High DHEA-S: what it means

Dehydroepiandrosterone sulphate (DHEAS, often written DHEA-S) is the sulphated form of DHEA, a weak androgen present in the blood of both men and women. Lab Tests Online UK explains that the body can convert it into stronger androgens such as testosterone and androstenedione, or into oestrogen.

It is made mainly by the outer layer of the adrenal glands, the adrenal cortex, under the control of pituitary hormones including ACTH. Because the adrenals are its main source, it is used as a marker of adrenal function rather than ovarian or testicular function.

Lab Tests Online UK states that elevated DHEAS may indicate an adrenal cancer or adrenal hyperplasia (excessive growth of the adrenal glands), and that increased concentrations are not diagnostic of a specific condition. They usually indicate the need for further testing to pinpoint the cause of the hormone imbalance. Cancer Research UK describes adrenal cortical cancer as very rare, and notes that some adrenal tumours are not cancer at all.

In people with an enzyme deficiency that causes increased DHEAS, such as in disorders of sex development, the hormone may be requested to monitor treatment. Raised DHEAS is also something clinicians look for in girls and women with signs of excess male hormone.

It is just as important to know what a high result does not mean. The same source says normal DHEAS concentrations are frequently seen with PCOS because that condition is usually related to ovarian androgen production, mainly testosterone. A raised DHEAS therefore tends to point away from the ovaries and towards the adrenal glands.

Elevated concentrations may not be noticed in adult men, but in women they can lead to missing periods (amenorrhoea) and visible virilisation. Lab Tests Online UK lists the changes, which vary in severity, as a deeper voice, increased facial or body hair (hirsutism), male pattern baldness, increased muscularity, acne and enlargement of the Adam's apple. It also notes that not everyone with an elevated level has symptoms.

The NHS describes hirsutism as thick, dark hair on the face, neck, chest, tummy, lower back, buttocks or thighs in women, usually linked to changes in androgen levels. The most common cause is polyendocrine metabolic ovarian syndrome (PMOS, previously called PCOS). It advises an urgent GP appointment if new thick, dark hair suddenly starts to grow on the face and body, your voice is getting lower or your muscles are getting bigger, because these may signal a hormone-producing tumour.

• Missing or irregular periods.

• New or increasing facial and body hair.

• Acne and scalp hair thinning in a male pattern.

• A deepening voice or increased muscle bulk, which should prompt an urgent appointment.

In children, DHEAS has a more specific role. Lab Tests Online UK says it may be useful in investigating precocious (early) puberty in some boys, and in girls only when precocious puberty comes with signs of virilisation. It may also be used in specialist assessment of disorders of sex development, such as in babies with ambiguous genitalia.

A high DHEAS can reflect adrenarche, the activation of the adrenal gland before the ovaries or testicles, where a surge of adrenal androgens, primarily DHEAS, can result in some body hair and adult body odour. Premature adrenarche is mostly benign and is more common in girls and in children of South Asian and Afro-Caribbean origin, according to the same source. A paediatric endocrinologist will decide whether anything further is needed.

This table brings together the explanations described in the sources used for this page.

Because DHEAS is not a diagnosis, the next step is to look at the whole hormone picture. Lab Tests Online UK says more commonly other hormones such as FSH, LH, prolactin, oestrogen and testosterone are measured to evaluate suspected PCOS and rule out other causes of infertility, amenorrhoea, virilisation and hirsutism, and that DHEAS is sometimes used in investigating Cushing's syndrome.

If the DHEAS is high alongside other abnormal hormone results, or symptoms are developing quickly, a GP may refer you to an endocrinologist. Imaging of the adrenal glands and further hormone tests may then be arranged. If you take DHEA supplements, the clinician may ask you to stop them before repeating the test, but only do this on the advice of the clinician who ordered it.