DHEA and DHEA‑Sulfate Tests Complete Guide

Empower yourself with the facts. This updated 2025 guide demystifies dehydroepiandrosterone (DHEA) and its sulfated form (DHEA‑S) by explaining what these hormones do, why testing them matters and how to interpret the results. You’ll get practical insights into blood and saliva tests, normal ranges, causes of high or low levels and next steps for both men and women. Use this article as a roadmap to navigate your hormone health with confidence.

Introduction: DHEA & DHEA‑S in 2025

DHEA and DHEA‑S are steroid hormones made primarily in your adrenal glands. They serve as building blocks for testosterone and estrogen and influence sexual development, fertility, mood and energy. Levels of both hormones peak in the late teens and early twenties and decline steadily with agemedlineplus.gov. Because they change over the lifespan and may signal underlying endocrine disorders, doctors increasingly use DHEA and DHEA‑S tests to evaluate adrenal function and investigate unexplained symptoms such as irregular periods, hirsutism or precocious pubertymy.clevelandclinic.org. In 2025, at‑home test kits and saliva testing are more widely available than ever, but confusion about test types and interpretation persists. This guide aims to clear that up.

What Are DHEA and DHEA Sulfate? Key Differences

DHEA (dehydroepiandrosterone) is an active steroid that can be converted into testosterone and estrogen. It is produced in the adrenal glands, brain and gonads and freely crosses the blood–brain barrier. DHEA circulates for only 30 minutes to a few hours before being metabolized to its sulfated form. Because it fluctuates quickly, measuring DHEA directly is difficult.

DHEA‑S (dehydroepiandrosterone sulfate) is DHEA with an attached sulfate group. This sulfated version is far more stable; it has a half‑life of 7–10 hours and circulates at concentrations 100–1000 times higher than DHEA. DHEA‑S acts as a storage reservoir: it can be converted back into DHEA when needed, but it has only about 5 % of the androgenic activity of testosterone. DHEA‑S is easier to measure and is the predominant form tested in clinical practice

Summary of differences

Why DHEA/DHEA‑S Testing Matters

DHEA‑S tests are used to evaluate adrenal gland function, distinguish sources of androgens and screen for disorders that cause excess or deficient androgen production. According to the Cleveland Clinic, DHEA‑S is converted into androgens and estrogens and plays a critical role in male puberty and reproduction my.clevelandclinic.org. Doctors order the test to investigate adrenal tumors, congenital adrenal hyperplasia (CAH) or early puberty my.clevelandclinic.org notes that DHEA‑S measurements help diagnose polycystic ovary syndrome (PCOS) and differentiate adrenal versus ovarian causes of virilization.

Because DHEA‑S declines with age, abnormally high or low results can signal a problem even when other hormones appear normal. The test also helps identify causes of fertility problems, irregular menstruation and masculine characteristics in women, and it can monitor treatment for adrenal disorders (via testing.com). Monitoring DHEA‑S is therefore an important part of a comprehensive hormone workup.

Who Should Get Tested – Indications and Risk Factors

Healthcare providers may order a DHEA‑S test when you or your child has signs of androgen excess or deficiency. Common indications include:

• Excess hair growth (hirsutism), deepening voice, hair loss or severe acne in women and girls. High DHEA‑S levels in females can cause abnormal menstruation, excess facial or body hair, hair loss, infertility and severe acne (via my.clevelandclinic.org).

• Irregular or absent periods or infertility. DHEA‑S testing is often part of the workup for PCOS or other reproductive disorders.

• Virilization or precocious puberty in children. Boys with early development or girls developing masculine features may need a DHEA‑S test to rule out adrenal hyperplasia or tumors.

• Suspected adrenal tumors or CAH. Elevated DHEA‑S can indicate an adrenal carcinoma, adenoma or congenital enzyme deficiency.

• Symptoms of adrenal insufficiency. Low DHEA‑S may accompany Addison disease or hypopituitarism, causing fatigue, dehydration, low blood pressure and weight loss.

Testing is also used to monitor adrenal function after surgery or treatment, and to assess the effectiveness of hormone replacement therapy. Your clinician will decide if and when to order the test based on symptoms, medical history and other hormone measurements.

Types of DHEA Tests: Blood vs. Saliva

Most DHEA or DHEA‑S tests use a blood sample drawn from a vein. Blood testing measures total hormone levels—both protein‑bound and free fractions—and is considered the gold standard for diagnosing adrenal disorders. Labs typically measure DHEA‑S rather than DHEA because it is more stable and less affected by short‑term fluctuations. Serum tests are widely accepted by medical guidelines and covered by insurance in many circumstances.

Saliva testing measures only the “free,” bioavailable fraction of hormones. Because saliva is essentially filtered blood, small unbound steroid molecules like DHEA can enter saliva through the salivary glands. Saliva tests are non‑invasive, convenient and useful for tracking daily fluctuations in cortisol, DHEA and other hormones. However, saliva testing for DHEA or DHEA‑S is less widely used for formal diagnosis because reference ranges are less standardized and results can be affected by contamination or improper collection. If you choose saliva testing, look for a CLIA‑certified laboratory and discuss results with a knowledgeable healthcare provider.

How to Prepare for a DHEA/DHEA‑S Test

DHEA‑S tests generally require little preparation. MedlinePlus notes that no special restrictions are needed, but you should tell your doctor about all supplements and medications you take. Biotin and DHEA supplements can interfere with the assay. Because DHEA‑S levels are relatively stable throughout the day, sample timing is less critical than for cortisol testing. Some clinicians still prefer a morning blood draw to control for diurnal variation. Smoking and nicotine use may increase DHEA‑S, so avoid nicotine before the test. If you’re taking DHEA supplements, your provider may ask you to stop them before testing to avoid skewed results.

What to Expect During the Test

For a blood test, a phlebotomist will place a tourniquet around your arm, insert a small needle into a vein and collect a vial of blood. The procedure takes a few minutes and feels like a quick pinch. Afterwards, you may have slight bruising or soreness at the puncture site. There is a very low risk of infection or fainting. No fasting is typically required; however, follow your provider’s specific instructions.

For a saliva test, you will collect saliva into a small tube at home. Do not eat, drink, smoke, brush your teeth or use mouthwash for at least 30 minutes beforehand, as these can contaminate the sample. If you are using hormone creams or gels, avoid touching the collection tube with your hands to prevent transfer. Sample collection is often done multiple times over a day to capture diurnal patterns. Ship the kit back to the laboratory as instructed.

Understanding Your DHEA Test Results

Reference ranges vary by laboratory and depend on age and sex. MedlinePlus provides these typical DHEA‑S serum ranges:

 

Results outside these ranges don’t always mean something is wrong; they must be interpreted in the context of other hormones and symptoms. Laboratories may report DHEA or DHEA‑S values in different units (e.g., ng/mL); your doctor will convert and interpret accordingly.

Common Causes of High or Low DHEA Levels

High DHEA or DHEA‑S levels

High DHEA‑S can result from conditions that cause excess androgen production or adrenal stimulation. Common causes include:

• Congenital adrenal hyperplasia (CAH). Inherited enzyme deficiencies lead to overproduction of adrenal androgens.

• Adrenal tumors or carcinoma. A benign adrenal adenoma or cancer can secrete large amounts of DHEA‑S.

• Polycystic ovary syndrome (PCOS). Women with PCOS may have elevated DHEA‑S along with high LH/FSH ratios and cystic ovaries.

• Early (precocious) puberty or virilization in children. Excess DHEA‑S triggers early development of secondary sex characteristics.

• Other rare causes. Ovarian cancer and certain medications (e.g., DHEA supplements, high‑dose testosterone) can increase DHEA‑S.

Symptoms of high DHEA‑S include increased body or facial hair, deepened voice, hair loss, irregular menstruation, infertility and severe acne. In boys or girls, precocious puberty may appear as early pubic hair, growth spurts or early menstruation.

Low DHEA or DHEA‑S levels

Low levels usually reflect reduced adrenal output. Causes include:

• Addison disease (primary adrenal insufficiency). Autoimmune destruction of the adrenal cortex leads to low cortisol and low androgens.

• Hypopituitarism or secondary adrenal insufficiency. Pituitary disease reduces ACTH stimulation, lowering DHEA‑S.

• Normal aging. DHEA and DHEA‑S decline steadily with age

• Glucocorticoid medications. Chronic steroid use suppresses adrenal hormone production

Symptoms of low DHEA‑S can include fatigue, dizziness, weight loss, low sex drive and mood changes. Because these signs are nonspecific, further evaluation is often necessary.

DHEA and DHEA‑S in Men’s and Women’s Health

In women

Moderate DHEA‑S levels help maintain estrogen and testosterone balance, support bone density and modulate mood. High levels may cause PCOS‑related symptoms such as irregular cycles, infertility, hirsutism, acne and alopecia. Low DHEA‑S can contribute to low libido, decreased energy, impaired immune function and thinning bones, particularly after menopause. Because DHEA‑S declines sharply with age, some women consider DHEA supplements; however, these should be used only under medical supervision (see below).

In men

DHEA and DHEA‑S contribute to testosterone production and help regulate mood, muscle mass and fertility. Low DHEA‑S may accompany adrenal insufficiency and contribute to fatigue, erectile dysfunction or mood issues. High DHEA‑S is less common in men but can indicate adrenal tumors or anabolic steroid use. In aging men, DHEA‑S declines and may be associated with decreased bone density and cognitive changes.

Next Steps After Your Results: When and Who to Consult

Abnormal DHEA‑S results should prompt a conversation with your healthcare provider. Do not self‑diagnose or self‑treat—DHEA‑S is just one piece of your hormone puzzle. Your doctor may order additional tests, including cortisol, ACTH, testosterone, LH/FSH, estradiol, prolactin or thyroid hormones. Imaging studies may be needed to rule out adrenal or ovarian tumors. Endocrinologists specialize in hormone disorders and should be consulted for unexplained elevations or persistent symptoms.

If results point toward PCOS, Addison disease or other conditions, treatment will focus on the underlying cause. Lifestyle changes such as stress reduction, balanced diet, exercise and weight management can support healthy adrenal function and hormone balance. Retesting may be recommended to monitor changes over time.

DHEA Supplements: Evidence and Risks (2025 Update)

DHEA supplements are marketed for anti‑aging, weight loss, sexual function and athletic performance. However, high‑quality evidence for these uses is limited. The Cleveland Clinic cautions that there is no reliable evidence that DHEA prevents aging‑related problems and notes that supplements can cause side effects such as acne, oily skin, hair growth, mood changes, liver inflammation and interactions with medications. People with hormone‑sensitive cancers, PCOS or pregnancy should avoid DHEA supplements. Because DHEA can convert to estrogen or testosterone, supplementation may exacerbate conditions like prostate enlargement or breast cancer.

If you are considering DHEA supplementation, consult a qualified healthcare professional and request hormone testing before and after. DHEA is a controlled substance in some countries; in the United States it is available over‑the‑counter but unregulated by the FDA. For most people, focusing on adrenal health, diet, sleep and stress management is safer than unmonitored DHEA supplementation.

Frequently Asked Questions (2025)

What is a DHEA or DHEA‑S test?

A DHEA or DHEA‑S test measures the level of these hormones in your blood (or saliva). The test helps evaluate adrenal function, diagnose disorders like PCOS, congenital adrenal hyperplasia or adrenal tumors, and investigate symptoms such as abnormal hair growth, irregular periods or early puberty.

Who should consider getting a DHEA or DHEA‑S test?

Anyone experiencing unexplained fatigue, hirsutism, acne, infertility, irregular menstruation or early puberty may benefit from testing. Doctors also order it to monitor known adrenal disorders and differentiate the source of excessive androgens

What’s the difference between blood and saliva DHEA tests?

Blood tests measure total DHEA/DHEA‑S (bound and free) and are the standard for diagnosing adrenal disorders. Saliva tests measure the free, bioavailable fraction and can be collected at home. Saliva testing is useful for tracking daily fluctuations but isn’t as widely used for clinical diagnosis.

How do I prepare for a DHEA or DHEA‑S test?

Tell your healthcare provider about any supplements and medications. Most DHEA‑S blood tests require no fasting. Avoid smoking and nicotine before the test. For saliva tests, do not eat, drink, brush your teeth or use mouthwash for at least 30 minutes before collection.

What do high or low DHEA levels mean?

High levels may indicate congenital adrenal hyperplasia, PCOS, adrenal tumors or early puberty. Low levels may point to Addison disease, hypopituitarism or natural aging. Your provider will interpret results in context.

Are DHEA supplements helpful or safe?

Evidence is mixed; supplements can cause side effects and have not been proven to prevent aging. Only take DHEA under medical supervision and after confirming a deficiency.

How soon can I expect the test results?

Most laboratories return blood or saliva results within a few days. Your healthcare provider will explain the findings and recommend any follow‑up testing or treatment.

What happens after I get my DHEA test results?

Discuss the results with your provider. They may order additional tests, adjust medications or refer you to an endocrinologist. Lifestyle changes and regular monitoring are often part of the management plan.

Glossary: Key Hormone Terms

• Adrenal glands – small glands on top of each kidney that produce hormones including cortisol, adrenaline and androgens.

• Androgens – “male” sex hormones such as testosterone; present in all genders and influence sex characteristics, libido and muscle mass.

• Congenital adrenal hyperplasia (CAH) – a group of genetic disorders causing enzyme deficiencies that lead to excess androgen production.

• Dehydroepiandrosterone (DHEA) – a steroid hormone precursor to testosterone and estrogen.

• Dehydroepiandrosterone sulfate (DHEA‑S) – the sulfated storage form of DHEA, produced mainly by the adrenal glands.

• Hypopituitarism – decreased hormone production by the pituitary gland, which can lower adrenal hormones.

• Polycystic ovary syndrome (PCOS) – a common endocrine disorder in women characterized by irregular ovulation, excess androgens and insulin resistance.

BreakoutLabs Approach: Innovative Hormone Testing

At BreakoutLabs, we’re committed to empowering you with actionable hormone insights. Our at‑home Hormone Root Cause Test measures DHEA, DHEA‑S and related biomarkers through a simple blood spot collection. Samples are processed in CLIA‑certified laboratories, and results are reviewed by board‑certified clinicians. You receive a Personalized Hormone Blueprint™ outlining your levels, explaining potential root causes and providing evidence‑based next steps. For those who need more frequent monitoring or prefer non‑invasive samples, we also offer a Saliva Cortisol and DHEA Panel to track daily hormone rhythms. Whether you’re evaluating PCOS, adrenal fatigue or simply curious about your hormonal health, we provide clear guidance and support along the way.

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