Effects of dehydroepiandrosterone (DHEA) supplementation on sexual function in premenopausal infertile women
To investigate the effects of dehydroepiandrosterone (DHEA) supplementation on female sexual function in premenopausal infertile women of advanced ages.
This observational study was conducted in an academically affiliated private fertility center. Patients included 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4–8 weeks after initiating 25 mg of oral micronized DHEA TID.
Age of patients was 41.1 ± 4.2 years, BMI 24.4 ± 6.1 kg/m2, 86% were married, and 42% were parous. Following supplementation with DHEA, all serum androgen levels increased (each P < 0.0001), while FSH levels decreased by 2.6 ± 4.4 from a baseline of 10.3 ± 5.4 mIU/mL (P = 0.009). The FSFI score for the whole study group increased by 7% (from 27.2 ± 6.9 to 29.2 ± 5.6; P = 0.0166). Domain scores for desire increased by 17% (P = 0.0004) and by 12% for arousal (P = 0.0122); lubrication demonstrated an 8% trend towards improvement (P = 0.0551), while no changes in domain scores for orgasm, satisfaction, or pain were observed. Women in the lowest starting FSFI score quartile (<25.7), experienced a 6.1 ± 8.0 (34%) increase in total FSFI score following DHEA supplementation. Among these women, improvements in domain categories were noted for desire (40%), arousal (46%), lubrication (33%), orgasm (54%), satisfaction (24%), and pain (25%).
This uncontrolled observational study implies that supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.
KeywordsFemale sexual function Infertility Hormone status Androgens Dehydroepiandrosterone (DHEA)
This work was supported by the Foundation for Reproductive Medicine and intramural funds of the Center for Human Reproduction.
V.A.K., D.H.B., and N.G. developed the concept of the study; all authors contributed to data accumulation. S.K.D., A.W., and V.A.K. contributed to data analysis; all authors contributed to data interpretation. V.A.K. wrote the manuscript. All authors contributed to revisions of the manuscript and approved the final submission. V.A.K. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Availability of data and material
Anonymized patient level data are accessible by contacting Mrs. Jolanta Tapper at email@example.com.
Compliance with ethical standards
Conflict of interest
N.G. and D.H.B. are co-inventors on several pending and already awarded U.S. patents claiming fertility benefits from androgen supplementation in women with low functional ovarian reserve (LFOR). Both receive royalties from Fertility Nutraceuticals, LLC, in which N.G. also holds shares. Other authors declare that they have no conflict of interest.
This study received Institutional Review Board (IRB) approval (ER11052015-01) on 11/11/2015 from the IRB of the Center for Human Reproduction. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
- 2.J.M. Weinberger, J. Houman, A.T. Caron, J. Anger, Female sexual dysfunction: a systematic review of outcomes across various treatment modalities. Sex Med Rev. 2018 Feb 3. pii: S2050-0521(18)30001-5. https://doi.org/10.1016/j.sxmr.2017.12.004
- 4.R. Basson, J. Berman, A. Burnett, L. Derogatis, D. Ferguson, J. Fourcroy, I. Goldstein, A. Graziottin, J. Heiman, E. Laan, S. Leiblum, H. Padma-Nathan, R. Rosen, K. Segraves, R.T. Segraves, R. Shabsigh, M. Sipski, G. Wagner, B. Whipple, Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J. Urol. 163, 888–893 (2000)CrossRefGoogle Scholar
- 9.M.M. Kushnir, T. Blamires, A.L. Rockwood, W.L. Roberts, B. Yue, E. Erdogan, A.M. Bunker, A.W. Meikle, Liquid chromatography-tandem mass spectrometry assay for androstenedione, dehydroepiandrosterone, and testosterone with pediatric and adult reference intervals. Clin. Chem. 56, 1138–1147 (2010)CrossRefGoogle Scholar
- 18.C.S. Scheffers, S. Armstrong, A.E. Cantineau, C. Farquhar, V. Jordan, Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst. Rev. 1, CD011066 (2015)Google Scholar
- 20.F. Labrie, D.F. Archer, W. Koltun, A. Vachon, D. Young, L. Frenette, D. Portman, M. Montesino, I. Côté, J. Parent, L. Lavoie, A. Beauregard, C. Martel, M. Vaillancourt, J. Balser, É. Moyneur; VVA Prasterone Research Group, Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause 23, 243–256 (2016)CrossRefGoogle Scholar
- 22.N. Gleicher, A. Kim, A. Weghofer, A. Shohat-Tal, E. Lazzaroni, H.J. Lee, D.H. Barad, Starting and resulting testosterone levels after androgen supplementation determine at all ages in vitro fertilization (IVF) pregnancy rates in women with diminished ovarian reserve (DOR). J. Assist. Reprod. Genet. 30, 49–62 (2013)CrossRefGoogle Scholar
- 26.A. Sen, H. Prizant, A. Light, A. Biswas, E. Hayes, H.J. Lee, D. Barad, N. Gleicher, S.R. Hammes, Androgens regulate ovarian follicular development by increasing follicle stimulating hormone receptor and microRNA-125b expression. Proc. Natl. Acad. Sci. U.S.A. 111, 3008–3013 (2014)CrossRefGoogle Scholar
- 33.N. Gleicher, K. Seier, V.A. Kushnir, A. Weghofer, Y.G. Wu, Q. Wang, D.F. Albertini, D.H. Barad, Associations between peripheral androgens and cortisol in infertile women. J Steroid Biochem Mol Biol. 2016 Apr;158, 82-89Google Scholar