Low DHEA-S is usually caused by normal aging, reduced adrenal function, pituitary or hypothalamic problems, corticosteroid treatment, or certain medications and hormones. A single low result does not necessarily mean you have a disease. DHEA-S naturally declines with age, so results must be compared with the laboratory's age-specific reference range.
Main Causes of Low DHEA and DHEA-S
| Possible cause | Why levels may fall |
|---|---|
| Normal aging | The adrenal glands produce less DHEA and DHEA-S over time. Levels usually peak in early adulthood and then decline, including in women. |
| Adrenal insufficiency or Addison's disease | Damage or reduced activity in the adrenal cortex can lower DHEA-S along with cortisol. In primary adrenal insufficiency, aldosterone may also fall. Autoimmune disease is a common cause of Addison's disease. |
| Pituitary or hypothalamic disorders | The pituitary hormone ACTH stimulates adrenal DHEA-S production. A pituitary tumor, injury, infection, surgery, or hypopituitarism can reduce ACTH and lower DHEA-S. |
| Long-term or high-dose corticosteroids | Prednisone, dexamethasone, and other glucocorticoids can suppress the hypothalamic-pituitary-adrenal axis. DHEA-S may remain low after long-term corticosteroid treatment is reduced or stopped. |
| Hormonal contraception or estrogen treatment | Oral contraceptives can lower measured DHEA-S. The effect varies, so the result needs to be considered alongside the person's treatment and symptoms. |
| Other medications | Insulin, some anticonvulsants, statins, cholestyramine, dopaminergic medicines, fish oil, and vitamin E have been reported to lower DHEA-S in some people. A medication effect is more likely when the reduction is mild and other adrenal tests are normal. |
| Suppression of adrenal or pituitary signaling | Chronic opioid treatment and some serious illnesses can suppress the systems that regulate adrenal hormone production. This may reduce DHEA-S. |
Is Low DHEA Caused by Menopause?
Usually, menopause itself is not the main cause of low DHEA-S. Most circulating DHEA-S comes from the adrenal glands rather than the ovaries. However, adrenal DHEA production declines with age, often during the same years as perimenopause and menopause. This can make the two changes seem connected.
Ovarian failure mainly lowers estrogen and ovarian androgens. It does not usually cause the same degree of DHEA-S reduction as an adrenal or pituitary disorder.
What Symptoms Can Occur With Low DHEA?
Low DHEA-S may cause no specific symptoms. When symptoms occur, they are more likely to result from the underlying condition, particularly adrenal insufficiency.
Possible symptoms include:
- Persistent fatigue or muscle weakness
- Reduced appetite or unintentional weight loss
- Low blood pressure, dizziness, or fainting
- Nausea, vomiting, diarrhea, or abdominal pain
- Salt cravings
- Low blood glucose
- Darkening of the skin, especially with Addison's disease
- Irregular or absent menstrual periods
- Reduced interest in sex
These symptoms can also occur with thyroid disease, anemia, depression, sleep disorders, nutritional deficiencies, medication effects, and other conditions. Symptoms alone cannot confirm that DHEA-S is low or identify the cause.
What Does a Low DHEA-S Blood Test Mean?
A low DHEA-S result means that adrenal androgen production is below the laboratory's reference range. It does not diagnose Addison's disease or another adrenal disorder by itself.
A clinician may review:
- Your age and the laboratory's reference range
- Whether the test measured DHEA or DHEA-S
- Your symptoms and blood pressure
- Corticosteroids, birth control, opioids, and other medications
- Cortisol and ACTH levels
- Electrolytes, glucose, renin, and aldosterone when adrenal insufficiency is suspected
- A corticotropin, or cosyntropin, stimulation test when confirmation is needed
DHEA-S is generally more stable in the blood than DHEA. Age, medication, laboratory method, and medical history still affect how the result should be interpreted.
When Should Low DHEA Be Medically Evaluated?
Arrange a routine medical appointment if a low DHEA-S result occurs with persistent fatigue, weight loss, low blood pressure, menstrual changes, reduced libido, or a history of pituitary disease or long-term steroid use.
Seek urgent medical care for severe vomiting or diarrhea, fainting, confusion, severe weakness, dehydration, or sudden severe abdominal or back pain, especially if adrenal insufficiency is suspected. These symptoms can indicate an adrenal crisis, which requires emergency treatment.
Should Females Take DHEA Supplements for a Low Result?
No. Do not start DHEA supplements solely because a blood test is low. The cause should be established first. DHEA supplements can interact with medicines and may cause androgenic effects such as acne, unwanted facial hair, scalp hair loss, or menstrual changes. A DHEA supplement available to order on Amazon is easy to obtain, but the label gives no indication of whether it suits your result, which is what the evaluation is for.
The Endocrine Society discusses a carefully monitored DHEA trial only for selected women with confirmed primary adrenal insufficiency who continue to have problems such as low libido, depressed mood, or low energy despite optimized standard adrenal hormone replacement. This is different from treating an isolated low DHEA-S result in an otherwise healthy woman.
Low DHEA-S is often related to aging or medication effects. A markedly low result with fatigue, weight loss, low blood pressure, vomiting, skin darkening, or menstrual changes warrants evaluation for adrenal or pituitary disease.