Hormones
DHEA-S
Adrenal hormone and precursor of male hormones; measured with symptoms of too much male hormone in women.
Everything about this testWhat it measures
DHEA-S (dehydroepiandrosterone sulfate) is made mainly by the adrenal glands, controlled by ACTH from the pituitary gland; the ovaries and testicles make a small amount. It is a precursor: the body can convert DHEA-S into stronger male hormones such as testosterone and androstenedione, and into estrogen. Because DHEA-S comes mainly from the adrenal glands, it is a measure of male hormone production by the adrenal glands. The value depends strongly on age and sex.
- Too much male hormone from the adrenal glands in women with excess hair growth, acne or irregular periods
- An additional test when investigating PCOS (polycystic ovary syndrome), especially if free testosterone is not abnormal
- Congenital adrenal hyperplasia (CAH, a congenital disorder in the production of adrenal hormones), especially the mild form that only causes symptoms in adulthood
- Rarely: a tumor of the adrenal gland that makes male hormones
High
A slightly raised DHEA-S usually has no serious cause. In women it can fit PCOS or a mild form of CAH, with symptoms such as excess hair growth on the chin, upper lip, chest or abdomen, acne and irregular periods. Using DHEA tablets or anabolic substances also raises the value. In men, a raised value often causes no symptoms. Rarely: a strongly raised value, especially together with rapidly developing masculinization (deeper voice, strong hair growth, more muscle mass), fits a tumor of the adrenal gland; this needs prompt investigation.
Low
DHEA-S falls gradually with age; a low value in older people is normal and not a deficiency that needs treatment. Use of corticosteroids (such as prednisone, also as an inhaler or skin cream) suppresses control by ACTH and lowers DHEA-S. A low value can also fit reduced function of the adrenal glands or the pituitary gland, but there are then other symptoms and it is mainly cortisol that is abnormal. A low value without symptoms usually has no meaning.
Preparation
- Do you take biotin (vitamin B8, often in hair and nail supplements)? Stop at least 2 days before the sample is taken, or 4 days for a high dose.
If your result is abnormal
With a raised value, the GP looks at the symptoms, medicines and supplements, and usually has testosterone, SHBG and, if needed, androstenedione and 17-hydroxyprogesterone measured. With a strongly raised value or rapidly developing masculinization, a prompt referral to an internist-endocrinologist or gynecologist follows. With a low value and symptoms of adrenal insufficiency, cortisol and ACTH are tested.
Reliability
DHEA-S is not a stand-alone test for a diagnosis. According to the Dutch Society for Clinical Chemistry (NVKC), a raised value does not give a specific diagnosis and further tests are needed to find the cause. The Dutch PCOS guideline (NVOG, 2023) advises measuring free testosterone first when PCOS is suspected; DHEA-S and androstenedione have only limited value for diagnosing PCOS, but can help if another cause of too much male hormone is suspected. In people without symptoms, a slightly abnormal value is hard to interpret.
Limitations
- Age and sex: the reference values differ strongly between age groups and between men and women; the value falls with aging.
- Reference values differ by laboratory and measurement method, so the same number can be interpreted differently.
- Medicines and substances: DHEA supplements and anabolic substances raise the value, corticosteroids lower it.
- In women, hormonal contraception makes the assessment of male hormones unreliable; the PCOS guideline advises stopping it for at least 3 months for this.
How common is this
Excess hair growth (hirsutism) affects about 5 in 100 women. The most common cause of too much male hormone is PCOS; often the amount of male hormone is normal and the skin is more sensitive to it. An adrenal tumor that makes male hormones is rare.
Who is this useful for
Useful for women with excess hair growth, acne or irregular periods, in addition to testosterone and SHBG, especially if testosterone is not clearly abnormal, and with rapidly developing signs of masculinization. Not useful as a measure of aging, energy, stress or muscle building in healthy people: the value is not supported for that, and a low value is no reason to use DHEA.
Downsides and risks
- A slightly abnormal value without symptoms can lead to unnecessary worry about the adrenal glands and to unnecessary follow-up tests.
- 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.
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