Understanding High DHEA Levels: Causes, Symptoms, and Next Steps
Elevated DHEA (DHEA-S) meaning: PCOS, CAH, supplements, smoking or, rarely, an adrenal tumor. Age-based ranges in µg/dL and µmol/L, plus low DHEA-S.
An elevated DHEA (dehydroepiandrosterone) result – almost always measured as DHEA sulfate, or DHEA-S – means your adrenal glands are making more of this androgen precursor than is typical for your age and sex. In women the most common reason is polycystic ovary syndrome (PCOS), usually with a mild to moderate rise. Less often it points to congenital adrenal hyperplasia (CAH), and a very high level can be a sign of an androgen-producing adrenal tumor. Smoking, DHEA-containing supplements and some medicines can also push the result up. A low DHEA-S, by contrast, is most often simply a result of age, because levels fall steadily after early adulthood; less often it reflects underactive adrenal or pituitary glands (Addison disease, hypopituitarism) or glucocorticoid (steroid) medicines.
What DHEA and DHEA-S are
DHEA is a steroid hormone made mainly by the adrenal glands, with smaller amounts from the ovaries and testes. The body converts it into androgens (such as testosterone) and estrogens [1][3][5]. Most DHEA circulates as DHEA sulfate (DHEA-S), which is the form in the bloodstream and the one laboratories usually test [4]. DHEA-S levels are stable through the day, so the time of the blood draw does not matter [3].
Levels change a great deal across life. Adrenal production rises at adrenarche, typically between 6 and 8 years of age [4]; DHEA is at its highest in early adulthood (around 20 to 24 years) and then slowly falls [4]. That is why a result has to be read against an age- and sex-specific range.
Reference ranges
Ranges vary between laboratories and methods; always compare with the range printed on your report. US labs usually report DHEA-S in micrograms per decilitre (µg/dL); UK and European labs in micromoles per litre (µmol/L). One widely used reference (UCSF Health) gives [2]:
| Age | Women | Men |
|---|---|---|
| 18–29 | 45–320 µg/dL (1.2–8.7 µmol/L) | 110–510 µg/dL (3.0–14.0 µmol/L) |
| 30–39 | 40–325 µg/dL (1.1–8.8 µmol/L) | 110–370 µg/dL (3.0–10.0 µmol/L) |
| 40–49 | 25–220 µg/dL (0.7–6.0 µmol/L) | 45–345 µg/dL (1.2–9.4 µmol/L) |
| 50–59 | 15–170 µg/dL (0.4–4.6 µmol/L) | 25–240 µg/dL (0.7–6.5 µmol/L) |
| Over 59 | below 145 µg/dL (below 3.9 µmol/L) | below 204 µg/dL (below 5.5 µmol/L) |
An NHS laboratory using a different method (LC-MS/MS) gives, for example, 1.2–8.0 µmol/L for women and 1.8–12.8 µmol/L for men aged 20–39 [6] – a reminder that the same number can be normal in one lab and borderline in another.
Causes of elevated DHEA-S
Most common, and factors that affect the test
- Polycystic ovary syndrome (PCOS). A common hormone disorder in women of reproductive age; DHEA-S is typically mildly to moderately raised [1][2][6].
- Smoking or nicotine before the test raises the level [3].
- DHEA or DHEA-S supplements. UCSF asks people to tell their provider if they take vitamins or supplements containing DHEA or DHEA-S, because these affect the test [2]; DHEA is converted in the body into sex hormones [5].
- Some medicines. Cleveland Clinic notes that certain diabetes and blood pressure medicines can raise DHEA-S [3].
Less common
- Congenital adrenal hyperplasia (CAH). An inherited group of enzyme defects that make the adrenal glands overproduce androgens. Rises are usually modest in 21-hydroxylase deficiency, the most common form, and larger in the rare 3-beta-hydroxysteroid dehydrogenase form [1][2][6].
- Early puberty in girls [2].
Rare
- Adrenal tumors, benign or cancerous (adrenocortical carcinoma). Pronounced elevations of DHEA-S may suggest an androgen-producing adrenal tumor [1][3][6].
- Ovarian tumors [1][3].
Symptoms
The number itself causes nothing; symptoms come from the extra androgens. Women and girls may notice excess facial or body hair (hirsutism), acne, irregular or missed periods, thinning hair on the top of the head, a deepening voice or increased muscle bulk; fertility can be affected [1][3]. In boys, high levels can cause early puberty. Adult men often have no symptoms at all [1][3].
What usually happens next
- Repeat the test if the rise is mild or a supplement, smoking or medicine could explain it; ask your provider whether anything should be paused beforehand [3].
- Companion tests: testosterone and estrogen are often measured in the same blood draw [3]. Depending on the picture, clinicians may add tests for CAH or other adrenal hormones.
- Looking for a tumor. A pronounced elevation leads to further tests aimed at the adrenal glands and ovaries, because it can suggest an androgen-producing tumor [1][6].
Low DHEA-S
Because many people search for the opposite result: DHEA-S naturally falls with age [3][4]. A level below the range for your age may be linked to Addison disease (adrenal insufficiency), hypopituitarism (an underactive pituitary gland) [1][2] or glucocorticoid (steroid) medicines [2]. Symptoms that can accompany low levels include low sex drive, erectile dysfunction in men, and – in adrenal insufficiency – dizziness, salt craving, nausea and unexplained weight loss [1][3]. Cleveland Clinic notes that fish oil and vitamin E can lower DHEA-S [3].
Frequently asked questions
What does high DHEA mean?
It means your adrenal glands (or, rarely, ovaries) are producing more androgen precursor than usual for your age and sex. PCOS is the most common explanation in women; CAH and adrenal tumors are less common [1][2][6].
Is elevated DHEA dangerous?
A mild rise usually is not dangerous in itself, but the cause matters. A pronounced elevation needs further investigation, because it can suggest an androgen-producing adrenal tumor [1][6].
Can high DHEA cause hair loss or acne?
Yes. Excess androgens can cause acne and thinning hair on the top of the head, as well as unwanted facial and body hair in women [1][3].
Can high DHEA affect fertility?
In women, high DHEA-S is associated with irregular or missed periods and infertility, often as part of PCOS [1][3].
What does low DHEA-S mean in men?
Levels fall naturally with age. A value below the age range may reflect adrenal or pituitary underactivity or steroid medicines, and can come with low libido or erectile dysfunction [1][2][3].
Do I need to fast for a DHEA-S test?
No special preparation is needed, and you can usually eat normally. Tell your provider about any supplements containing DHEA, and avoid smoking beforehand [2][3].
When to see a doctor
It is worth discussing a high DHEA-S result with your doctor soon, especially if you have irregular periods, new or increasing facial or body hair, or acne that is hard to control. Make the appointment promptly if symptoms such as voice deepening or rapid hair growth appeared over weeks to months, or if a child shows signs of early puberty. If you take DHEA supplements, mention them rather than changing anything on your own before the visit.
Sources
- DHEA Sulfate Test — MedlinePlus, U.S. National Library of Medicine
- DHEA-sulfate test — UCSF Health
- DHEAS Test (DHEA Sulfate Test) — Cleveland Clinic
- Adrenarche — Cleveland Clinic
- Dehydroepiandrosterone (DHEA) — Merck Manual Consumer Version
- Dehydroepiandrosterone sulphate, serum — Newcastle upon Tyne Hospitals NHS Laboratories
Decisions about your health should always be made in consultation with your healthcare provider.