By Dr. David LaMond Founder and Medical Director, Blue Sky MD Medical Director, DermaBlue
Every week, I see a version of the same frustrated patient.
She is on well-managed estrogen and progesterone therapy. Her hot flashes are gone. Her sleep has improved. Her labs look good. And she still says some version of the following:
“My skin is still dry.” “I still feel like my face looks thin and dull.” “I did everything right, so why doesn’t my skin feel like it used to?”
For years, my answer focused almost entirely on estrogen and progesterone, because those are the hormones most hormone therapy protocols are built around. But there is a third hormone that deserves far more attention in this conversation than it typically gets, and it is one that most women have never had tested.
That hormone is DHEA.
Dehydroepiandrosterone, or DHEA, is sometimes called the body’s “mother hormone” because it is the raw material your body uses to manufacture both estrogen and testosterone, locally, inside tissues throughout the body, including the skin. And here is the part I think is genuinely under-appreciated: in women, DHEA often declines faster and earlier than estrogen itself, frequently dropping sharply in the very years surrounding the menopause transition.
If a woman’s skin is still struggling despite appropriate estrogen and progesterone therapy, DHEA is one of the first places I look.
What DHEA Actually Does for Skin
Most women have heard of estrogen’s role in skin health. Far fewer have heard of DHEA’s, even though the two are closely connected.
DHEA is produced primarily by the adrenal glands, not the ovaries. On its own, it has relatively modest direct effects. Its real importance lies in what your body does with it afterward: skin cells themselves contain the enzymes needed to convert DHEA locally into estrogen and testosterone, right where it’s needed. Researchers call this process intracrinology, and it means the skin is not simply a passive recipient of hormones traveling through the bloodstream. It is actively manufacturing some of its own hormonal support from the DHEA circulating through it.
Once converted, these hormones act on two different but equally important cell types in the skin:
Fibroblasts
These are the cells responsible for producing collagen. When DHEA converts into estrogen locally and binds estrogen receptors on fibroblasts, it supports collagen synthesis and the small blood vessels that keep skin nourished.
Sebocytes
These are the oil-producing cells in the skin. When DHEA converts into testosterone and binds androgen receptors on sebocytes, it supports sebum production and skin thickness.
In other words, DHEA is not just “another hormone in the background.” It is a supply line that feeds both the structural side of skin health (collagen, via estrogen) and the hydration and thickness side (sebum, via androgens), through conversions that happen inside the skin itself.
The DHEA Cliff
Here is what makes this especially relevant for women in perimenopause and menopause.
DHEA levels peak around age 30 and decline steadily after that, by an estimated 60 ng/mL per year. By a person’s mid-70s, DHEA levels may be only 10 to 20 percent of what they were in young adulthood.
That decline alone would be significant. But women experience something additional: DHEA appears to fall especially sharply during the fifth and sixth decades of life, with research describing a roughly 40 percent decrease between ages 50 and 60.
This is not the same timeline as estrogen decline, and it is not automatically corrected by estrogen or progesterone therapy, because DHEA comes from the adrenal glands rather than the ovaries. A woman can be doing everything right with her menopausal hormone therapy and still be running low on DHEA, simply because no one has measured it.
I sometimes describe this to patients as a second, separate cliff, one that happens on its own schedule and requires its own evaluation.
What I See Clinically
In practice, the pattern I associate with declining DHEA, particularly when skin concerns persist despite otherwise well-managed hormone therapy, tends to include:
- Skin that feels persistently dry despite good estrogen support
- Thinner-feeling skin, especially through the cheeks and temples
- A duller, less luminous complexion
- Reduced skin resilience and slower-feeling recovery from irritation
- Low energy or fatigue that doesn’t fully improve with estrogen alone
- Reduced libido alongside the skin changes
- Thinning hair or brittle nails appearing around the same time
- A general sense of “flatness” that patients struggle to put into words
None of these signs are unique to low DHEA on their own. That is exactly why testing matters rather than guessing. We’ve written a broader guide to DHEA, its role in energy, mood, bone health, and libido, and what optimal levels look like, and I’d encourage anyone curious about the full picture to start there. This article is focused specifically on the skin piece of that picture, which deserves its own deeper look.
Why DHEA Gets Missed So Often
In my experience, there are three reasons DHEA rarely gets the attention it deserves in conversations about menopause and skin.
Most hormone therapy protocols are built around estrogen and progesterone.
These are the hormones most directly tied to hot flashes, night sweats, and bone health, so they understandably get the most attention. DHEA is not part of a standard menopause hormone panel in many practices.
DHEA is adrenal, not ovarian.
Because it doesn’t come from the ovaries, it isn’t corrected simply by replacing what menopause takes away. It has its own independent decline curve and needs its own lab value.
The DHEA/skin connection isn’t widely taught.
Even among clinicians who test DHEA for energy, mood, or libido, the specific mechanism connecting it to collagen and sebum production in skin is not something most training programs emphasize.
The result is a gap. Essentially, a woman can have appropriately managed estrogen and progesterone, normal thyroid function, and still have skin that isn’t responding the way it should, because DHEA was never part of the equation.
Should You Have Your DHEA Tested?
I generally think DHEA testing is worth considering for women who are in perimenopause or menopause and experiencing any of the following, particularly if skin concerns persist despite otherwise appropriate hormone therapy:
- Persistent skin dryness or thinning that hasn’t improved with estrogen therapy
- A duller or less resilient complexion than expected
- Fatigue, low mood, or reduced libido alongside the skin changes
- Thinning hair or brittle nails
- A general sense of reduced vitality that hasn’t been explained by other labs
Testing is simple, a blood draw measuring DHEA-sulfate, and it gives us an objective number to work from rather than guesswork. This is a standard part of our advanced lab testing here at Blue Sky MD.
Treating Low DHEA at Blue Sky MD
When DHEA testing shows levels below what we would expect for a healthy, vital woman, we consider bioidentical DHEA supplementation as part of an overall hormone optimization plan, alongside estrogen, progesterone, and testosterone as appropriate.
DHEA dosing for women is typically much lower than for men, and it requires monitoring. Because DHEA converts into both estrogen and testosterone in the body, supplementation can occasionally cause androgen-related side effects such as acne or unwanted hair growth if dosed too high, which is exactly why we test, dose conservatively, and recheck levels rather than treating this as a one-size-fits-all supplement. Our full guide to DHEA covers dosing ranges and monitoring in more detail.
The goal is not to chase a number for its own sake. It is to restore enough of the raw material your skin, along with the rest of your body, needs to keep doing its job.
Why Blue Sky MD Partners With DermaBlue
Correcting a DHEA deficiency addresses the internal supply line. It does not, on its own, reverse collagen and volume that have already been lost over years of decline.
At Blue Sky MD, we treat the hormonal foundation. We test DHEA alongside estrogen, progesterone, testosterone, and thyroid function, and we optimize that foundation so your skin has the raw material it needs to repair and maintain itself.
Our sister practice, DermaBlue, treats the visible result. For skin that has already thinned, lost firmness, or developed fine lines and crepiness over time, their team uses tools like RF microneedling, XERF radiofrequency skin tightening, and biostimulatory injectables to actively rebuild collagen and structure.
In my experience, patients get the most durable, natural-looking results when both sides of this are addressed together: the hormonal environment that determines how well skin can repair itself, and the direct treatments that help it along.
Who Should Consider a Hormone Evaluation That Includes DHEA?
A comprehensive hormone evaluation, one that specifically includes DHEA rather than stopping at estrogen and progesterone, may be worth considering if you are in perimenopause or menopause and experiencing:
- Skin dryness or thinning that hasn’t responded to your current hormone therapy
- A dull, tired-looking complexion despite good skin care
- Fatigue or low energy that persists despite treatment
- Reduced libido
- Thinning hair or brittle nails
- A sense that something is still “off” even though your main menopausal symptoms are controlled
Women should not be told that persistent skin changes are simply something to accept once estrogen and progesterone are addressed. In many cases, there is another piece of the picture still worth testing for.
My Approach to DHEA
I don’t believe in treating DHEA as a miracle anti-aging supplement, and I am cautious of how it’s sometimes marketed that way. What I do believe is that it is a real, measurable, and frequently overlooked hormone with a legitimate, well-described role in skin health, and it deserves to be tested rather than ignored.
My approach for a woman whose skin isn’t responding as expected generally follows this sequence:
- Confirm that estrogen, progesterone, and thyroid function are already well-managed, since these remain the foundation of menopausal hormone care.
- Test DHEA-sulfate levels rather than assuming they are adequate.
- Evaluate the full clinical picture, energy, mood, libido, hair, and skin, alongside the lab result.
- Consider conservative, monitored DHEA supplementation when levels are low and symptoms support it.
- Refer to DermaBlue for direct treatment of any collagen loss or skin laxity that has already occurred, so the hormonal foundation and the visible skin concern are addressed together.
Skin health during menopause is rarely explained by a single hormone. DHEA is one piece that is tested far less often than it should be.
Schedule a Personalized Consultation
If your skin still isn’t behaving the way you’d expect despite hormone therapy, it may be worth having a fuller picture of your hormone levels, including DHEA. Contact Blue Sky MD to schedule an evaluation >>
Learn more about hormone therapy for women at Blue Sky MD >>
Read our full guide to understanding DHEA >>
Women who want to address visible collagen loss or skin laxity directly can also connect with our sister practice for a complimentary aesthetic consultation, with locations in Asheville and Hendersonville.
Dr. David LaMond Founder and Medical Director, Blue Sky MD Medical Director, DermaBlue