Hormones
DHEA
The free DHEA in saliva; follows a daily rhythm and cannot be compared one to one with DHEA or DHEA-S in blood.
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 of male hormones and of estrogen. Saliva contains only the free part that is not bound to proteins in the blood. Like cortisol, DHEA follows a daily rhythm: the value is highest shortly after waking up and lowest late in the evening. Most of the DHEA in the body circulates as DHEA-S, a form that hardly ends up in saliva.
- Use of DHEA as a supplement
- A sign of extra production of male hormones in the adrenal glands, although DHEA-S in blood says more about this
High
A raised value is often due to the time of collection (the value is highest shortly after waking up), to eating, drinking, smoking or bleeding gums just before collection, or to the use of DHEA tablets. Stress and illness also raise the value temporarily. In women, extra production of male hormones in the adrenal glands, for example with PCOS or a mild form of congenital adrenal hyperplasia, can go together with excess hair growth, acne and irregular periods; this is assessed with blood tests.
Low
A low value is normal later in the day and decreases gradually with age. Corticosteroids (tablets, inhaler, nasal spray, skin cream or injection) also lower the value. Reduced function of the adrenal glands is rare and comes with symptoms such as severe tiredness, weight loss and low blood pressure; it is then mainly cortisol that is abnormal, and this is determined in blood. A low value is not proof of 'adrenal fatigue': that is not a recognized condition.
Preparation
- Fill the first tube straight after waking up and the next ones after 30 and 60 minutes.
- Do not eat, drink, smoke or brush your teeth until after the third tube. Do not use mouthwash or dental floss that day.
- Do you use hormone preparations such as hydrocortisone or progesterone? Then stop 48 hours beforehand, in consultation with your doctor.
- Stop supplements that affect hormones, such as maca, 5 days beforehand.
If your result is abnormal
With symptoms that fit too much male hormone, the GP usually has DHEA-S, testosterone and SHBG measured in blood. With symptoms that fit adrenal insufficiency, a morning cortisol measurement in blood follows. An abnormal saliva value without symptoms usually does not lead to further tests.
Reliability
The value in saliva cannot be compared one to one with blood: saliva tests only measure the free DHEA, and the relation to blood varies per person and per moment. For saliva there are few agreed cut-off values, and the meaning of an abnormal value has been little studied. The time of collection strongly determines the result, because DHEA has a daily rhythm. For a question about too much or too little adrenal hormone, DHEA-S and cortisol in blood say more.
Limitations
- Timing: only a sample taken at the agreed time, usually shortly after waking up, can be compared with the reference values; with night shifts, jet lag or an irregular sleep pattern the daily rhythm is shifted.
- Collection: do not eat, drink, smoke or brush your teeth just before collecting; brushing your teeth and blood from the gums can strongly disturb the result. Rinse your mouth with water about ten minutes beforehand.
- DHEA supplements raise the value strongly; corticosteroids lower it.
- Measurement methods for saliva are not standardized; reference values differ by laboratory.
How common is this
How often an abnormal DHEA in saliva occurs in people without symptoms is not known for the Netherlands. Adrenal conditions are rare; tiredness and stress symptoms are much more common and usually do not fit an adrenal disease. Excess hair growth affects about 5 in 100 women, usually due to PCOS.
Who is this useful for
The result says the most in people who use DHEA supplements and want to see whether this raises the value. With symptoms that fit too much male hormone, such as excess hair growth or acne, DHEA-S and testosterone in blood say more. Not suitable for measuring stress, tiredness or 'adrenal fatigue'. In people without symptoms, an abnormal value says little.
Downsides and risks
- An abnormality without symptoms means little; a 'low' value is sometimes seen as a reason to take DHEA, which is not supported by evidence and is on the doping list.
- A falsely abnormal value due to the timing or the way of collecting can cause unnecessary worry and unnecessary 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