Dehydroepiandrosterone sulfate (DHEAS) is a steroid hormone that circulates in high concentrations. It functions as a precursor, convertible into potent sex hormones, including androgens and estrogens. While small amounts are produced by the gonads and the brain, the majority of DHEAS is synthesized by the adrenal glands.
This hormone serves as a valuable biomarker for assessing adrenal gland function. Unlike many other hormones whose levels fluctuate throughout the day, DHEAS concentration remains relatively stable, allowing a single measurement to provide a reliable snapshot of adrenal activity.
Understanding the DHEAS Test
The level of DHEAS is typically determined through a simple blood test. Clinicians measure DHEAS rather than its unsulfated form, DHEA, because DHEAS has a much longer half-life and greater stability in the bloodstream. This consistent concentration simplifies testing, as the blood sample can be drawn at any time of day without affecting the result.
The primary diagnostic purpose of the DHEAS test is to evaluate the function of the adrenal glands, particularly in cases of suspected hormone overproduction. Since the adrenals produce nearly all circulating DHEAS, an abnormal level often points directly to a problem originating in these glands. The test also helps medical professionals differentiate between excess androgen production coming from the adrenal glands versus that coming from the ovaries or testes.
Interpreting the results requires careful consideration of reference ranges, which are not universal. Normal DHEAS levels vary significantly based on a person’s age and sex. For example, levels naturally peak around puberty and in early adulthood, then begin a steady decline as a person ages. A laboratory will use its specific, established reference range to determine if a patient’s level is abnormally high or low.
Health Implications of Elevated DHEAS
An elevated DHEAS level often signifies an overproduction of androgens, almost always pointing toward a pathology of the adrenal gland. One significant cause is Congenital Adrenal Hyperplasia (CAH), an inherited disorder where an enzyme deficiency leads to the adrenal glands producing too much of certain hormones, including DHEAS. This condition, particularly in its non-classical or late-onset form, presents with symptoms of androgen excess.
Adrenal tumors, which can be benign (adenoma) or malignant (carcinoma), are another cause of high DHEAS. These tumors autonomously produce excessive hormone amounts, sometimes reaching concentrations that warrant immediate investigation. A DHEAS level over 600 micrograms per deciliter can strongly indicate an androgen-secreting adrenal cortical adenoma.
In women, elevated DHEAS levels are frequently associated with symptoms of hyperandrogenism (excess male hormones). Symptoms include hirsutism (excess coarse body and facial hair), acne, and irregular menstrual cycles. Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder where elevated DHEAS can occur, suggesting the adrenal glands contribute to the overall androgen excess in affected women.
Health Implications of Depleted DHEAS
Abnormally low DHEAS levels are primarily a sign of adrenal insufficiency, where the adrenal glands are unable to produce sufficient amounts of hormones. This includes primary adrenal insufficiency, such as Addison’s disease, or secondary forms where the pituitary gland fails to stimulate the adrenals. In these cases, the deficiency of DHEAS is often accompanied by a deficiency in other adrenal hormones, such as cortisol.
Low DHEAS levels are also frequently observed in patients with severe critical illnesses, such as septic shock. The depletion of DHEAS is hypothesized to be a sign of exhausted adrenal reserve and has been suggested as a prognostic marker for patient outcomes. Low levels in acutely ill patients may contribute to an imbalance between immunosuppressive and immunostimulatory pathways.
Beyond acute illness and clinical insufficiency, DHEAS levels decline naturally as a person ages, a phenomenon sometimes referred to as “adrenopause.” By the age of 80, DHEAS levels can be as low as 20% of the concentrations seen in early adulthood. This age-related decrease has been linked to a variety of issues common in older adults, including fatigue, sarcopenia (muscle loss), reduced bone density, and a decline in overall well-being.
DHEAS deficiency in older adults may involve reduced immune function and negative impacts on metabolic function. Although DHEAS is not considered essential for life, replacement therapy has been studied in adrenal insufficiency patients, showing improvements in quality of life and body composition. However, routine DHEAS supplementation for all low levels remains a topic of ongoing discussion and research.