Does DHEA help with weight gain during perimenopause?

DHEA has some evidence for influencing body composition during perimenopause, but it is not a reliable weight loss supplement and it will not reverse the metabolic changes of this transition on its own. The perimenopause weight picture is complicated: falling estrogen shifts fat distribution toward the abdomen, insulin sensitivity decreases, muscle mass tends to decline, and total energy expenditure gradually slows. DHEA is relevant here primarily through its conversion to testosterone, which supports lean muscle mass and may help preserve the metabolic activity that muscle provides.

The most cited body composition study is a 2004 randomized controlled trial published in JAMA, which found that two years of DHEA supplementation (50 mg per day) in older men and women reduced abdominal fat and improved insulin sensitivity compared to placebo. Bone density also improved. A smaller follow-up study in menopausal women found that DHEA combined with resistance training produced better lean mass outcomes than exercise alone. However, these studies were in older postmenopausal women, not women actively in the perimenopause transition, and the absolute differences in fat mass were modest. Other trials have not replicated meaningful fat loss. The honest summary is that DHEA may help preserve muscle and slightly improve fat distribution, but it is not a meaningful weight loss tool.

Perimenopause specifically accelerates abdominal fat accumulation because visceral fat tissue is highly responsive to the estrogen withdrawal that occurs during this time. DHEA's relevance is partly that its conversion to estrogen and testosterone can partially compensate for the hormonal signals that normally keep fat distribution more peripheral. Women with lower DHEAS levels at baseline may benefit more, since the supplementation is genuinely restoring a deficit. Women with normal DHEAS levels are less likely to see body composition benefits from additional DHEA. Testosterone conversion from DHEA also supports muscle protein synthesis, which helps maintain the lean mass that keeps metabolism active as estrogen falls.

For body composition purposes, studies have used 25 to 50 mg per day orally. The JAMA trial used 50 mg. Studies have used 50 mg as the reference dose for body composition outcomes. Talk to your healthcare provider about the right dose for your situation. Higher doses are not more effective for body composition and significantly increase the risk of androgenic side effects. The androgenic pathway that supports muscle is the same one that can cause acne, oily skin, and unwanted hair growth if testosterone rises too high.

DHEA pairs reasonably well with resistance training for lean mass preservation, which is the strongest evidence-based intervention for body composition in perimenopause. Protein intake adequate to support muscle synthesis also matters more than any supplement. Do not add DHEA to an existing hormone therapy regimen without your provider's knowledge. If you have or have had breast cancer, ovarian cancer, uterine cancer, endometriosis, PCOS, or uterine fibroids, do not use DHEA without discussing it with your healthcare provider first. Androgenic side effects including acne, oily skin, facial hair growth, scalp hair thinning, and voice changes can occur, and these risks are particularly relevant for weight management discussions where higher doses are sometimes considered. OTC availability does not make DHEA safe to self-dose.

Body composition changes from DHEA, if they occur, are slow and modest. Most studies showing benefit ran for 12 to 24 months. Do not expect visible changes in a few weeks. Tracking waist circumference and how clothes fit over months is more meaningful than scale weight for this purpose, since muscle gain can offset fat loss on the scale while your actual composition improves.

See a doctor if perimenopause weight changes are rapid and unexplained, if you have symptoms suggesting thyroid dysfunction (fatigue, cold sensitivity, hair changes, constipation), or if you have developed new metabolic symptoms like increased thirst or frequent urination alongside the weight gain. Weight changes in perimenopause can also unmask pre-diabetes or worsen cardiovascular risk factors, both of which need medical evaluation and management beyond any supplement.

Tracking weight, waist measurements, and energy levels alongside your menstrual cycle helps you separate hormonally driven fluctuations from trends. The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log symptoms and patterns daily so you can have an evidence-based conversation with your provider rather than guessing at what is driving your body composition changes.

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