Does DHEA help with anxiety during perimenopause?

DHEA has some genuinely interesting neurological connections to anxiety, but it also carries significant safety considerations during perimenopause that you need to understand before deciding whether it is appropriate for you. DHEA is a hormone precursor produced primarily by your adrenal glands. In the body, it converts to both estrogen and testosterone, making it hormonally active in ways that require careful consideration, not something to add to your routine casually just because it is available over the counter. One specific mechanism that researchers find compelling: DHEA can convert to allopregnanolone, a neurosteroid that acts on GABA receptors in the brain. GABA is your primary calming neurotransmitter, and declining allopregnanolone during perimenopause is associated with anxiety, mood instability, and poor sleep. This makes the theoretical connection between DHEA and anxiety worth understanding, even though the clinical evidence is mixed.

The research on DHEA and anxiety has produced genuinely interesting but inconsistent results. A double-blind, placebo-controlled trial published in Archives of General Psychiatry in 2005 found that DHEA supplementation at 90 mg per day significantly reduced depression and anxiety scores in people with midlife-onset mood disorders compared to placebo. A 2011 study in Biological Psychiatry found that DHEA modulated the stress response in healthy adults by blunting cortisol reactivity to laboratory stressors. However, these studies were not conducted exclusively in perimenopausal women, and results across larger populations are inconsistent. Some people with DHEA supplementation show clear anxiety improvement, others show no change, and some experience worsening anxiety because DHEA also converts to testosterone, which at higher levels can increase irritability and agitation. The unpredictability of individual conversion rates makes blood testing before starting strongly recommended.

Perimenopause creates a specific anxiety profile driven by multiple overlapping factors that DHEA may partially address and partially miss. Fluctuating estrogen destabilizes the amygdala's threat response, making anxiety feel more hair-trigger than before. Progesterone loss removes a GABA-modulating calming effect, raising baseline anxiety. Night sweats and poor sleep amplify anxiety reactivity the following day. The physical unpredictability of perimenopausal symptoms, including heart palpitations and sudden hot flashes, can trigger health anxiety independently. DHEA touches some of these pathways through its conversion to neurosteroids and its potential to support hormonal signaling more broadly. But because it converts to both estrogen and testosterone, its net effects on your specific anxiety are impossible to predict without knowing your baseline hormone levels. A DHEAS blood test before starting is not optional, it is genuinely recommended, and it helps your provider determine whether DHEA makes sense for you and at what dose.

Studies on DHEA for mood and anxiety have used doses ranging from 25 mg to 100 mg daily. Some research has found benefit at lower doses of 25 mg to 50 mg with fewer androgenic side effects. Talk to your healthcare provider about the right dose for your situation. DHEA is available over the counter in the United States and some other countries, but OTC availability does not make it safe to self-dose. Because DHEA is genuinely hormone-active, the dose matters significantly, and exceeding what your body needs can cause androgenic side effects including acne, oily skin, unwanted facial or body hair growth, scalp hair thinning, and in some cases voice changes. These effects are generally dose-dependent and reversible when the dose is lowered or stopped, but they can be distressing while they are happening.

DHEA carries critical safety considerations that must be discussed with your healthcare provider before you start. If you have a personal or family history of hormone-sensitive conditions, including breast cancer, ovarian cancer, uterine cancer, endometriosis, uterine fibroids, or PCOS, DHEA is not appropriate without specialist guidance because it converts to estrogen and testosterone and can stimulate hormone-sensitive tissue. If you are currently on hormone therapy, adding DHEA changes your total hormone exposure in ways that require monitoring by your prescribing provider. DHEA can also interact with blood thinners, insulin, and corticosteroids. If you are on hormone therapy and experience new or worsening androgenic symptoms (acne, hair changes), DHEA is a likely contributor that needs to be disclosed.

If your provider determines DHEA is appropriate for you, give it eight to twelve weeks of consistent use before evaluating whether anxiety is improving. Some people notice mood and energy shifts within four weeks. Track your anxiety levels using a consistent daily rating so you have objective data rather than impressions. If androgenic side effects appear, discuss lowering the dose with your provider before discontinuing entirely, as a lower dose may maintain the benefit you are experiencing without the unwanted effects.

See your doctor if anxiety is interfering with sleep, work, or relationships, if you are experiencing panic attacks or physical anxiety symptoms like racing heart, chest tightness, or difficulty breathing, or if anxiety feels significantly new or worsened since perimenopause began. These are signs that the anxiety deserves proper evaluation and potentially more targeted treatment. DHEA is not a substitute for evidence-based anxiety treatment. Cognitive behavioral therapy, hormone therapy when appropriate, and medication (such as SSRIs or SNRIs) are all options with strong evidence for anxiety during this life stage and should be on the table as part of the conversation with your provider.

Logging your anxiety severity, sleep quality, mood, and any supplement changes daily gives you and your provider meaningful data to work with instead of approximations. PeriPlan lets you track these patterns consistently so you can see what is changing and what is not. Download it at https://apps.apple.com/app/periplan/id6740066498.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.