DHEA Improves Sexual Function in Some Premenopausal Women

Fran Lowry

October 10, 2018

Androgen supplementation with dehydroepiandrosterone (DHEA) significantly improves sexual function in premenopausal, infertile women with poor sexual function, according to results from a new study.

"I want to stress that the patients in our study were not patients with female sexual dysfunction disorder. These were infertility patients in their 30s and 40s," said lead investigator Vitaly Kushnir, MD, from the Center for Human Reproduction in New York City and Wake Forest University in Winston–Salem, North Carolina.

"Overall, the patients who were enrolled showed very minimal improvements, but there was a subgroup of women who had low baseline sexual function scores who actually showed pretty robust improvement," he reported at the American Society for Reproductive Medicine (ASRM) 2018 Scientific Congress in Denver.

"DHEA remains an investigational drug for sexual dysfunction. This is something that will need to go through more trials. But I think we have identified a subgroup of women who do seem to benefit," he told Medscape Medical News.

In their prospective cohort study, Kushnir and his colleagues assessed 50 premenopausal women who were older (average age, 41 years) and seeking treatment for infertility.

DHEA has been used to try to improve sexual function in postmenopausal or perimenopausal women, but all these women were premenopausal. "That's an important caveat," Kushnir pointed out.

All the women completed the Female Sexual Function Index (FSFI) questionnaire and underwent comprehensive endocrine evaluations — including androgens, such as DHEA, DHEA sulfate, total testosterone, and free testosterone — at the beginning of the study and then 4 to 8 weeks after starting oral DHEA 75 mg once daily.

All serum androgen levels increased after DHEA supplementation (P < .001 for all). In addition, follicle-stimulating hormone levels decreased by 2.6 mIU/mL, from a baseline of 10.3 mIU/mL (95% confidence interval [CI], 0.7 - 4.6; P = .009).

In the study cohort, mean FSFI score increased by 7%, with scores for desire, arousal, and lubrication increasing by 17%, 12%, and 8%, respectively. There were no changes in scores on the orgasm, satisfaction, or pain domains.

However, women whose FSFI scores were in the lowest quartile at baseline saw the greatest benefit, with an average increase of 34%.

And improvement was seen in all domains of sexual functioning for these women. Increases were 40% for desire, 46% for arousal, 33% for lubrication, 54% for orgasm, 24% for satisfaction, and 25% for pain.

In addition, the increase in free testosterone was greater in women with baseline FSFI scores in the lowest quartile than in those with scores in the highest quartile (1.8 vs 0.5 pg/mL; P = .04).

This is not an aphrodisiac. It doesn't seem to improve the sexual function of somebody who doesn't have a problem to begin with.

"This is not an aphrodisiac. It doesn't seem to improve the sexual function of somebody who doesn't have a problem to begin with," Kushnir explained.

"We will need a larger randomized study in which some patients will be treated with placebo," he noted. Participants should be premenopausal with "either female sexual dysfunction disorder or poor sexual function at baseline."

"Before I would say this is a clinically significant finding, I would want to see a longer-term study," said Elizabeth Ginsburg, MD, from Brigham and Women's Hospital and Harvard Medical School in Boston, who is an ASRM board member.

"The tricky thing is that they did the FSFI scores 4 to 8 weeks after starting DHEA, and the placebo effect of pretty much everything lasts about 3 months," she told Medscape Medical News. "To ensure that the findings are not just related to a placebo effect, they would need to do a longer trial, ideally with a placebo group."

"It would be great if this actually did something, because DHEA is probably fairly benign in the dose they gave," Ginsburg added.

"Until there is a longer trial and a placebo group, I would not personally recommend this for patients with low sexual function. But it is interesting preliminary data," she said.

This study was supported by the Foundation for Reproductive Medicine and Center for Human Reproduction. Kushnir and Ginsburg have disclosed no relevant financial relationships. Kushnir's coauthors reported financial relationships with Fertility Nutraceuticals, LLC; Merck Austria; and Nutraceuticals, LLC.

American Society for Reproductive Medicine (ASRM) 2018 Scientific Congress: Abstract 0-49. Presented October 8, 2018.

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