High DHEA or DHEA-S levels are treated by addressing the underlying cause, not by trying to lower the result with supplements or medication on your own. Common causes include DHEA supplements, polycystic ovary syndrome (PCOS), nonclassic congenital adrenal hyperplasia, Cushing syndrome, and, less often, an adrenal or ovarian hormone-producing tumor.

A healthcare professional should review a high result, particularly when androgen-related symptoms are developing quickly or becoming severe.

High DHEA Treatment at a Glance

Possible situation Usual next step
Taking DHEA, pregnenolone, testosterone, or an androgen-containing product Stop or adjust the product only with medical guidance. Repeat testing if advised.
High DHEA-S with irregular periods, acne, or excess hair Check for PCOS and other causes of androgen excess.
High 17-hydroxyprogesterone Test for nonclassic congenital adrenal hyperplasia.
Rapid virilization or markedly high DHEA-S Arrange prompt endocrinology assessment and possible adrenal or pelvic imaging.
High DHEA-S with weight gain, easy bruising, muscle weakness, or high blood pressure Evaluate for Cushing syndrome.
Adrenal or ovarian tumor Seek specialist treatment, which may include surgery.

What Is the Difference Between DHEA and DHEA-S?

DHEA, or dehydroepiandrosterone, is an adrenal androgen precursor. DHEA-S, or dehydroepiandrosterone sulfate, is its more stable form and the form laboratories commonly measure. The adrenal glands produce most DHEA-S. The ovaries produce smaller amounts of related androgens.

A clinician interprets the result using:

  • Your age and sex
  • The laboratory's reference range
  • The units, such as micrograms per deciliter
  • Whether the test measured DHEA or DHEA-S
  • Your symptoms and menstrual pattern
  • Other androgen and adrenal test results

One mildly high result does not diagnose PCOS, adrenal disease, or cancer.

Step 1: Confirm the Result and Review Possible Causes

A clinician may repeat the test, especially when the result does not fit your symptoms. Current androgen-excess guidance recommends collecting hormone samples in the morning, preferably after fasting and, when practical, during the early follicular phase of the menstrual cycle. Liquid chromatography tandem mass spectrometry may be useful when an immunoassay result does not match the clinical picture.

Tell your clinician if you take or have recently taken:

  • DHEA or "adrenal support" supplements
  • Pregnenolone supplements
  • Testosterone, hormone pellets, or compounded hormones
  • Performance-enhancing steroids
  • Fertility or menopause treatments
  • Oral contraceptives or other prescribed medication

Also describe when your hair growth, acne, hair loss, or menstrual changes began and how quickly they progressed.

DHEA supplements can increase androgen effects. In women, they may cause acne, oily skin, and male-pattern hair growth. DHEA should not be used during pregnancy or breastfeeding unless it has been specifically prescribed. If you are not sure whether a product in your cabinet contains it, the label will say; this is a commonly bought DHEA capsule, and its page lists the hormone and the amount per serving. Stopping an over-the-counter product like this is usually the first thing a clinician will ask about.

Step 2: Have the Underlying Cause Investigated

Testing may include total and free testosterone, sex hormone-binding globulin, DHEA-S, and early-morning 17-hydroxyprogesterone. Depending on your symptoms, a clinician may also order pregnancy testing, thyroid testing, prolactin, androstenedione, cortisol testing, or other adrenal tests.

PCOS

PCOS is a common cause of androgen excess. It may cause irregular periods, acne, facial or body hair growth, infertility, and insulin resistance. DHEA-S can be high with PCOS, but DHEA-S alone cannot establish the diagnosis. Other causes must be excluded.

Treatment may include:

  • A combined oral contraceptive to regulate periods and reduce androgen-related symptoms when pregnancy is not desired
  • Spironolactone or another antiandrogen when unwanted hair continues after initial treatment
  • Reliable contraception while taking an antiandrogen because some of these medicines can harm a developing fetus
  • Laser hair removal, electrolysis, or another direct hair-removal method
  • Lifestyle treatment when overweight or obesity contributes to PCOS and metabolic risk

The Endocrine Society recommends oral contraceptives as initial medication for most premenopausal women with bothersome hirsutism who are not trying to conceive. If symptoms continue after about six months, a clinician may add an antiandrogen with appropriate contraception. Insulin-lowering medication should not be used solely to treat unwanted hair.

Nonclassic Congenital Adrenal Hyperplasia

Nonclassic congenital adrenal hyperplasia, usually caused by 21-hydroxylase deficiency, can increase adrenal androgens. Possible effects include irregular periods, excess hair, acne, and infertility.

Screening generally begins with an early-morning 17-hydroxyprogesterone test. Further testing may follow when the result is abnormal or unclear.

Not every woman with nonclassic congenital adrenal hyperplasia needs medication. An endocrinologist may prescribe a glucocorticoid when symptoms are significant, infertility is linked to androgen excess, or pregnancy management requires treatment. Do not start long-term steroid treatment without specialist guidance. Excessive glucocorticoid exposure can cause important complications.

Cushing Syndrome

Cushing syndrome causes excess cortisol and can also affect androgen levels. Possible signs include progressive abdominal weight gain, easy bruising, purple stretch marks, muscle weakness, high blood pressure, diabetes, and menstrual changes.

Treatment targets the source of cortisol excess. That source may be an adrenal tumor, pituitary tumor, or another hormone-producing tumor. Lowering DHEA alone will not treat Cushing syndrome.

Adrenal or Ovarian Tumors

A tumor becomes more concerning when androgen excess develops quickly, symptoms are severe, or hormone levels are markedly abnormal. New androgen excess after menopause also needs prompt assessment. Current guidance recommends urgent imaging for severe biochemical androgen excess and adrenal imaging when adrenal androgens are substantially elevated.

A DHEA-S result of about 700 micrograms per deciliter or higher is often used as a warning level for adrenal evaluation. It does not, by itself, diagnose cancer. The laboratory reference range, test method, age, symptoms, testosterone level, and rate of change all affect the interpretation.

Evaluation may include:

  • Repeat hormone testing
  • Adrenal CT or MRI
  • Pelvic ultrasound or MRI
  • Cortisol testing
  • Referral to an endocrinologist, gynecologic endocrinologist, or adrenal specialist

Androgen-producing adrenal tumors are rare. If a tumor is confirmed, treatment depends on its size, hormone activity, imaging findings, and pathology. Surgery is often needed for a hormone-producing or suspicious adrenal tumor. Cancerous tumors require specialist oncology care.

How to Manage Symptoms Caused by High Androgens

Treating the cause addresses the hormone problem, but symptoms may need their own treatment.

Unwanted Facial or Body Hair

Options include:

  • Shaving, trimming, waxing, or threading
  • Laser photoepilation for suitable hair and skin types
  • Electrolysis, especially for white or blonde hair
  • Prescription medication to reduce new hair growth

The Endocrine Society recommends combining medical treatment with direct hair removal when further cosmetic improvement is wanted. Hair-growth treatments usually take several months to show their full effect.

Acne and Oily Skin

A primary care clinician or dermatologist may recommend topical retinoids, benzoyl peroxide, antibiotics when appropriate, or hormonal treatment. Severe, scarring, or rapidly worsening acne needs medical assessment.

Irregular or Absent Periods

Irregular periods can result from PCOS, congenital adrenal hyperplasia, pregnancy, thyroid disease, high prolactin, undernutrition, or another endocrine condition. Treatment depends on whether the goal is cycle control, protection of the uterine lining, symptom relief, or pregnancy.

When Should High DHEA Be Assessed Promptly?

High DHEA or DHEA-S should be assessed promptly when androgen-related changes appear quickly, are severe, or begin after menopause.

Contact a healthcare professional about:

  • Rapid growth of facial, chest, or abdominal hair
  • Deepening of the voice
  • Clitoral enlargement
  • Rapid scalp hair loss or male-pattern balding
  • Sudden severe acne
  • Rapid increase in muscle mass
  • New irregular or absent periods
  • New androgen excess after menopause
  • A markedly elevated DHEA-S result, particularly near or above 700 micrograms per deciliter

These findings do not prove that a tumor is present. They do make it important to check for an adrenal or ovarian source.

What Not to Do

  • Do not take more DHEA to correct another hormone imbalance.
  • Do not self-prescribe prednisone, dexamethasone, or hydrocortisone.
  • Do not assume that one high DHEA-S result proves PCOS.
  • Do not start spironolactone or another antiandrogen without discussing pregnancy prevention and medication risks.
  • Do not rely on detoxes, "adrenal fatigue" products, or over-the-counter hormone-balancing supplements.
  • Do not ignore rapidly progressive virilization symptoms.

The next step is to review the actual DHEA or DHEA-S result, laboratory range, symptoms, and related hormone tests with a primary care clinician, gynecologist, or endocrinologist.