Today, we’re going to dig into an adrenal hormone called DHEA (dehydroepiandrosterone), courtesy of this question I received from a blog reader via email:
“Over a year ago I went to a gynecologist with the suspicion I had high testosterone levels and maybe have PCOS. Weirdly, my testosterone levels are normal but the gynecologist was alarmed by my high DHEA levels and told me to find an endocrinologist as soon as possible.
After a year or so of trying to get a referral that was accepted by Medicare (no easy feat), I have seen an endocrinologist three times and have gotten my blood tested with the same results: high DHEA levels. He is concerned but only enough to say that my levels need to be monitored for several months before we make any kind of decisions as far as medicine or whatever.
As an average person is inclined to do, I’ve done a fair bit of reading online (ugh) and 90% of what I’ve seen seems to relate to adrenal fatigue and other flaky sounding faux diagnostics. I’m super confused, my doctor doesn’t have great bedside manner, and I would love to hear from someone who might be inclined to write a rational and educated blog post explaining DHEA and what “woo-woo” ideas are out there and how to avoid them.”
Jennifer’s (not her real name) question is a good one, as there is a hefty dose of nonsense out there when it comes to the discussion of DHEA. As a general rule:
If your doctor/provider is ordering a DHEA level because she thinks it may be high, that’s usually appropriate. If your provider is ordering it because she thinks it might be low, you are probably wandering into Quackery territory. Finally, if your provider is ordering it “just because,” then you need to run – not walk – out of that office and head for the hills.
To understand why your doctor might want to look for a high DHEA level, I need to do a brief review (warning: this gets boring for a few sentences) of what the heck DHEA is, just so we’re all on the same page. It is one of the most abundant (but weak!) circulating androgenic (masculinizing) hormones in premenopausal women. Importantly, DHEA levels have a diurnal variation (they are higher in the morning), whereas DHEA-S[ulfate] levels are stable throughout the day. Because DHEA-S levels are stable and present at a higher concentration than DHEA levels, DHEA-S is what we measure in patients. So if you see DHEA on your lab results instead of DHEA-S, that’s a red flag that your provider may not know what she’s doing.
DHEA-S is produced de novo only by your adrenal glands, and it then gets converted to stronger, more active androgens, like androstenedione, androstenediol, testosterone, and 5-dihydrotestosterone (5-DHT). Testosterone and 5-DHT are the hormones primarily responsible for androgenic effects (they are the hormones that actually bind to the androgen receptor).
When it comes to androgenic effects, most women are not concerned with all the good stuff that androgens do; rather, the reason why they seek help from the doctor is because of the bad stuff that excess androgens do to females. Mainly, we’re talking about acne; dark, coarse hairs on the face and body; loss of hair from the head; and irregular periods.
When a woman presents to her doctor with signs of androgen excess, it’s quite reasonable to check one or more of the above androgenic hormones, to see if there is obvious over-production. There isn’t universal agreement on exactly how much money to spend on lab testing, but it’s fairly common to check at least testosterone +/- DHEA-S. For various reasons – some of which involve the idiosyncrasies of different testosterone assays out there – one or more of the measured androgens may be high, while others may be normal (i.e. Jennifer’s DHEA-S could be elevated and the testosterone normal, as she suggested).
The vast majority of adolescents and young women with elevated levels of one or more androgens will ultimately be diagnosed with PCOS (polycystic ovarian syndrome). A detailed discussion of PCOS is outside the scope of this piece; it deserves a dedicated post.
A source of confusion for women (and sometimes their doctors) is when androgen levels are elevated and the diagnosis isn’t PCOS. What else could it be? As I’ve stated before, this blog is not a “medical-o-pedia” site, but I’m always happy to link out to good sources of information. If you’re really interested in delving into the detailed differential diagnosis, you can check out the Endocrine Society’s guidelines for diagnosing and managing hirsutism in premenopausal women. You’ll notice that the ES’s guideline paper does not go into detail about every possible diagnosis they list in the differential, but if you want to know more about a particular diagnosis, chances are the ES has published a guideline about just that topic on their website. If you happen to be a postmenopausal woman, I don’t want you to feel left out, so you can also get as deep into the weeds as you like by reading Hyperandrogenism after Menopause.
To summarize, most cases of modestly elevated androgen levels in premenopausal women represent PCOS. When it’s not PCOS, there’s a relatively short list of other things your endocrinologist should consider. Now, when the androgen levels get really high, the first thing most patients want to know is, “Is it cancer?!” To address that, we have to define “really high.” Unfortunately, there isn’t universal consensus, because plenty of women have high numbers without invoking a malignant process. As a general rule, though, we try to rule out the presence of an ovarian tumor when the testosterone is above 150-200 ng/dL (5.2-6.9 nmol/L); we look for an adrenal tumor when the DHEA-S is above 600-700 mcg/dL (16.3 – 19 μmol/L).
Now that we’ve covered the aspects of androgen measurement that are evidence-based, let’s turn our attention to the aspects of DHEA that stray into the realm of quackery. Earlier, I gave you the rule of thumb that, if your doctor is looking for high levels, that tends to be kosher. Let’s talk about the (usually) non-kosher search for low levels.
Naturopaths and other non-evidence-based practitioners may check blood and salivary levels of DHEA, DHEA-S, and other adrenal hormones as part of a workup for “adrenal fatigue.” Unfortunately, they are attempting to diagnose a condition that does not exist. If you haven’t already, now would be a great time to read one of my prior posts, Adrenal Fatigue – A Fraud Perpetrated On Unsuspecting Patients.
This is a fairly simple concept. Adrenal fatigue ≠ exist. Do not be fooled by your naturopath with variations on the theme of adrenal burnout:
- We just need to support your adrenals.
- Your hormones are just a little out of balance, but we can restore that balance.
- Yes, your numbers are normal, but in my experience, most women do better with high-normal levels.
Now that we’ve gotten that out of the way, the broader question is, “Is there an actual androgen deficiency syndrome in women?” According to the best available evidence, there is no reliable way to make that diagnosis in women who are otherwise healthy. However, there are a few situations in which women could potentially suffer from androgen deficiency and might benefit from treatment:
- Women who have had both ovaries removed have lower testosterone levels than women who go through a natural menopause, as the postmenopausal ovary continues to make testosterone.
- Women with primary adrenal insufficiency (Addison’s disease or adrenal failure of other causes) obviously won’t make as much adrenal androgen.
- Women with pituitary failure (hypopituitarism), particularly pituitary glands that are no longer making ACTH or gonadotropins (the hormones that stimulate the adrenals and ovaries, respectively) may have lower androgen levels.
If you really want to dig into the details of androgen therapy for women, you can do that here. This is a simplified version, based on the evidence:
- There is no clear correlation of blood androgen levels with symptoms like decreased sexual desire or general well-being. Therefore, looking for low levels of androgens is usually going to be a fool’s errand.
- There is no good evidence that routinely treating low levels of androgens with T (testosterone) or DHEA leads to an improvement of symptoms.
- There is no good long-term safety data regarding the use of T or DHEA for women.
- The best evidence for benefit from T therapy is in postmenopausal women with hypoactive sexual desire disorder.
The Role for Androgen Therapy in Evidence-Based Endocrinology
In Endocrinology, we traffic in quantifiable hormones that have measurable effects on the body. We love to look at numbers and symptoms, track them, and optimize them. So what do we do when that’s not possible? This is where the art of medicine comes into play. Unfortunately, when the evidence base is thin (or when the evidence clearly shows that a treatment is likely to be ineffective), this provides a hole that naturopaths and other fringe practitioners are eager to fill. This results in women getting loaded up with hormonal pills, drops, and creams – some will be ineffective, and some will be harmful.
In my practice, I do not routinely search for low androgen levels in women with nonspecific symptoms of fatigue, decreased libido, etc. However, in women with true adrenal failure or hypopituitarism who have mood or libido symptoms, I will sometimes empirically try 25-50mg of DHEA. I honestly haven’t used it often enough to form an opinion of whether it works. Anecdotally, I can say that the women in whom I’ve tried it have felt no better.
In postmenopausal women with sexual dysfunction/low desire, I have rarely prescribed a compounded testosterone cream, starting with 300-400 mcg to the skin once daily. Ordinarily, “compounding” is a dirty word in Endocrinology, as it is associated with compounding pharmacies, which have no external oversight and tend to do some quacky things. But, since there is no FDA-approved formulation of testosterone for women, I use the compounding pharmacy. I have seen clinical improvement in a couple of women over the years, but I admit that I haven’t used it often enough to have an informed opinion.
In the above examples, I monitor DHEA-S and testosterone levels, respectively, to make sure I’m not giving the woman too much. I will boost the dose until we either see symptom relief, side effects, and/or levels that are too high. If we boost the dose to achieve a robust blood level and there is no clinical improvement within a few months, then we stop therapy.
The Bottom Line
Looking for high levels of androgens in women who present with signs of male hormone excess is reasonable. Searching for low levels of androgens in otherwise healthy women with nonspecific symptoms is not recommended. Treating these healthy women with a cocktail of androgenic hormones and passing it off as balancing their hormones is quackery, pure and simple.
Have you had androgen testing? Have you ever been told your levels are high? Low? What type of treatment did you have, and did it work? If you’re a doctor, how do you handle healthy patients who request this type of testing?
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66 Replies to “Hormone Spotlight: DHEA Demystified”
I would LOVE your thoughts on Non-Classical Congenital Adrenal Hyperplasia. My daughter has been diagnosed with a rare form of this and was also born without a thyroid. The thyroid is an easy thing to dose/test/etc but the adrenal issues are much more complex.
Abigail, is there are a particular aspect of management of CAH that you’re interested in? It’s a vast topic, as you likely know by now.
I am looking for more information on the emotional effects of CAH. My daughter has full blown breakdowns with near hysteria and I don’t know if that is more likely to be thyroid related or adrenal related. Also- reading blood tests regarding CAH has me scratching my head. I do have a great pediatric endocrinologist for her but would like to have a firmer understanding on the topic.
Abby, I’m so sorry to hear that your daughter is having such a hard time. I’m glad to hear you have a great pediatric endocrinologist, as the emotional effects of CAH in kids is well outside my wheelhouse. Your doctor may be able to recommend some reading material (if she/he hasn’t already) that will provide some clarity about interpreting the blood tests. But the interplay of adrenal hormones, thyroid hormone, and general brain chemistry is a tough thing to get a handle on, so I hope your doc can steer you in the right direction. I wish you the best of luck.
Hello! Thank you so much for your insight. It has been helpful. I have chronic painful cystic acne, as well as worsening anxiety disorder.
I’m going to have my hormones retested, but in my past bloodwork my hormone levels have always been within normal range EXCEPT my most recent test. My Testosterone had gone from 17 to 2. I had been tested for pcos 4 times in total.
I was at 17 in July and 2 last week.
My last two PCOS blood tests were taken 2 days before my period.
Prior to my recent bloodwork, I was taking DIM with CDG & Primrose oil (I have been on primrose for a few months with no side effects)
I was taking 100 mg of DIM. I felt sick within the two weeks I was on DIM. Nausea, migraines, breast tenderness, so I stopped.
I had a unilateral oophorectomy in 2011. I have had worsening cystic acne ever since.
I’m reading that can cause fluctuating testosterone levels as well.
I am now currently on a low sugar, gluten/dairy free diet that consists of a lot of healthy fats veggies.
I did take a DUTCH (urine) test and a natural doctor said
“The biggest red flag for me is your high 5-alpha-reductase conversion path. This means that you are converting androgens way to quickly into DHT which is causing acne/oily skin and a whole host of other symptoms! This high 5-a-reductase pathway is usually caused by two things, a sensitivity to androgens OR (more likely) high cortisol levels! High cortisol would also indicate an inability to eliminate excess oestrogen properly, therefore creating high oestrogen levels”
Unsure what any of this could mean. Is she on to something? I don’t know where to turn. I have been at this a few years and i’m just lost.
I almost wish my bloodwork revealed PCOS! What could cause such a significant drop in testosterone? Should I be tested further?
Standard PCOS bloodwork may not be revealing enough.
Any advice would be so helpful. Thanks so much.
I was diagnosed with premature ovarian failure a few years ago in my 20s. I think I’ve had most general hormones tested except for dhea. Is it irrevelant? Just wondering because while I feel immensely better on hrt still have some lingering issues and wonder if something else is still off balance. I’m not into quackery medicine but I can see how people with my diagnosis end up there sometimes. Obgyns are great but not really hormonal experts. Reproductive endocrinologists just want to get you pregnant. 🙂 Could an endocrinologist help? I enjoy the blog..some really great perspective!
Hi Trena, while DHEA-S testing probably won’t tell you a whole lot of useful information, it’s not wrong to chat with an Endo, maybe just once, to get your residual questions answered. POF (or Premature Ovarian Insufficiency, as it’s often called now) can be a very frustrating diagnosis, as it often has no clear “cause,” so you’re just left treating the end result (i.e. HRT). If you do decide to see an Endo, I’d recommend someone whose profile states an interest in women’s health, if you can find one. I say this because I rarely see anybody for POI, so I feel like I am not much better than OB/GYN in this realm.
You may find information here that is helpful, I know I did. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684134/
Jim’s link is to a case published in an integrative medicine “journal.” This is pseudoscience masquerading as legitimate. Don’t fall for it.
I am a 29 y/o female with a laundry list of symptoms. My doctor tested my DHEA and it was 1123 ng/dL. I saw an endocrinologist who felt that it was a non specific test, and ran all the other major hormones you would to check for a pituitary disorder. All the hormones were within normal limits and she does not suspect PCOS. She told me there was nothing else to be done and had no further recommendations. Thoughts?
My apologies, but I am unable to dispense individual medical advice.
Back in my mid to late 30’s, I had high DHEA-S and was told I had PCOS (I was thin and athletic and in the military). I didn’t understand anything about it then. I also didn’t think it was the right diagnosis at the time. 3 years ago, I found I had Endometriosis with two 5cm cysts on my ovaries and a lot of small cysts and multiple adhesions. I had surgery and have been on Norethindrone since then. I thought turning 50 might be the magic time of menopause for me, but when I stopped the Norethindrone, 30 days later, I spotted and all those pms symptoms came right back. So still not sure now if the PCOS was really the right thing or if it was Endometriosis all along. I have never had my DHEA-S checked since. Not sure if DHEA-S would have anything to do with Endometriosis or if I have just been unlucky to have had both Endometriosis and PCOS. I did have mostly regular periods, but they just got more and more painful until I had to go the the Emergency room in extreme pain. I thought I had appendicitis!
I have DHEA-S level of 388. I’m going through menopause. I’m mainly concerned because I am losing my hair. It first started as Alopecia Arreata 4 years ago and now I’m told I have Hashimotos. All of my bald patches have grown in, but now losing on my sides and top of scalp. My adrenal gland was tested along with my thyroid because my thyroid AB antibodies were also high and was diagnosed with Hashimotos. My TSH levels were normal range as well. Endocrinologist told me I have excess DHT. I am currently trying Nutrafol for the past 2 months, which is an all natural supplement specifically for hair loss due to stress, excess DHT, etc. I also have RA (which I’ve had for 26 years and have been on several biologist, but none have never made me lose my hair). I feel helpless.
My doctor has me on 50mgs of DHEA per day. I have tested to be 17.1 umol/L . He says this is perfect, but I can’t find any information that backs it up. Most information says this is too high. What is your opinion.
I’m sorry, but it’s my policy to not offer specific advice of this nature.
great break down of DHEA for women…
but what about DHEA for dudes?
May you briefly explain it, or maybe write a blog about it?
I would love to hear your thoughts.
In the absence of adrenal failure, not sure there is much role for DHEA in men. In the presence of adrenal failure, it’s probably still not too useful. Haven’t seen much data on that.
So do i get this right? – The DHEA level a guy has is tightly controlled by the body and “just right” for this individual, provided that no “serious” pathology exists… ?
And this applies also to testosterone, estrogen, etc etc.
So the notion that low levels of androgens or sexhormones may signal that something is wrong (maybe lack of sleep, high stress, nutrient deficiency, …, …) is incorrect? Or phrased differently; lifestyle (if its not too extreme of course) basically has little influence on those hormonal levels ?
I wouldn’t say that lifestyle has no effect on these hormones. I’m just saying that there is usually no good reason to check a DHEA-S level in a man. As for lifestyle, testosterone is a classic example of a male hormone that can be low in the setting of significant weight gain, but then it can rise when that weight is lost.
Ok i see.
As far as testosterone is concerned, is it analogous to TSH/T4? – meaning that one could look at luteinizing hormone and assess whether its low or high.
If LH is low, the body is fine with the amount of testo it has, but
if LH is high, the body perceives a deficiency of testo and combined with low T-levels it could suggest that the body has issues producing it?
So i guess what im ultimately trying to ask is, would it make sense to look at LH to find out if somebody has truly “low T”?
Good question. No, the LH-testo relationship is not really like the TSH-FT4 relationship. With the pituitary-thyroid axis, the most common derangement would be a primary failure of the thyroid to release adequate amounts of thyroid hormone, which leads to an exponential rise in the TSH. Therefore, when the thyroid is failing mildly, and the FT4 is “normal” but perhaps lower than what is normal for that person, the TSH will demonstrate a disproportionate rise out of the normal range. So TSH is a very sensitive test to detect primary hypothyroidism, since it will usually become elevated long before the FT4 is ever low.
With testosterone deficiency, primary testicular failure is usually not the most common cause of low T. When the testicles do fail, you will see a low T and a high LH. But usually the T is low in men who have gained some weight around the middle. This is much more common than primary hypogonadism (testicular failure). When the T is low in overweight men, or other men whose pituitary glands simply aren’t stimulating the testes appropriately, the most common lab picture is a lowish T and normal LH. Occasionally, the LH can be frankly low, but usually it’s normal.
So the LH is a necessary test to check if the T is frankly low, as it can distinguish between a primary testicular problem vs a pituitary problem. But because the most common reason for low T is NOT primary hypogonadism, you cannot use a normal LH as a reason to say that the low T level is “normal.”
I recently had labs done and my DHEA-S level was 400.1. I was diagnosed with hypothyroidism in February, and have a significant history of trauma resulting C-PTSD and chronic depression. I had my right ovary removed in March due to bad cysts and it was in really bad shape when the surgeon finally got it out. My progesterone levels have always been really really low despite having labs drawn around ovulation.
I guess my question is are there any supplements you would recommend I research for lowering my DHEAs levels? Also, would you say the DHEAs levels are connected to my hormonal imbalance, or that that may be the root of my hormonal imbalance? Are there any other labs you would recommend I ask my dr to run or check for?
I’m sorry, Maeve, but it’s my policy to answer only general questions. I cannot provide specific medical advice.
Women don’t care about the good stuff that androgens are known for? Clearly you don’t understand women’s needs. Naturopaths AND other non-evidenced based practitioners? Quiet the statement you’re making there–can you back that a bit more, because that sounds like quackery. How about MDs prescribing pharmaceutical agents that have very little evidence and list of negative side effects–that’s not quackery? Keep writing…and hopefully you don’t work with patients directly!
I have secondary adrenal insufficiency brought on by too many years of steroid puffer use for severe asthma. Not treating the asthma wasn’t an option either as death was a very real possibilty. It’s a damned if you do and damned if you don’t situation. Needless to say, there is no escaping adrenal insufficiency either and been told that we just need to focus on a good treatment plan for the Adenal insufficiency. Yup adrenal crisis are no fun either. Being a chemist who works in radioparmaceytical research, I’ve also given thought to DHEA replacement, as my last blood tests revealed undetectable levels of DHEAS and non of testosterone either. Yup the libido is definately in the tank but I somehow doubt that providing DHEA will give a lot of overall benefit. Having crappy cortisol levels is a sure thing to feeling really bad, but when I’m stable in that regard I feel pretty darn good. Just wishing stability was more present 100% of the time, but that won’t happen either. I know others with adrenal insufficiency who use DHEA, for some it gives them a bit of a boost energy wise and for others it does nothing but give them greasy acne skin. I feel that I already have enough on my plate then to add another drug on top. My only beef is that so many people equate adrenal fatigue with the real condition and then have the gall to tell you that you’re wasting your time on conventional doctors and that you can heal up your glands with a better diet and rest. They don’t even want to understand how dangerous this condition can get when entering into an adrenal crisis. I refuse to talk about with people anymore. Well accept I’ve let out first adders know at work what to do if they find me unconscious.. knock on wood that never happens!
I had levels over 700. I was also under EXTREME stress. My ultrasound showed no cancer, but a complex ovarian cyst. My levels came down to 550 pre surgery and 450 after surgery to remove the ovary. But I am still struggling with excess hair growth and anxiety attacks. I am also under fairly severe stress.
My question is whether I am doing something wrong. I had major problems taking birth control in my 20s (im in my late 40s), and to get better I started drinking raspberry leaf tea and have continued for over 20 years. I also now take shitawari, and started around the time the anxiety attacks did, but that is also when the extreme stress began. Both herbs increase estrogen. But without them my libido and menustration fall off quickly. With them both are excellent. I cant really reduce stress other than with medication due to my situation, so im just having trouble figuring it all out. I have figured out that alcohol makes the symptoms a million times worse and also makes me have edema, so ive stopped it almost completely.
Unfortunately I am unable to address specific, individual situations. My apologies.
could you please answer the first part of her question? is 700 dhea means cancer?
I also have levels above 700, waiting for more tests.
do you have any updates?
I have secondary adrenal insufficiency from years of steroid puffer use for severe asthma. I’ve also had my serum DHEAS and testosterone levels measured, which by the way were both non detectable. Oh joy! I guess that explains the lack of sex drive. I’ve not tried supplementing either of those hormones, and talking to other AI people in the community, it seems to be a hit or miss thing. Maybe one of theses days I will try DHEA and see if it also helps with energy.
Can you clarify the age range for 600-700 of dheas as a general rule for testing for tumors? Seeing an endocrinologist for dheas of 376 at age 46 and finally seeing it doesn’t HAVE to mean cancer. Good lord the internet is a scary place if your dheas are high… and they won’t say what’s “high” like is 400 “scary get a surgery to remove probable tumor” high or “let’s watch this thing and get more tests” high? I’m a full time assistant professor and full time PhD student going through a divorce. Can’t help but think stress has something to do with it. The crazy high libido is kinda fun though…
I think you’re alluding to the fact that the normal reference range for DHEA-S starts shifting down with age, such that we might get more concerned about an “elevated” level in a 75 yo woman, as opposed to the same level in a 45 yo woman. I want to avoid giving too many “hard” numbers here, as there is a very wide range of levels we see that do NOT represent a tumor/cancer. Suffice it to say, though, that I often see levels in the 300s in young women, and I’ve never seen that due to a cancer.
I have been sick for 2 years, I had my hormones checked and I had high DHEA S and almost non existent pregnenolone <5, I was 57 at the time, I have gained 50 lbs in a year and a half, now I’ve been diagnosed with RA, sjrogrens syndrome , hypothyroidism , no libido, adult acne, fatigue, it just goes on and on ! Any answers
I have yet to see any explanation of low free testosterone, paired with high DHEA-S (>500). Is there anything that could explain a pairing like this? Thanks.
I am in this same situation, and no one has been able to explain it either!
AP – Did you ever find an answer to this?
I had a level of 591 for DHEA-S, but when I asked my gynecologist (who I was referred to for my PCOS) he said it was not necessary to retest because the levels would be “corrected by the birth control.” It seems like retesting DHEA-S levels to monitor them is done by most doctors. How come they skipped over this with me because I was taking birth control? I was diagnosed at a young age- 25.
In general, androgen testing for PCOS is done as a diagnostic tool, once, and then not repeated. Although some docs may like to retest, there usually isn’t much utility in retesting, unless the doc is worried about a tumor and just wants to be sure that the androgen levels really do come down or stay stable with treatment.
The reason for not retesting is that we are looking for resumption of normal periods, improvement in hirsutism, decrease in acne and hair loss, etc. None of that can be correlated to a precise androgen level. As long as we are seeing a clinical improvement, we usually don’t care what the androgen level is doing.
That said, I will occasionally repeat a very high androgen level, just to reassure myself and the patient that it isn’t in territory that could suggest alternate diagnoses besides PCOS.
I see this is an older post, but was curious if you were tested for NCAH too?
I am disappointed that you did not address elevated DHEA-S in male patients. Like an SHBG discussion, endocrinologists always focus on females for certain hormones, as if they can be any random number in men without consequence.
I am a male with life-long elevated DHEA-S (~ 25% above reference range) along with lifelong secondary hypogonadism. Hormone replacement therapy does not lower my DHEA-S.
There are a few published hypotheses about a male version of PCOS. This seems to be true for me, as I have elevated free androgens (up to 5% of total, always out of range high while on hormone therapy), with elevated DHEA-S and a very low SHBG (< 15 nmol/L.)
I wonder if you would consider this to be a problem.
I suppose that the question for males would be: why would anyone check their DHEA-S in the first place? What clinical phenotype would suggest a high DHEA-S level? If you can provide me with a reference to a paper about a male version of PCOS, I’m happy to take a look, as I am not familiar with it.
“Male PCOS equivalent and nutritional restriction: Are we stepping forward?”
“Polycystic ovary syndrome in men: Stein-Leventhal syndrome revisited.” https://www.ncbi.nlm.nih.gov/pubmed/17134841
“Hormonal profile of men with premature balding.”
Premature androgenic alopecia has been suggested as a feature of the male equivalent of the syndrome of polycystic ovary. However, the hormonal pattern of men with premature balding has been investigated in only a few studies with inconsistent results.]
Interesting, thanks. I had never heard anyone use the term “male PCOS” before now. From what I’m seeing in those papers, it sounds like an overweight male with premature balding should be considered in a similar light to an overweight woman with irregular periods and signs of androgen excess (hirsutism, hair loss, acne). If that’s the case, then we really don’t need a DHEA-S level to tell us to counsel that man about weight management strategies and consider insulin sensitizers (like metformin) if he has signs of insulin resistance. We also wouldn’t need the DHEA-S level to tell us to give that man finasteride or dutasteride to attempt to slow down the hair loss. Bottom line: I’m not sure how helpful the additional lab testing is in these cases, as it doesn’t necessarily give us more actionable information.
DHEA-S was tested to rule out low DHEA and associated diseases. Elevated DHEA-S could be associated with adrenal tumors, CAH and various hydroxylase deficiencies. As far as symptoms of high DHEA-S are concerned, this can cause elevated peripheral conversion to androgens and estrogens in both men and women. This has been shown to reduce SHBG, for example, and it could very well be the reason for my own lack of same.
We don’t know what clinical phenotype would suggest a low male SHBG aside from hypothyroidism or type 2 diabetes, and yet my own SHBG is inexplicably half the normal value, and quite inappropriate altogether because it has led to hypogonadism by nearly doubling the free-to-bound steroid hormone ratio(s) and allowing hypothalamic feedback to occur at a much reduced total testosterone level. Yet, you won’t find this in the literature — anywhere — because no one has bothered to study it directly, and instead it must be pieced together from common sense and a small study that notes oxandrolone when used in AIDS patients reduces SHBG which causes hypogonadism.
Hello HD –
I found your website when I was diagnosed with Hashimoto’s and found it to be a wonderful resource as I was navigating that education for the first time.
I ended up back here after getting a screening that showed high levels of DHEAS in my blood, much like the letter writer. I’ve been trying to do my research again, and it seems like there might be a normal correlation between DHEAS and thyroid hormone production (higher DHEAS if hyper, lower DHEAS if hypo); that said, it seems like that isn’t what happened to me. I know you won’t provide individual advice and I definitely don’t want it, that’s what my endo is for – I’m just trying to understand what might cause that inverse relationship to appear if there’s any knowledge on why.
I’m actually not familiar with any strong correlation between DHEAS levels and thyroid levels. Can you tell me where you read that?
I can’t remember where I first saw it; these were the two things that had me confused.
I’ll be the first to admit I’m not medically educated and may have misread these too. I just have weeks to go before I can see an endo and I’m trying to understand what they’ll even be looking for.
Interesting. I had never come across this stuff. I get the sense that the levels of these androgens can be a little higher or lower in untreated hyper- or hypothyroidism. But as long as the person’s thyroid hormone level is normal, the thyroid doesn’t have any effect on the androgen levels.
I’m a 43 year old male…I got my test results and my dhae s is 620dl.
Doctor said stress might be the reason since my cortisol level is normal .. I’m worried 😟 .. They are asking me to do more tests . Should I be worried?
The Dhea s range for men from 20 to 29 is 280 to 640 µg/dL or 7.56 to 17.28 µmol/L. And it will decrease as you age…so if you are worried seeing the number 600-700 can be a tumor..that reference might be for females as they have much lower normal range than men. If 600-700 is for men then, most of the men in 20s will have tumors. And from my understanding cortisol level will be high for that kind of diagnosis.
I wouldn’t worry about it
Hello. I have high DHEAS levels and a pituitary tumor. The tumor is non functional but since I cannot find an explanation for the high DHEAS I often wonder if it could be caused simply by having a tumor in my pituitary gland. I know for sure that i do not have Cushing’s nor hyperprolactenemia. My testosterone levels are normal but on the high side an my cortisol is normal. I recently took vitex because I have problems with my period too and am amazed that this helped my DHEAS levels. They are just a little high now. From what I know vitex is a pituitary herb not an adrenal herb or adaptogen so I cannot figure out why it worked. Any thoughts on the vitex and the pituitary tumor? Thank you.
Does a dheas level above 700 always mean a tumor? if not and its not pcos then what’s the reason?
It does not always mean a tumor. I’m not going to offer a differential diagnosis in this forum, however.
Our 17year old daughter has been experiencing significant distributed hair loss since puberty 4 years ago. She has seen a Pediatrics dermatologist with no findings. The only other symptom which I do feel is outside of what is normal is episodes or rage and anger. The few medical professionals she has seen keep saying that her hair loss is probably genetic, which I am not aware of. Her latest blood test revealed an elevated DHEA Sulphate 12.8 with a normal level .7 Testosterone. Our Paediatrician ordered more bloodwork before she will refer her to an Endocrinologist. I’m rather frustrated knowing this is not normal, this isn’t a teen being vain. It’s shockingly noticeable which is affecting her mental health. We’ve done the Naturopath, vitamins and Rogain to no avail. What should we be looking at more specifically? What blood tests should we be looking at in her case? Her fear of needles just adds to the pressure. Any guidance is greatly appreciated!
Any updates in your daughter’s condition?
I have a question. Why is DHEAS high sometimes when you have high prolactin levels like when having a prolactinoma. How is DHEAS increased in this scenario? Thank you for your time.
I had to look this one up. It seems that some studies have noted a positive correlation while others have noted an inverse correlation between prolactin and DHEA-S levels. From my limited literature search, it seems like the mechanism by which the two would be related is unclear. If anyone else figures this out, please let me know.
I have always wondered about this. If you have high LH and DHEAS but only mildly high testosterone and estrogen, what would be causing the high DHEAS in this case? At first doctors thought it was PCOS but later on dismissed it as I neither pass the progesterone challenge test nor have insulin resistance nor high cortisol nor NCAH either. So far they just labeled it “idiopathic hyperandrogenism” because we just do not know what is causing the high LH nor the high DHEAS (both precursors of testosterone and estrogen) in the first place. Does idiopathic hyperandrogenism truly exist? I also happen to have a non functional pituitary tumor but was assured it is doing nothing. Thank you.
Although I can’t speak to your situation, yes, idiopathic hyperandrogenism is a diagnosis. You can find review articles on Pub Med that address it.
Thank you. I can’t help but wonder if the tumor could have anything to do with this. What if the tumor was a hypothalamic tumor instead found on the hypophyseal-hypothalamic portal which is where the GnRH pulse generator is found? Maybe it could alter it enough to cause the high LH and later DHEAS. I mean one of my MRI report s stat early it is in the right posterior lobe near the hypothalamus yet said it most likely represented a pituitaria adenoma. What if it was a hypothalamic one instead? I have heard these can even cause precocious puberty in kids.
If you think the above is a possibility, what doctor do you think could help me in identifying what type of tumor I have, where it is, and if it is in an area where it could cause this? Thank you in advance. This would help me tremendously.
Could you please explain the relationship between DHEA-S and Cortisol (or link a source)? Both are produced in the adrenal glands, but it sounded to me that DHEA-S is more related to other androgens (testosterone) etc. I saw some sources online talk about DHEA-S to cortisol ratio and how stress alone can increase DHEA-S. Is there some truth to that or is it in the naturopath territory too?
I realize this reference is dense, and I know it’s annoying to have to register to read it, but at least registration is free. This will tell you more than you ever wanted to know about cortisol and DHEA-S: https://www.endotext.org/section/adrenal/.
I don’t have any questions. This is all new for me and I appreciate reading about info others have experienced so I figured I would throw ours in here. I can update more results later. My 16 year old daughter who has been spot on 28 day regular with her menstral cycle since she was 12 all of a sudden stopped having it about 4 months ago. We have had a couple of appts. Pcos was mentioned at the main culprit but she has no other symptoms of it. I appreciate her dr for following up with testing right away because she was concerned how it was all presenting. Great intuition in that one. 3 weeks ago they took 6 vials of bloodwork. She checked everything. We had our follow up yesterday. This is what was found. Most everything looked good. Her thyroid is fine. Female hormones are fine among other things. Her Dhea-s is 724 and her testosterone was high. I don’t remember that number but it was also very high. We are getting a cat scan ASAP to hopefully rule out adrenal tumor and a referral to a top endocrinologist in our area. The dr was upfront with me stating there a few choices of what this could mean. Could it still be Pcos even though she isn’t presenting other symptoms? sure. But the numbers were alarming enough and how this presented to get her further tested right away. This came out of nowhere so we are a little floored by it. Crossing fingers for the best outcome possible of coarse. These are things you never want to hear. Thanks for listening and I appreciate the read <3
Hi. Just wondering about your daughter. My 17 year old daughter has similar labs with a dhea-s over 700 and high testosterone. We are waiting for a ct. thank you!
Hi! I did a 24 hour saliva test. My DHEA-s came back on the low side. My doctor gave me a DHEA spray (5 mg per spray). After working my way up to 15 mg a day, I noticed my otherwise dead libido was reviving. The taste of the spray became a problem, so I turned to a capsule form. Unfortunately the dosage was 25 mg per cap. After a few weeks (?) of 25 mg/day I noticed acne developing, so I ordered bloodwork to check DHEA-s, estrogen, progesterone, and testosterone. DHEA-s was improved but still at the lower end of the range. Testosterone and estrogen were too high, progesterone was normal. Needless to say I stopped the DHEAs immediately. Acne stopped within two weeks. Will talk to my doctor about maybe restarting the 5 mg dosages.
But it was so nice to have a libido while it lasted a couple of weeks. That was my experience with DHEA supplementation