The Forgotten Adrenal Hormone
When patients come to NOVA Wellness for a hormonal evaluation, the markers that tend to drive the conversation are testosterone, estrogen, progesterone, and thyroid. These are the hormones most people have heard of. They're the ones with recognizable names and familiar symptoms when they're off.
But there's a marker that shows up on almost every comprehensive panel we run — one that consistently explains symptoms that the other hormones don't fully account for — and most patients have never heard of it.
DHEA-S.
It is, in my experience, one of the most underappreciated pieces of the hormonal picture. And for patients whose fatigue, low libido, or poor recovery haven't fully responded to other interventions, it's often exactly where the missing piece is hiding.
What DHEA Actually Is
DHEA — dehydroepiandrosterone — is a steroid hormone produced primarily by the adrenal glands, with smaller contributions from the ovaries in women and the testes in men. Its sulfated form, DHEA-S, is what we measure in a blood test — it's more stable in circulation and gives us the most reliable clinical picture of adrenal androgen output.
DHEA is often described as a precursor hormone — the raw material your body converts into other hormones downstream, particularly testosterone and estrogen. This makes it a foundational piece of the endocrine system. When DHEA-S is low, the body has less raw material available for sex hormone synthesis, which can compound deficiencies in testosterone and estrogen even when those hormones are being supported directly.
But DHEA is not just a precursor. It has its own biological activity at receptor sites throughout the body — influencing immune function, neurological health, bone density, body composition, and mood independently of what it converts into. It's more than a building block. It's an active player.
When It Peaks — And When It Doesn't
DHEA production peaks in the mid-20s. From there, it declines at approximately 2 percent per year for the rest of life — one of the most predictable and consistent hormonal declines in human physiology.
By the time a person reaches their 40s, DHEA-S levels may be 50 percent of what they were at peak. By the 70s, they may be 10 to 20 percent of peak. This decline happens regardless of overall health, fitness level, or lifestyle — it is built into the aging process in a way that few other hormonal changes are.
This is one reason DHEA has attracted significant research interest in longevity medicine. Its steady decline correlates with many of the functional changes associated with aging — and the question of whether restoring DHEA levels can modify those changes is one that has been studied across multiple populations and clinical contexts.
The Cortisol Connection — The Part That Matters Most Clinically
DHEA and cortisol share the same adrenal origin. Both are produced from cholesterol through the same initial enzymatic pathway. And here is where the clinical picture gets particularly relevant for the patients I see most often.
When the body is under chronic stress — physical or psychological — cortisol production is upregulated. The adrenal glands prioritize cortisol, the acute stress response hormone, at the expense of DHEA. This is sometimes called the cortisol steal — the shared precursor being redirected preferentially toward cortisol production, leaving less available for DHEA.
The result is a pattern I see regularly in clinical practice: patients who have been under sustained stress for months or years present with both elevated cortisol markers and suppressed DHEA-S. They are simultaneously over-producing the hormone that drives inflammation, fat storage, and muscle breakdown — and under-producing the hormone that supports immune resilience, lean tissue, energy, and sex drive.
This pattern also explains why some patients feel only partially improved when cortisol is addressed but DHEA is ignored. The two are interrelated. Addressing one without the other leaves the picture incomplete.
What Low DHEA-S Actually Feels Like
The symptoms of low DHEA are nonspecific — meaning they overlap with a lot of other hormonal deficiencies — which is one reason it gets missed. Fatigue, low libido, poor recovery from exercise, depressed mood, difficulty building or maintaining muscle, reduced mental sharpness, and impaired immune resilience are all associated with low DHEA-S.
These are the same symptoms that lead most people to testosterone or thyroid conversations. And in many cases, those are the right conversations. But when testosterone or thyroid support produces only partial improvement — or when a patient's symptoms don't fully align with their other lab findings — DHEA-S is one of the first additional markers I look at.
Two populations where this is particularly common deserve specific mention.
Women in perimenopause and menopause. DHEA-S declines in women during the perimenopausal transition, compounding the simultaneous decline in testosterone and estrogen. Because DHEA contributes to both testosterone and estrogen production, low DHEA-S can amplify deficiencies in both simultaneously. For women who are on estrogen and progesterone therapy but still reporting fatigue, low libido, and poor recovery — DHEA-S is often the overlooked piece.
Men and women under chronic high stress. As discussed above, sustained cortisol elevation suppresses DHEA production. Patients dealing with demanding careers, caregiving responsibilities, sleep deprivation, or prolonged emotional stress often present with DHEA-S levels that are low for their age — not just because of the natural age-related decline, but because chronic stress has accelerated that decline. This is measurable. And it's addressable.
Testing and Reference Ranges — The Normal vs. Optimal Problem Again
DHEA-S is measured with a simple blood test, which we draw right here in the office. It's included in our comprehensive panels and can be added individually when indicated.
Reference ranges vary by age and sex, which reflects the natural decline. The clinical challenge — familiar from our conversation about testosterone and thyroid — is that a DHEA-S level can be "normal for your age" while still being well below the range where most people feel and function optimally.
A 52-year-old woman with a DHEA-S of 45 µg/dL is in the lower portion of the reference range for her age and may be told her level is acceptable. But if her symptoms suggest low adrenal androgen activity and her level was 180 µg/dL ten years ago, that 45 represents a dramatic functional decline — even though the lab flag is absent.
At NOVA, I look at DHEA-S relative to the patient's symptoms, their cortisol pattern, their other hormone levels, and their history — not just whether the number falls within the printed range.
When Supplementation Makes Sense — And When It Doesn't
DHEA is available over the counter in the United States, which creates its own problem. Patients sometimes come in already supplementing with DHEA purchased online or from a health food store — often at doses that aren't calibrated to their specific level, age, or hormonal context.
This matters. DHEA converts downstream into both testosterone and estrogen. In women, excess DHEA supplementation can produce androgenic effects — acne, oily skin, unwanted hair growth — if doses are too high or not matched to the patient's specific needs. In men, it can raise estradiol if aromatization is already elevated. The appropriate dose is individual, not standard.
When supplementation is indicated at NOVA, we use pharmaceutical-grade DHEA at doses determined by labs and symptoms — typically 10 to 25 mg for women and 25 to 50 mg for men as starting points, with follow-up testing to confirm the response. We monitor both DHEA-S levels and downstream hormone markers to ensure the conversion profile is appropriate.
What I won't do is recommend DHEA supplementation without testing first. Taking a supplement that raises a hormone you don't need to raise — or that pushes a conversion pathway in the wrong direction — is not a neutral action. The body's endocrine system is not a simple input-output machine. It is an interconnected network, and interventions in one area have effects throughout.
The Bigger Picture
DHEA-S belongs in every comprehensive hormonal evaluation — not as an afterthought, but as a foundational piece of the adrenal-sex hormone axis. It is inexpensive to test, clinically informative, and frequently the missing variable in patients whose other hormonal markers have been optimized without full resolution of symptoms.
If you've had your testosterone, thyroid, and other hormones evaluated and still don't feel the way you expected to — a DHEA-S level you haven't seen is one reasonable place to look.
Book a free 30-minute consultation at novawellnessut.com or call and text us at (801) 449-1402. We draw labs right here in the office — no separate lab visit required.
Matt Nelson, NP
NOVA Wellness — Orem, Utah
(801) 449-1402 · novawellnessut.com
