DHEA-Sulfate (DHEA-S)
DHEA-S is the dominant adrenal androgen — useful for distinguishing adrenal vs ovarian sources of high androgens in women, and for screening adrenal tumours.
What it measures
DHEA-S is produced almost entirely by the adrenal cortex (zona reticularis) and is the most abundant circulating steroid hormone in humans. Because the ovaries make minimal DHEA-S, it's the cleanest biomarker for adrenal androgen output. Levels peak in the third decade and decline roughly 2% per year — by age 70 most people sit at 10-20% of their twenties value. DHEA-S has a long half-life and stable diurnal pattern, unlike its parent DHEA, making it the practical test.
What a high value can mean
- Adrenal androgen-secreting tumour — usually >700 μg/dL; rapid hirsutism, virilisation, voice deepening.
- Congenital adrenal hyperplasia (CAH) — late-onset forms can present in adulthood with mild hirsutism.
- PCOS — modest elevation in some patients; ovarian testosterone usually dominant.
- Cushing's syndrome (some forms) — adrenal pathology can co-elevate DHEA-S.
- Pregnancy — physiological surge.
What a low value can mean
- Adrenal insufficiency / Addison's disease — co-low with cortisol and aldosterone.
- Hypopituitarism — low ACTH → low adrenal androgens.
- Chronic illness, malnutrition — non-specific suppression.
- Normal ageing — values in 70s match what would be 'low' in 20s.
- Long-term oral contraceptives, glucocorticoids — suppression.
When to discuss with a doctor
DHEA-S is ordered when a woman has new hirsutism, alopecia, acne, irregular menses, or signs of virilisation. A value above 700 μg/dL or rising rapidly warrants imaging for an adrenal mass. Modestly raised values are more often PCOS-spectrum than adrenal disease. Mediora.AI shows the value against age + sex band; androgen-excess workup is endocrinology + gynaecology.