A year-long French study finds that...
Women in Love

Do you think it's worth it - the - the sex part?" 
"The act of loving, itself?" 
"Yes; is it worth anything to you?" 
"But how can you separate it?" he said. "All our 
intimacy culminates then." 
"Not for me," she said. 
            -Sons and Lovers, D.H. Lawrence 
                     (editor's emphasis)

All too often, as men and women age, sexuality takes a back seat. This is particularly true for women, for whom the integration of sexuality with love and intimacy is usually more important than for men. Men may claim that the act of loving brings it all together, but women often know when that is not true. Nevertheless, from a woman's perspective, the culmination is more clearly a three-legged table, supported by sexuality, love, and intimacy.

Unfortunately, libido, sensitivity, and response fade with age, and the balance is upset. Thus, women are more and more deprived of what is perhaps the greatest blessing of life: the ecstasy of sexual passion. In our earlier years, when libido was high and we were more fully conscious of our desires and our desirability, the unhampered flow of energy from mind to body frequently exceeded all expectations. If libido is the ignition system not only of sexuality, but of intimacy and love, what is it worth to be able to rescale the peaks of passion?

The glad tidings are that there is a biochemical solution for slowing, stopping, and even reversing the decline of libido that occurs with age. Although prior studies have indicated that enhancement of libido is plausible, until now there has been no firm answer. But with the recent publication of a major French study led by world-renowned neurosteroid researcher Étienne-Émile Baulieu, the concept of "sunset" sexuality is shattered.1 What Baulieu and colleagues have found is that supplementing orally with 50 mg of the adrenal steroid dehydroepiandrosterone (DHEA) can weave together a panoply of measurable effects. It is dramatically clear that in women over 70, DHEA can heighten sexuality and the ability to enjoy physical love. The opportunities for fulfillment are within ready reach of age-ripened women. Who could be more worthy?

As the years take their toll, we know that there is a profound decrease in blood levels of DHEA. But we also know, from many studies, that it is possible to replace the declining DHEA through oral supplementation. Thus we can help to maintain hormone levels or even restore them to those of young adults. And supplementing with DHEA counteracts some of the degenerative processes associated with aging.2

Dr. Baulieu first isolated and identified DHEA more than 30 years ago while working with the sex hormones testosterone and estrogen, which are chemical derivatives of DHEA. (Actually, estrogen is not a hormone, but the collective name for a class of female sex hormones, such as estrone and estradiol.) As he and his colleagues suggest, the widespread commercial availability of DHEA outside the regular pharmaceutical-medical network in the United States warrants appropriate long-term clinical trials in elderly men and women.* Even though there have been thousands of studies of DHEA over the last four decades, including hundreds of trials showing it to be safe and effective, the bulk of these studies have been short-term. Long-term studies are needed to indicate the true potential of DHEA.

There are two requirements that must be met if a supplement such as DHEA is to gain acceptance in the marketplace. One is proof of safety, and the other is proof of efficacy. So what Baulieu alludes to is the need for more knowledge about safety, efficacy, andapplicability - knowing how to use it.  He and his colleagues are to be congratulated for the present study. They have added a major confirmation to the growing body of information about this powerhouse hormone, and the case is even stronger than before. DHEA is one of the most important supplements one can take.

In the French study, 280 healthy women and men (140 of each, aged 60 to 79), were given 50 mg of oral DHEA or placebo daily for a year. Each group was selected so that half of the men and half of the women were in the age range of 60 to 69, while the other two halves were in the range of 70 to 79.

The study was double-blinded. The subjects were evaluated at the beginning (month 0), halfway through (month 6), and at completion (month 12) for the following parameters:

  • Steroid levels: DHEA, testosterone, androstenediol, and estradiol
  • Other hormones, such as luteinizing hormone and thyroid-stimulating hormone
  • Bone turnover, including bone-mineral density and bone-loss measurement
  • Skin quality, including sebum production, hydration, and pigmentation
  • Sexual function, such as libidinal interest and quantitative and qualitative satisfaction
  • Vascular properties of arteries, including wall thickness, diameter, and flexibility
  • Prostate function (in men) and glycemia values

As we have been led to expect from prior studies, DHEA was restored to more youthful levels in both men and women. The hormones testosterone and estradiol also increased with DHEA supplementation, although more so in the women than the men (recall that all women have some male sex hormones, and all men have some female sex hormones).

In the women over 70, bone turnover improved, as did the quality of their skin. There was also a significant increase in libido. There were no indications of any harmful consequences from taking 50 mg/day of DHEA during the one-year study.

One of the greatest hazards of aging, especially for women, is decreased bone density (osteoporosis), which renders them vulnerable to life-threatening fractures caused by the loss of structural integrity. When a woman falls and breaks her hip at this point in life, she has a high probability of going downhill rapidly.

But in the French study, women over the age of 70 who took DHEA were found to have improved bone turnover, increased bone density in various bones, and decreased bone loss. Increased levels of bone loss have been shown to be predictive of hip fracture in women older than 75 years. Thus it is reasonable to speculate that DHEA can help restore proper bone metabolism.

In the French study, skin improvements were observed, particularly in women, in terms of hydration (moisture retention), epidermal thickness, sebum production, and pigmentation. Skin improvements could be considered to be antiaging benefits. Among the principal functions of skin are protection, excretion (of waste, such as sweat), secretion (of nonwaste, such as oils), absorption, thermoregulation (thermostatic function), pigmentogenesis (color maintenance), sensory perception, and regulation of immunological processes.2

Hydration. Hydration refers to the skin's ability to retain water and keep itself moist. It also reflects how well the skin's protective barrier function works. Ironically, studies have shown that many moisturizers rapidly impair the skin's function as a barrier, thus increasing its susceptibility to irritants.3 Unlike these "moisturizers," DHEA was found to increase hydration without any indication of harm. Hydration is also associated with increased smoothness of the skin.

Sebum Production. As important as the water content of skin is, so it is with fat content. Sebum is a fatty substance secreted by the skin's sebaceous glands. As women age, its production tends to decline. Sebum contains many important protective factors. For example, secretions from the sebaceous glands have recently been found to serve as a major physiologic route of vitamin E delivery to the skin.4 In the French study, sebum production was increased in all four groups taking DHEA, but most noticeably in the women over 70.

Skin Pigmentation. The effects induced by oral DHEA are beneficial for the skin, and this can improve one's self-image. Surprisingly, taking DHEA significantly decreased facial skin pigmentation, which manifests as yellowness. The benefit was most pronounced in women over 70, who tend to be more concerned about age-related changes in skin color than men. In their evaluation of the significance of reduced yellowing, the researchers thought that this represented a rejuvenation process.

Epidermal Thickness. The aging process tends to result in thinning of the epidermis - the outer, nonvascular layer of the skin, and the frontier of the immune system - rendering its protective function less effective. In the French study, DHEA was found to increase epidermal thickness, much as estrogen does. The control groups, however, were found to suffer normal, age-related epidermal atrophy. This was noted in all four groups, but especially in those who had very low DHEA levels when the study began.

Anatomical changes in aging skin result in altered physiological behavior and susceptibility to disease.5 Decreased skin renewal and tissue repair accompany the aging process. The rate of hair and nail growth declines, as well as the quantity of the skin's secretions. Immune system protection, antigen activity, and blood supply to the skin also decline. Among other deteriorations are reduced inflammatory response, impaired thermal regulation, reduced tactile sensitivity, and diminished pain perception.

The most amazing finding of the French study was the degree of heightened sexual awareness reported by the over-70 women. The measures of this enhancement included:

  • Increased libido, in both mental (subjective fantasy experience) and physical (objective signs of sexual excitement) terms
  • Increased sexual activity (intercourse or masturbation)
  • Increased sexual satisfaction (both qualitative and quantitative)

These measures were fairly similar to those of another recent study, in which researchers tested younger women who had abnormally low levels of DHEA owing to diagnosed adrenal insufficiency.6 In that double-blind, placebo-controlled study, 24 such women were given 50 mg of DHEA orally each morning for four months. Then, following a washout period (i.e., no DHEA) of one month, they and the placebo group were switched to the opposite regimens.

The results were dramatic: The women using DHEA had significantly increased frequency of sexual thoughts, sexual interest, and satisfaction with both the mental and physical aspects of sexuality. It was as if they had been awakened from sexual hibernation. But the French study was different in that the women were healthy; in fact, they were extremely healthy for their age. Yet even in the older of the two groups of women, they too experienced a dramatic sexual awakening.

While in the French study there was a small increase in estradiol levels, in the study of younger women with adrenal insufficiency, there was no increase in the estrogen. The idea that the amount could be responsible for the differences was entertained as a possibility. In both studies, however, DHEA was found to produce a slight increase in testosterone, which is known to have a beneficial effect on libido.

Even though enhanced libido occurred primarily in the older women (the same group who showed improvement in bone turnover and various aspects of skin quality), Baulieu et al. did not believe that the increase in estrogen levels was responsible. His reasoning was that because the elevated estrogen had no discernible effect on the women under 70, it could not have been responsible by itself.

It is entirely possible that DHEA did confer benefits in both age groups but that, because all the subjects were so healthy, the benefits could not be seen in the younger (60-69) women. The study concluded by stating that further analysis may show that all four of the experimental groups may have benefited from the DHEA.

The nutrients choline and vitamin B5 are the precursor and cofactor, respectively, in the production of the neurotransmitter acetylcholine. Because of its role in the regulation of muscles, acetylcholine is thought to be instrumental in the physiological aspects of sex, and because of its role in the pleasure center of the brain to attenuate activity there as part of the cholinergic system, it is thought to be necessary for the initiatory aspects of sex, which are likely to include libido-driven behavior.7

Women who wish to improve their sexuality should not overlook the benefits of the amino acid arginine. A recent study indicates that a principal benefit of estrogen supplementation may be its ability to increase the production of the neurotransmitter nitric oxide (NO), which plays an important role in sexual function in both men and women. Moreover, the study found that enough supplementary arginine - arginine is a vital necessity for NO production - can obviate the need for estrogen, decreasing the risk of cardiovascular decline, without the liability of increased cancer risk.8 The possible effects of arginine on endocrine function and atherosclerotic processes were investigated in this double-blind, placebo-controlled, single-crossover study. When 9 grams of arginine or placebo were given daily for one month to postmenopausal women receiving no estrogen, the production of growth hormone increased in the arginine group, as would be expected, but there were no effects on the levels of a wide variety of other important substances, including insulin, adrenaline and related compounds, total cholesterol, triglycerides, and low-density lipoproteins. The researchers judged the safety of oral arginine administration to be very good.

Nitric oxide levels are now thought to decline with the onset of menopause.9Recognizing that estrogen replacement therapy is used successfully to combat sexual dysfunction10 and that NO pathways are believed to be involved in female sexual dysfunction leads to the conclusion that arginine, as the body's primary source of NO (upon which the effect of Viagra in both men and women is based11), may play a direct role in enhancing sexuality. And given that other recent studies have caused concern regarding the cavalier use of estrogen replacement therapy, arginine is likely to be a wise choice.

The herb Ginkgo biloba has been shown to be of clear benefit for women's sexual dysfunction resulting from the use of antidepressants.12 In a trial with 63 subjects, 33 of them women, ginkgo generally had a positive effect on all four phases of the sexual response cycle: desire, excitement (erection or lubrication), orgasm, and resolution (afterglow). This conclusion makes sense, given what we know about the ability of ginkgo to improve the dynamics of blood flow and to increase selectively the release of nitric oxide synthase,13 the enzyme that interacts with arginine to produce NO.

Surprising at it may seem, complaints of sexual dysfunction by women may outnumber those by men. One study puts the figure at approximately 75% of all women, with variation depending on age.14 Typical complaints include decreased libido, vaginal dryness, painful intercourse, lessened genital sensation, and, last but not least, difficulty or inability in achieving orgasm. Thus the realm of female sexual dysfunction is a problem of huge proportions that affects the quality of life of many women and prevents happiness.

Had D. H. Lawrence - who got us to think deeply about the value of romantic passion and love in our lives - known about the role of hormones and biochemistry, he might not have chosen to use the mining industry as a background metaphor for his novel Women in Love. On some levels we have gone far beyond the black mining shafts, so suggestive of what was then not known about the physiology of love.

Were Lawrence alive today and planning his novel in a contemporary setting, he might choose as a background metaphor the pharmaceutical industry, and specifically the steroid hormone/nutrient subindustry. Why? Without the concept of mine-shaft collapses and other calamities, in the final outcome of his novel, love might have a swinging chance to endure for a lifetime and triumph. Well, at least in the Hollywood ending, this would be true, and why not? Lawrence, too, would have been affected by the insights of the biochemical/psychopharmacological revolution. In the Hollywood version, women might still be in love, or more in love, as is more apt to be the case for those who artfully use DHEA, arginine, choline, viamin B5, and ginkgo.


  1. Baulieu ÉÉ, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy MP, Latour F, Leaud MC, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharrière O, Nouveau S, Rakoto-Arison B, Souberbielle JC, Raison J, Le Bouc Y, Raynaud A, Girerd X, Forette F. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci 2000 Apr 11;97(8):4279-84.
  2. Cerimele D, Celleno L, Serri F. Physiological changes in ageing skin. Br J Dermatol 1990 Apr;122 Suppl 35:13-20.
  3. Held E, Sveinsdottir S, Agner T. Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants. Acta Derm Venereol1999 Jan;79(1):49-51.
  4. Thiele JJ, Weber SU, Packer L. Sebaceous gland secretion is a major physiologic route of vitamin E delivery to skin. J Invest Dermatol 1999 Dec;113(6):1006-10.
  5. Balin AK, Pratt LA. Physiological consequences of human skin aging. Cutis 1989 May;43(5):431-6.
  6. Arlt W, Callies F, van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte HM, Allolio B. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 1999 Sep 30;341(14):1013-20.
  7. Lynch CS, Ruppel TE, Domingue RN, Ponthier GL. Scopolamine inhibition of female sexual behavior in rhesus monkeys (Macaca mulatta). Pharmacol Biochem Behav 1999 Aug;63(4):655-61.
  8. Blum A, Cannon RO 3rd, Costello R, Schenke WH, Csako G. Endocrine and lipid effects of oral L-arginine treatment in healthy postmenopausal women. J Lab Clin Med 2000 Mar;135(3):231-7.
  9. Majmudar NG, Robson SC, Ford GA. Effects of the menopause, gender, and estrogen replacement therapy on vascular nitric oxide activity. J Clin Endocrinol Metab 2000 Apr;85(4):1577-83.
  10. Sarrel PM. Effects of hormone replacement therapy on sexual psychophysiology and behavior in postmenopause. J Womens Health Gend Based Med 2000;9 Suppl 1:S25-32.
  11. Shen WW, Urosevich Z, Clayton DO. Sildenafil in the treatment of female sexual dysfunction induced by selective serotonin reuptake inhibitors. J Reprod Med1999 Jun;44(6):535-42.
  12. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998 Apr-Jun;24(2):139-43.
  13. Chen X, Salwinski S, Lee TJ. Extracts of Ginkgo biloba and ginsenosides exert cerebral vasorelaxation via a nitric oxide pathway. Clin Exp Pharmacol Physiol 1997 Dec;24(12):958-9.
  14. Berman JR, Berman LA, Werbin TJ, Goldstein I. Female sexual dysfunction: anatomy, physiology, evaluation and treatment options. Curr Opin Urol 1999 Nov;9(6):563-8.

    * What Dr. Baulieu doesn't say is that the commercial availability of DHEA has represented a learning opportunity for researchers and the public at lar