DHEA-S, a hormone produced by the adrenal glands, plays a pivotal role in the body's endocrine system. It is a precursor for other hormones like estrogen and testosterone, influencing various physiological processes. Understanding the importance of DHEA-S testing is important as it pertains to comprehensive hormonal evaluation and supporting overall well-being. DHEA-S levels can provide valuable insights into adrenal gland function and hormonal balance, helping to uncover potential endocrinological imbalances. The DHEA-S blood test is one tool that can guide individuals and their healthcare providers in making informed decisions about their health.

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What is DHEA-S?

DHEA, or dehydroepiandrosterone, is a hormone produced by the adrenal glands, which are located on top of your kidneys. The ovaries, testes, and brain also synthesize it in smaller amounts. DHEA is a precursor hormone, meaning it is converted into other hormones in the body. DHEA is converted into DHEA-S (dehydroepiandrosterone sulfate) in the adrenal glands through a process called sulfation. Both DHEA and DHEA-S are important hormones in the endocrine system with various roles.

DHEA serves as a precursor for the production of sex hormones, including estrogen and testosterone. In tissues such as the ovaries, testes, and peripheral tissues, DHEA is converted into these sex hormones, which are crucial for developing secondary sexual characteristics and reproductive functions. DHEA levels tend to decrease with age, and some people use DHEA supplements for anti-aging effects. (19) 

DHEA-S is the sulfated form of DHEA and is the most abundant circulating steroid hormone in the body. It acts as a reservoir that can be converted back into DHEA and other active sex hormones when needed. DHEA-S is measured in the blood as a marker to assess adrenal gland function because its concentration in blood is about a thousand-fold greater than that of DHEA and has low variability throughout the day. (6) 

The DHEA-S Test: Purpose and Procedure

The DHEA-S test is ordered for various reasons related to evaluating adrenal gland function and diagnosing certain medical conditions. Conventionally, DHEA-S testing is often used to assess adrenal gland function because abnormal levels can indicate adrenal disorders such as adrenal tumors or adrenal hyperplasia. Doctors may also order DHEA-S to diagnose testicular and ovarian conditions and evaluate early puberty in boys or masculinization of women and girls. (7) 

DHEA-S is often measured with other hormone tests, including estrogen, testosterone, cortisol, and sex hormone-binding globulin (SHBG). 

The DHEA-S test is a simple blood test performed through a blood spot or blood draw. Blood spot is often used as an alternative to phlebotomy in babies and young children. It is a method of collecting blood samples by pricking the fingertip or heel with a lancet. For blood draws, a healthcare provider draws the sample using a needle inserted into a vein in the arm.  

Unlike other hormones, DHEA-S levels are stable throughout the day, so the timing of the test will not affect the results. Fasting is usually not required, so eating and drinking as usual is okay before the test unless otherwise specified by your healthcare provider. Certain medications and supplements can skew accurate test results. Biotin, exogenous DHEA, nicotine, and medications that treat diabetes and high blood pressure can falsely increase DHEA-S levels. Fish oil and vitamin E can lower them. (6, 9)

Interpreting Your Test Results

Normal DHEA-S levels vary depending on age and sex. Levels outside normal ranges are abnormal and may indicate an underlying medical condition. Normal reference ranges may vary slightly between different laboratories, but typical DHEA-S reference ranges by age and sex are as follows (6, 8):  

Females

• 1-12 months: 4.8-64.1 µg/dL
• 1-4 years: 1.8-97.2 µg/dL
• 5-8 years: 26.1-141.9 µg/dL
• 9-11 years: 35-192.6 µg/dL
• 12-14 years: 67.8-328.6 µg/dL
• 15-19 years: 110−433.2 µg/dL
• 20-29 years: 65-380 µg/dL
• 30-39 years: 45-270 µg/dL
• 40-49 years: 32-240 µg/dL
• 50-59 years: 26-200 µg/dL
• 60-69 years: 13-130 µg/dL
• ﹥69 years: 17-90 µg/dL

Males 

• 1-12 months: 4.8-64.1 µg/dL
• 1-4 years: 0.1-56.4 µg/dL
• 5-8 years: 18-194 µg/dL
• 9-11 years: 49.5-270.5 µg/dL
• 12-14 years: 49.5-270.5 µg/dL
• 15-19 years: 115.3-459.6 µg/dL
• 20-29 years: 280-640 µg/dL

• 30-39 years: 120-520 µg/dL
• 40-49 years: 95-530 µg/dL
• 50-59 years: 70-310 µg/dL
• 60-69 years: 42-290 µg/dL
• ﹥69 years: 28-175 µg/dL

What High DHEA-S Levels Can Indicate

Symptoms that may indicate high DHEA-S levels include excessive body and facial hair growth (hirsutism), acne, female- and male-pattern baldness, irregular menstrual periods, deepening voice, increased muscle mass, aggressive behavior, and signs of early puberty. Let's discuss some common conditions that can cause elevated levels of DHEA-S.

Congenital Adrenal Hyperplasia (CAH)

CAH is a group of genetic disorders that affect the adrenal glands, which are small glands located on top of the kidneys. These disorders impair the adrenal glands' ability to produce essential hormones, including cortisol, aldosterone, and androgens (testosterone and DHEA). The most common form of CAH is due to a deficiency of an enzyme called 21-hydroxylase, which leads to decreased cortisol production and an overproduction of androgens. Classic CAH is typically diagnosed in infancy or early childhood through newborn screening programs and presents with the following signs and symptoms: 

• Ambiguous genitalia
• Rapid growth and early puberty
• Hirsutism
• Irregular menstrual periods
• Salt wasting, leading to dehydration, low blood pressure, and electrolyte imbalances

In addition to elevated DHEA-S levels, people with CAH also tend to have high levels of testosterone and 17-hydroxyprogesterone, low cortisol, hyponatremia (low sodium), and hyperkalemia (high potassium) (21).  

Adrenal Gland Tumor

Active adrenal tumors are abnormal growths that develop in the adrenal glands and secrete excess adrenal hormones. These tumors can be classified as either benign or malignant. Benign tumors, also known as adrenal adenomas, are non-cancerous and do not spread to other parts of the body. Malignant tumors, on the other hand, are cancerous and have the potential to invade nearby tissues and spread to distant organs, a condition known as adrenal cancer.

Polycystic Ovary Syndrome (PCOS)

PCOS is a common hormonal disorder among women of reproductive age. PCOS is characterized by multiple small cysts (fluid-filled sacs) in the ovaries, which can cause the ovaries to enlarge. The exact cause of PCOS is not fully understood, but it involves an imbalance in reproductive hormones, including high levels of androgens.

DHEA-S exhibits weak androgenic activity but can be metabolized to more active androgens, such as androstenedione and testosterone, causing the common features of PCOS, such as hirsutism, acne, irregular periods, and infertility. According to one study, serum DHEA-S levels are elevated in 34% of women with oligomenorrhea and 60% of women with hirsutism.  

What Low DHEA-S Levels Can Indicate

Symptoms of low levels of DHEA-S include unexplained weight loss, nausea, vomiting, dizziness, salt cravings, low libido, erectile dysfunction, and vaginal tissue thinning. These symptoms may be signs of an adrenal gland disorder or related to normal aging. (7) 

Adrenal Insufficiency

Primary adrenal insufficiency, also known as Addison's disease, is a rare but severe disorder where the adrenal glands fail to produce an adequate amount of certain hormones, primarily cortisol and aldosterone. In adrenal insufficiency, the lack of cortisol, which helps the body respond to stress, can lead to extreme fatigue, weakness, low blood pressure, and weight loss. Aldosterone deficiency can cause an electrolyte imbalance, leading to symptoms like dehydration, low blood sodium levels, and high blood potassium levels. (16)

Adrenal Fatigue

Adrenal fatigue is a term commonly used in complementary and integrative medicine to describe a cluster of non-specific symptoms such as fatigue, body aches, and difficulty coping with stress. However, it's important to note that adrenal fatigue is not a recognized diagnosis in conventional medicine. Instead, the concept of adrenal fatigue is often employed by functional medicine providers to describe a functional dysfunction within the hypothalamic-pituitary-adrenal (HPA) axis, a complex system that regulates the body's stress response.

Adrenal fatigue is thought to occur due to chronic stress, leading to an imbalance in the HPA axis and impaired stress hormone production and regulation. Functional medicine practitioners argue that prolonged stress can cause the adrenal glands to become overworked, resulting in abnormal cortisol secretion patterns and low DHEA-S levels. (3) 

Hypopituitarism

Hypopituitarism is a rare disorder that occurs when the pituitary gland, a small gland located at the base of the brain, fails to produce one or more hormones or produces them in insufficient amounts. The pituitary gland plays a crucial role in regulating various bodily functions by releasing hormones that stimulate other glands, including the adrenal glands. The pituitary gland releases adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce DHEA and DHEA-S. When there is insufficient stimulation due to the pituitary gland not producing enough ACTH, the adrenal glands may not produce adequate amounts of DHEA and DHEA-S.

Aging

Natural elevations in DHEA are observed in children beginning around age 7. DHEA levels typically peak around age 30, at which point levels start to fall. This natural reduction in DHEA levels is associated with the broader hormonal changes that occur with aging. (24) 

Some people consider DHEA supplementation to counter these age-related declines, believing it might have anti-aging effects or help manage certain health conditions. However, current evidence is insufficient to support the use of DHEA supplements in preventing age-related diseases. (24) 

Next Steps After Receiving Your Results

After receiving DHEA-S test results, it is crucial to prioritize consulting with an integrative endocrinologist or a medical specialist who can interpret the findings accurately and provide personalized guidance. These professionals have the expertise to understand the nuances of hormonal imbalances and can recommend appropriate next steps tailored to individual health needs.

Based on the DHEA-S results, further tests or investigations may be necessary to identify the underlying cause of imbalances. These could include additional blood, salivary, and urine tests to assess other hormones or imaging studies such as adrenal gland scans.

In addressing DHEA-S imbalances, lifestyle modifications, dietary changes, and medical interventions can play significant roles. Lifestyle adjustments, including stress management techniques, regular exercise, and adequate sleep, can positively impact hormone levels. Dietary changes, such as adopting a balanced diet rich in nutrients and antioxidants, may support adrenal health. Medical interventions may involve hormone replacement therapy or natural supplementation to help restore hormonal balance. (10, 18) 

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Summary

Empowering health through DHEA-S understanding is paramount, as accurate interpretation of DHEA-S test results is important in proactive health management. These results, often indicative of adrenal gland function and hormonal balance, can guide individuals toward informed decisions about their well-being. By taking proactive steps and working collaboratively with medical experts, individuals can address potential issues effectively, optimize their hormonal health, and ultimately enhance their overall quality of life.