Hormones
Dehydroepiandrosteron
Adrenal hormone and precursor of testosterone and estrogen; varies over the day, DHEA-S is usually the better measure.
Everything about this testWhat it measures
DHEA (dehydroepiandrosterone) is made mainly by the adrenal glands, controlled by ACTH from the pituitary gland. It is a precursor: the body converts it into stronger male hormones such as androstenedione and testosterone, and into estrogen. Most of it circulates in the blood as DHEA-S, the form with a sulfate group. Like cortisol, free DHEA follows a daily rhythm and is broken down faster, so the value can differ a lot from moment to moment.
- Too much male hormone from the adrenal glands in women with excess hair growth, acne or irregular periods, usually together with androstenedione and DHEA-S
- Use of DHEA as a supplement or medicine
- Rarely: a tumor or a congenital disorder of the adrenal gland that causes too much male hormone to be made
High
A raised DHEA is often due to the time of the blood draw: the value is highest early in the morning, and stress or illness raises it temporarily. Using DHEA tablets raises the value strongly. In women, a raised value, especially together with a raised androstenedione and DHEA-S, can fit extra production of male hormones in the adrenal glands, for example with PCOS or a mild form of congenital adrenal hyperplasia (CAH); symptoms with this are excess hair growth, acne and irregular periods. Rarely: a strongly raised value with rapidly developing masculinization fits a tumor of the adrenal gland.
Low
DHEA falls gradually with age; a low value in older people is normal and not a deficiency that needs treatment. A blood draw later in the day also gives a lower value. Use of corticosteroids (such as prednisone, also as an inhaler or skin cream) suppresses production. With reduced function of the adrenal glands or the pituitary gland, DHEA is low, but there are then other symptoms and it is mainly cortisol that is abnormal; in Addison's disease, DHEA is sometimes given as a medicine.
If your result is abnormal
With an abnormal value, the GP looks at the time of the sample collection, at supplements and medicines, and at DHEA-S, testosterone and the symptoms. With raised values and symptoms of too much male hormone, tests for PCOS or a referral to a gynecologist or internist-endocrinologist usually follow. With a low value without other abnormalities, follow-up tests are usually not needed.
Reliability
Free DHEA varies strongly over the day, which makes a single value hard to interpret, especially in people without symptoms. DHEA-S is much more stable over the day and better reflects what the adrenal glands produce; when testing for too much male hormone, DHEA-S therefore usually says more. Free DHEA is mainly useful for a specific question, and then together with other hormones. A low value does not show 'adrenal fatigue': that is not a recognized condition.
Limitations
- Timing: DHEA has a daily rhythm and is higher in the morning than later in the day.
- Age and sex determine the reference values; the value falls with aging.
- DHEA supplements raise the value strongly; corticosteroids lower it.
- Stress, illness and lack of sleep can temporarily raise the value. Reference values differ by laboratory and measurement method.
How common is this
Excess hair growth affects about 5 in 100 women; the most common cause of too much male hormone is PCOS. Adrenal diseases that clearly affect DHEA are rare: Addison's disease is estimated to occur in 40 to 115 per million inhabitants. How often an abnormal DHEA occurs in people without symptoms has not been recorded in Dutch figures.
Who is this useful for
Useful in limited situations: in women with excess hair growth, acne or irregular periods, in addition to testosterone, DHEA-S and androstenedione, and for a specific question from a specialist. Not useful as a measure of energy, aging, stress or 'adrenal fatigue', and not to decide whether DHEA use would be needed: there is no medical basis for that.
Downsides and risks
- A low value is often explained online as a deficiency and as a reason to use DHEA; there is no medical basis for this, and DHEA is on the doping list.
- Because of the large fluctuations over the day, a single value can wrongly be seen as abnormal and lead to unnecessary worry and follow-up tests.
Sources
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results