DHEA-Sulfate
DHEA-S is the main androgen produced by the adrenal glands. Testing helps determine the source of excess male hormones in women — whether from adrenals or ovaries. This distinction guides understanding of conditions like PCOS, congenital adrenal hyperplasia, and adrenal tumors. DHEA-S is stable throughout the day, so testing can be done anytime.
DHEA-S (dehydroepiandrosterone sulfate) is the most abundant steroid hormone in the human body and the primary androgen produced by the adrenal glands. Unlike testosterone, which in women comes from both ovaries and adrenals, DHEA-S is produced almost exclusively by the adrenal glands. This makes it the perfect marker for adrenal androgen production — if DHEA-S is elevated, the adrenal glands are the source.
Why does this matter? When a woman has symptoms of androgen excess — hirsutism, acne, hair loss — the question is often: where are the extra androgens coming from? DHEA-S answers this question. Elevated DHEA-S points to the adrenal glands as the source, while normal DHEA-S with elevated testosterone suggests ovarian origin (like PCOS). This distinction matters because treatment differs. DHEA-S also helps evaluate adrenal function, screen for adrenal tumors, and assess adrenal insufficiency.
Key Benefits of Testing
DHEA-S is the most specific marker for adrenal androgen production. Because it’s produced almost entirely by the adrenal glands (with minimal ovarian contribution), elevated DHEA-S definitively identifies adrenal androgen excess. This helps distinguish between adrenal and ovarian causes of hyperandrogenism in women.
DHEA-S is also remarkably stable — unlike cortisol, which fluctuates throughout the day, DHEA-S remains relatively constant. This means a single blood draw at any time of day gives reliable results, making testing convenient and reproducible.
What Does This Test Measure?
The DHEA-S test measures the concentration of dehydroepiandrosterone sulfate in blood. DHEA-S is the sulfated form of DHEA, produced primarily by the zona reticularis of the adrenal cortex. The sulfate group makes it water-soluble and extends its half-life, resulting in stable blood levels that are much easier to measure than DHEA itself.
What DHEA-S Does
DHEA-S serves as a precursor hormone — it can be converted into other hormones including testosterone and estrogen in peripheral tissues. In women, adrenal androgens (including DHEA-S) contribute significantly to total androgen production. In men, the adrenal contribution is relatively minor compared to testicular testosterone, so DHEA-S is less clinically significant.
DHEA-S Through Life
DHEA-S follows a distinctive pattern across the lifespan. Levels are high in newborns (from fetal adrenal production), drop during childhood, rise dramatically during adrenarche (around age 6-8), peak in the mid-20s, then steadily decline with age — falling to 10-20% of peak levels by age 70-80. This age-related decline has sparked interest in DHEA as an “anti-aging” hormone, though clinical benefits of supplementation remain unproven.
DHEA-S vs. DHEA
DHEA-S and DHEA exist in equilibrium, but DHEA-S is measured clinically because its levels are much higher and more stable. DHEA fluctuates throughout the day and has a short half-life, making measurement less reliable. DHEA-S reflects overall DHEA/DHEA-S production and is the standard clinical test.
Why This Test Matters
Identifying the Source of Androgen Excess
When women present with androgen excess symptoms, determining the source guides treatment:
| Finding | Likely Source | Common Causes |
|---|---|---|
| ↑ DHEA-S, normal testosterone | Adrenal | Adrenal hyperplasia, adrenal tumor |
| Normal DHEA-S, ↑ testosterone | Ovarian | PCOS, ovarian tumor |
| ↑ DHEA-S and ↑ testosterone | Both or PCOS | PCOS (mildly ↑ both), adrenal tumor |
| Markedly ↑ DHEA-S | Adrenal tumor | Adrenal carcinoma (requires urgent evaluation) |
For Women
Evaluates hirsutism and virilization. DHEA-S helps determine whether excess androgens causing unwanted hair growth, acne, or masculinization originate from the adrenal glands.
Supports PCOS evaluation. While PCOS is primarily an ovarian condition, some women with PCOS have mild adrenal androgen elevation. DHEA-S is part of comprehensive androgen assessment in PCOS workup.
Screens for adrenal tumors. Markedly elevated DHEA-S (typically more than 2-3 times the upper limit of normal) raises concern for adrenal tumor, particularly adrenal carcinoma, which requires urgent imaging and evaluation.
Evaluates congenital adrenal hyperplasia. Non-classic (late-onset) congenital adrenal hyperplasia can present in adulthood with androgen excess. DHEA-S may be elevated, prompting further testing (17-hydroxyprogesterone).
Assessing Adrenal Function
Screens for adrenal insufficiency. Low DHEA-S can indicate adrenal insufficiency, though it’s not the primary test (cortisol and ACTH are more important). In known adrenal insufficiency, DHEA-S confirms the adrenal androgen deficiency component.
Evaluates pituitary-adrenal axis. Because DHEA-S production is partly ACTH-dependent, very low levels can suggest pituitary or adrenal problems affecting the entire axis.
Value of Early Testing
Women with gradually worsening hirsutism or acne often delay evaluation, assuming it’s cosmetic. Early DHEA-S testing identifies whether adrenal androgen excess contributes — if so, treatment can slow or halt symptom progression. More importantly, markedly elevated DHEA-S can be the first sign of an adrenal tumor. Testing when symptoms first appear, rather than waiting until they’re severe, can catch serious conditions earlier when they’re more treatable.
What Can Affect DHEA-S Levels?
Causes of High DHEA-S
- Polycystic ovary syndrome (PCOS) — mild to moderate elevation in some women
- Congenital adrenal hyperplasia (CAH) — especially non-classic/late-onset form
- Adrenal tumors — adenomas or carcinomas; marked elevation suggests carcinoma
- Cushing syndrome (ACTH-dependent) — excess ACTH stimulates adrenal androgens
- Premature adrenarche — early activation of adrenal androgen production in children
- Stress — acute stress can transiently increase levels
- DHEA supplementation — exogenous DHEA raises DHEA-S
Causes of Low DHEA-S
- Adrenal insufficiency (Addison’s disease) — reduced adrenal steroid production
- Hypopituitarism — decreased ACTH reduces adrenal stimulation
- Aging — natural decline after age 30
- Chronic illness — suppresses adrenal function
- Long-term glucocorticoid therapy — suppresses adrenal androgen production
- Anorexia nervosa
DHEA-S and Age
Age dramatically affects normal ranges. A DHEA-S level that’s normal for a 25-year-old would be elevated for a 60-year-old. Always interpret results against age-appropriate reference ranges.
| Age Group | DHEA-S Pattern |
|---|---|
| Childhood (before adrenarche) | Very low |
| Adrenarche (6-8 years) | Rising |
| Puberty through mid-20s | Peak levels |
| 30s-40s | Gradual decline begins |
| 50s-60s | ~50% of peak |
| 70s-80s | ~10-20% of peak |
When Should You Get Tested?
For Women
Signs of androgen excess: Hirsutism (excess facial/body hair), persistent acne, male-pattern hair loss, deepening voice, increased muscle mass.
PCOS evaluation: As part of comprehensive androgen assessment when PCOS is suspected.
Virilization: Rapid onset of masculinizing features requires urgent evaluation — DHEA-S helps identify adrenal source.
Irregular periods with androgen symptoms: Helps distinguish adrenal from ovarian causes.
For Children
Premature adrenarche: Early appearance of pubic/axillary hair, body odor, or acne before age 8 in girls or 9 in boys.
Ambiguous genitalia or virilization: Part of evaluation for congenital adrenal hyperplasia.
For Both Sexes
Suspected adrenal insufficiency: Along with cortisol testing when adrenal failure is suspected.
Adrenal mass evaluation: When imaging incidentally discovers an adrenal mass, DHEA-S helps characterize whether it’s hormone-producing.
Fatigue with other adrenal symptoms: As part of comprehensive adrenal function assessment.
Understanding Your Results
DHEA-S interpretation depends on age, sex, symptoms, and clinical context.
For Women with Androgen Excess Symptoms
| DHEA-S Level | Interpretation | Next Steps |
|---|---|---|
| Normal | Adrenal source unlikely; consider ovarian cause | Check testosterone, consider PCOS evaluation |
| Mildly elevated | May be PCOS or non-classic CAH | Check 17-OH progesterone for CAH; complete PCOS workup |
| Moderately elevated | Adrenal hyperplasia or small adenoma possible | Consider adrenal imaging, 17-OH progesterone |
| Markedly elevated (>2-3x ULN) | Adrenal tumor — carcinoma until proven otherwise | Urgent adrenal CT/MRI; refer to endocrinology |
Low DHEA-S
Low DHEA-S for age may indicate adrenal insufficiency, though cortisol is the primary marker. In the context of fatigue, weight loss, low blood pressure, and other symptoms, low DHEA-S supports the diagnosis. In isolation, low DHEA-S (especially in older adults) may simply reflect normal aging.
Important: Degree of Elevation Matters
Mild DHEA-S elevations are common in PCOS and usually benign. Marked elevations — especially values more than two to three times the upper limit of normal — are concerning for adrenal tumors and require imaging. The higher the DHEA-S, the more urgent the evaluation.
What to Do About Abnormal Results
For Elevated DHEA-S
Assess the degree of elevation. Mild elevation is common in PCOS; marked elevation requires urgent evaluation for tumor.
Check for CAH. Measure 17-hydroxyprogesterone (ideally early morning) to screen for non-classic congenital adrenal hyperplasia, a common cause of adrenal androgen excess.
Consider adrenal imaging. If DHEA-S is significantly elevated or symptoms are severe/rapidly progressive, CT or MRI of the adrenal glands evaluates for tumor.
Treat underlying condition:
- PCOS: Lifestyle modification, oral contraceptives, anti-androgens as appropriate
- Non-classic CAH: Low-dose glucocorticoids if symptoms warrant treatment
- Adrenal tumor: Surgical removal; malignant tumors require oncologic management
For Low DHEA-S
Evaluate adrenal function comprehensively. Check morning cortisol, ACTH stimulation test if indicated.
Consider the clinical context. Low DHEA-S in an older adult without symptoms may be normal aging. Low DHEA-S with fatigue, weakness, and hypotension warrants full adrenal insufficiency workup.
DHEA supplementation: While some advocate DHEA supplements for low levels, evidence for clinical benefit is limited. Supplementation is not standard treatment for age-related decline and should be discussed with a physician.
Related Health Conditions
Polycystic Ovary Syndrome (PCOS)
About 20-30% of women with PCOS have elevated DHEA-S, reflecting adrenal contribution to their androgen excess. Most PCOS-related androgen elevation comes from the ovaries (testosterone), but adrenal androgens can add to the picture. DHEA-S testing helps characterize the androgen profile in PCOS.
Congenital Adrenal Hyperplasia (CAH)
CAH is a genetic disorder affecting adrenal steroid synthesis. The non-classic (late-onset) form can present in adolescence or adulthood with hirsutism, acne, and menstrual irregularities — mimicking PCOS. DHEA-S is often elevated. Diagnosis requires 17-hydroxyprogesterone testing. Treatment with low-dose glucocorticoids can normalize androgens.
Adrenal Tumors
Both benign adenomas and malignant carcinomas can secrete DHEA-S. Markedly elevated DHEA-S — especially with rapid symptom progression or virilization — raises concern for adrenal carcinoma, which is aggressive and requires prompt surgical management. Imaging and often surgical exploration are needed for diagnosis.
Adrenal Insufficiency
In primary adrenal insufficiency (Addison’s disease), the adrenal glands fail to produce adequate hormones including cortisol and DHEA-S. Low DHEA-S accompanies low cortisol. Treatment primarily involves cortisol replacement; DHEA replacement is sometimes added, particularly in women, for quality of life benefits.
Cushing Syndrome
ACTH-dependent Cushing syndrome (from pituitary or ectopic ACTH production) can elevate DHEA-S along with cortisol, because excess ACTH stimulates all adrenal steroids. DHEA-S is part of the biochemical evaluation when Cushing syndrome is suspected.
Hirsutism
Excess hair growth in women in male-pattern distribution results from androgen excess or increased follicle sensitivity. DHEA-S testing helps determine whether adrenal androgens contribute. If DHEA-S is the primary elevation, treatment targets the adrenal source.
Related Biomarkers Often Tested Together
Testosterone — Ovarian androgen marker; compared with DHEA-S to identify androgen source.
Free Testosterone — Active androgen fraction; may be elevated even when total testosterone is normal.
17-Hydroxyprogesterone — Screens for congenital adrenal hyperplasia when DHEA-S is elevated.
Cortisol — Primary adrenal hormone; tested with DHEA-S when adrenal insufficiency or Cushing syndrome is suspected.
ACTH — Pituitary hormone controlling adrenal function; helps classify adrenal disorders.
SHBG — Affects free androgen levels; part of comprehensive androgen assessment.
Note: Information provided in this article is for educational purposes and doesn’t replace personalized medical advice.
Frequently Asked Questions
DHEA-S (dehydroepiandrosterone sulfate) is an androgen hormone produced almost exclusively by the adrenal glands. It’s the most abundant steroid hormone in the body and serves as a precursor that can be converted to testosterone and estrogen.
DHEA and DHEA-S exist in balance, but DHEA-S is measured clinically because it has stable blood levels throughout the day. DHEA fluctuates and has a short half-life, making it less reliable to measure.
In women, DHEA-S helps determine the source of androgen excess. Because it comes almost exclusively from the adrenal glands, elevated DHEA-S points to adrenal causes (like CAH or tumors), while normal DHEA-S with elevated testosterone suggests ovarian causes (like PCOS).
Yes, significantly. DHEA-S peaks in the mid-20s and declines steadily, falling to 10-20% of peak levels by age 70-80. This is normal and results must be interpreted against age-appropriate ranges.
espite marketing claims, evidence for DHEA supplementation benefits is limited. While some studies suggest modest benefits for specific conditions, routine supplementation for “anti-aging” is not supported by strong evidence. Discuss with your doctor before supplementing.
Mild elevations are common in PCOS and usually benign. Marked elevations — more than 2-3 times normal — are concerning for adrenal tumors and require urgent imaging. Rapid symptom progression or virilization also warrants urgent evaluation.
Less commonly. In men, testicular testosterone dominates, so adrenal androgens are less clinically relevant. DHEA-S may be tested when adrenal tumors or adrenal insufficiency is suspected, but it’s not routinely checked for hormone symptoms.
References
Key Sources:
- Azziz R, et al. The androgen excess and PCOS society criteria for polycystic ovary syndrome. Fertil Steril. 2009;91(2):456-488.
- Speiser PW, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(11):4043-4088.
- Arlt W. Androgen therapy in women. Eur J Endocrinol. 2006;154(1):1-11.
