Prescription drug Published: RCT evidence Established use

Prasterone (vaginal DHEA): dosing, timing and what to expect

A 6.5 mg vaginal insert, one nightly, approved for moderate to severe painful intercourse due to vulvar and vaginal atrophy after menopause. Distinct from oral DHEA, which is a supplement taken for entirely different reasons.

Also known as Intrarosa, Vaginal DHEA

Educational research reference TRT / HRT & Ancillary

Quick reference. Everything you need to run Prasterone (vaginal DHEA) — dosing, frequency, reconstitution math for the vial sizes people actually buy, and what it stacks with. For anything specific to your situation, ask the Guru.

Prasterone (vaginal DHEA) quick start

Route: Vaginal
Typical dose: 6.5 mg
Frequency: Nightly
Half-life: Short; converted locally within the tissue.
Cycle: Continuous, nightly.

These are the numbers people actually run, drawn from the published record and from what the community has settled on over time. Educational reference, not medical advice — a starting point to work from, and one you can adjust as you learn how you respond.

How to run it

How often: Nightly
Cycle length: Continuous, nightly.
Half-life: Short; converted locally within the tissue.
Route: Vaginal

Consistency matters more than perfect timing. Pick a slot in your day you will actually keep, and let DoseIQ handle the rest.

For women

It is measurably absorbed — after twelve weeks, mean trough testosterone rose about 21% and estradiol about 19% from baseline — but it is treated clinically as a local therapy. The 2025 AUA/SUFU/AUGS guideline groups it with low-dose vaginal estrogen as not requiring endometrial surveillance.

What to expect

Most people tolerate Prasterone (vaginal DHEA) well. Here is what is worth knowing going in, so nothing catches you by surprise.

The label notes estrogen is a metabolite of prasterone, and that it has not been studied in women with a history of breast cancer.

Known interactions

Interactions involving Prasterone (vaginal DHEA)'s drug class that DoseIQ screens for. Each one cites where it comes from — an FDA label section or the published record — because an interaction warning you can't trace is just noise.

Serious Testosterone + warfarin — anticoagulation potentiated

Androgens increase warfarin's effect; INR can climb after starting or raising testosterone.

What to do: Tell the prescriber managing your warfarin about the testosterone — INR gets checked more often around any dose change.

Source: FDA label, testosterone products §7

Worth knowing Spironolactone blunts testosterone

Spironolactone blocks androgen receptors — it works directly against TRT's purpose.

What to do: Sometimes intentional (acne dosing is low); worth confirming the prescribers know about each other.

Source: Spironolactone pharmacology

Worth knowing Finasteride/dutasteride reshape TRT's DHT arm

They block conversion of testosterone to DHT — usually the deliberate point (hair), but it changes what a given T dose does.

What to do: Nothing to do if intentional; PSA readings run ~half their true value on these, which the Markers page notes.

Source: FDA labels, finasteride/dutasteride

DoseIQ screens your whole protocol against these rules automatically — every compound, prescription and supplement you track, cross-checked as you add them. Serious flags are always free.

Preparing it

Prasterone (vaginal DHEA) does not need reconstituting — it comes ready to use. Nothing to reconstitute — one insert, supplied with an applicator.

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This page is an educational research reference and is not medical advice. Dose figures reflect the published record and what the community has converged on — starting points to weigh, not instructions. Consult a qualified healthcare provider before starting any protocol.