0.3 % , 1 % or 2 % DHEA cream . Changes in the pangenomic expression profile were studied using Affymetrix Genechips . Significant changes ( p<0.05 ) in sixty-six  DHEA-responsive probe sets corresponding to 52 well-characterized genes and 9 unknown gene sequences were identified . A dose-dependent increase in the expression of several members of the collagen family was observed , namely COL1 , COL3 and COL5 as well as the concomitant modulation of SPARC , a gene required for the normal deposition and maturation of collagen fibrils in the dermis . Several genes involved in the proliferation and differentiation of keratinocytes were also modulated . In addition , topical DHEA reduced the expression of genes associated with the terminal differentiation and cornification of keratinocytes . Our results strongly suggest the possibility that DHEA could exert an anti-aging effect in the skin through stimulation of collagen bio synthesis , improved structural organization of the dermis while modulating keratinocyte metabolism ABSTRACT Background Sexual desire is affected by endocrine and psychosocial factors . Menopausal hormonal changes are relevant to the causes of sexual dysfunction during reproductive aging . Aim To evaluate the effects of different types of hormonal replacement therapy ( HRT ) on sexual function , frequency of sexual intercourse , and quality of relationship in early postmenopausal women . We recruited 48 healthy postmenopausal women aged 50–60 years ( mean age 54.5 ± 3.3 years ) . Women with climacteric symptoms were uniformly r and omized into three groups receiving either dehydroepi and rosterone ( DHEA 10 mg ) daily , or daily oral estradiol ( 1 mg ) plus dihydrogesterone ( 5 mg ) , or daily oral tibolone ( 2.5 mg ) for 12 months . Women who refused hormonal therapy were treated with oral vitamin D ( 400 IU ) . Efficacy was evaluated using the McCoy Female Sexuality Question naire before treatment and after 12 months . We evaluated the hormonal profile before treatment and after 3 , 6 and 12 months . Results The groups receiving DHEA or HRT reported a significant improvement in sexual function compared to baseline ( p < 0.001 and p < 0.01 , respectively ) using the McCoy total score . The quality of relationship was similar at baseline and after 3 , 6 and 12 months of treatment . There were significant increases in the numbers of episodes of sexual intercourse in the previous 4 weeks in women treated with DHEA , HRT and tibolone in comparison with the baseline value ( p < 0.01 , p < 0.05 , p < 0.01 , respectively ) . No changes in the McCoy score occurred in women receiving vitamin D. Conclusions Daily oral DHEA therapy at the dose of 10 mg , HRT and tibolone all provided a significant improvement in comparison with vitamin D  in sexual function and in frequency of sexual intercourse in early postmenopausal women Objective : Because a previous 1-week study has shown no or minimal changes in the serum levels of dehydroepi and rosterone ( DHEA ) and its metabolites after up to daily 1.8 % ( 23.4 mg ) intravaginal DHEA , the objective of the present study was to investigate the serum steroid levels during a 12-week daily intravaginal administration of 0 % , 0.25 % , 0.5 % , and 1.0 % DHEA ( Prasterone ) 1.3 mL ovules . Methods : In a double-blind , placebo-controlled phase III study , 218 postmenopausal women ( age range , 42 - 74 y ) were r and omized to receive daily one of four DHEA concentrations intravaginally .  Serum steroids were measured by a Good Laboratory Practice -vali date d mass spectrometry technology in sample s obtained at time of visit . Results : The serum levels of DHEA and 11 of its metabolites measured at screening , day 1 , and weeks 2 , 4 , 8 , and 12 in women showed no or minimal changes during the whole observation period , with all values remaining well within the limits of normal postmenopausal women . No accumulation of the steroid metabolites nor change in DHEA bioavailability was detected . Conclusions : The present data show that local daily intravaginal DHEA administration at DHEA doses of 3.25 - 13 mg was able to rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy and improve sexual function and caused no or minimal changes in serum sex steroid levels , which all remain within the normal postmenopausal range , thus avoiding the risks of all estrogen formulations Objective : Because the secretion of dehydroepi and rosterone ( DHEA ) , the exclusive source of sex steroids in postmenopausal women , is already decreased by 60 % and continues to decline at the time of menopause , the objective of this study was to examine the effect of intravaginal DHEA on the symptoms and signs of vaginal atrophy . Methods : This prospect i ve , r and omized , double-blind and placebo-controlled phase III clinical trial studied the effect of Prasterone ( DHEA ) applied locally in the vagina on the signs and symptoms of  vaginal atrophy in 216 postmenopausal women . Results : All three doses ( 0.25 % , 0.5 % , and 1.0 % ) of DHEA ovules applied daily intravaginally induced a highly significant beneficial change in the percentage of vaginal parabasal and superficial cells and pH as well as in the most bothersome symptom at 2 weeks . At the st and ard 12-week time interval , 0.5 % DHEA caused a 45.9 ± 5.31 ( P < 0.0001 vs placebo ) decrease in the percentage of parabasal cells , a 6.8 ± 1.29 % ( P < 0.0001 ) increase in superficial cells , a 1.3 ± 0.13 unit ( P < 0.0001 ) decrease in vaginal pH , and a 1.5 ± 0.14 score unit ( P < 0.0001 ) decrease in the severity of the most bothersome symptom . Similar changes were seen on vaginal secretions , color , epithelial surface thickness , and epithelial integrity . Comparable effects were observed at the 0.25 % and 1.0 % DHEA doses . Conclusions : Local Prasterone , through local and rogen and estrogen formation , causes a rapid and efficient reversal of all the symptoms and signs of vaginal atrophy with no or minimal changes in serum steroids , which remain well within the normal postmenopausal range . This approach avoids the fear of systemic effects common to all presently available estrogen formulations and adds a novel physiological and rogenic component to therapy INTRODUCTION Dehydroepi and rosterone ( DHEA ) and its sulfate DHEAS , which are the most abundant steroids in women , decline with age . We have shown association between low sexual function and low circulating DHEAS levels in women . AIM The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young individuals improves sexual function . METHODS Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week r and omized , double-blind , placebo controlled trial and received either DHEA 50 mg or placebo ( PL ) daily . MAIN OUTCOME MEASURES Efficacy was assessed through 26 weeks . The main outcome measures were the change in total satisfying sexual events ( SSE ) and the change in the Sabbatsberg Sexual Self-Rating Scale ( SSS ) total score . Secondary measures were the Psychological General Well-Being Question naire ( PGWB ) , and the Menopause-Specific Quality of Life Question naire ( MENQOL ) . Hormonal levels , adverse events ( AEs ) , serious adverse events ( SAEs ) and clinical labs were evaluated over 52 weeks . RESULTS Eighty-five participants ( 91 % ) were included in the 26-week efficacy analysis . There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS , PGWB , and MENQOL change scores . Overall AE reports and number of withdrawals as a result of AEs were similar in both groups ; however more women in the DHEA group experienced and rogenic effects of acne and increased hair growth . CONCLUSIONS In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA result ed in no significant improvements in sexual function over PL therapy over 26 weeks Following the compelling data obtained in a pivotal phase III clinical trial performed in 218 postmenopausal women suffering from vaginal atrophy who received daily intravaginal 0.25 , 0.5 or 1.0 % DHEA ( dehydroepi and rosterone ) ovules for 12 weeks , we have performed analysis of the four co- primary objectives at each site of that multicentre U.S. and Canadian trial . Comparison was made of the change in percentage of parabasal and superficial cells , vaginal pH and severity of the most bothersome symptom . The site-by-site ( seven sites ) analysis has shown that 10–13 women per group are generally sufficient to obtain a significant or highly statistically significant decrease in vaginal pH and percentage of parabasal cells and increased percentage of superficial cells at p values ranging from 0.02 to < 0.0001 . For vaginal pain as the most bothersome symptom , a statistically significant difference from baseline was found at six out of seven sites . The exceptionally high consistency between all sites in this phase III study and high potency of the compound permit to obtain a clinical ly and statistically significant to highly significant effect of treatment on all parameters of vaginal atrophy with the 0.5 % DHEA daily intravaginal dose which does not significantly affect the serum levels of oestrogens , thus avoiding systemic risks
target: There is no evidence that DHEA  improves quality of life but there is some evidence that it is associated with and rogenic side effects .
  There is uncertainty whether DHEA decreases menopausal symptoms , but DHEA may slightly improve sexual function compared with placebo
background: BACKGROUND During menopause a decreasing ovarian follicular response generally causes a fluctuation and eventual decrease in estrogen levels .
  This can lead to the development of various perimenopausal and postmenopausal symptoms ( for example hot flushes , night sweats , vaginal dryness ) .
  Dehydroepi and rosterone ( DHEA ) is one of the main precursors of and rogens , which in turn are converted to testosterone and estrogens .
  It is possible that the administration of DHEA may increase estrogen and testosterone levels in peri- and postmenopausal women to alleviate their symptoms and improve general wellbeing and sexual function ( for example libido , dyspareunia , satisfaction ) .
  Treatment with DHEA is controversial as there is uncertainty about its effectiveness and safety .
  This review should clearly outline the evidence for DHEA in the treatment of menopausal symptoms and evaluate its effectiveness and safety by combining the results of r and omised controlled trials .
  OBJECTIVES To assess the effectiveness and safety of administering DHEA to women with menopausal symptoms in the peri- or postmenopausal phase .