High DHEAS Symptoms: Causes, Signs & What to Do

High DHEAS is an adrenal androgen excess that causes androgen-driven symptoms in women and points to adrenal hyperactivity. This page covers the specific symptoms, likely causes, normal ranges, how it is treated, and when to act.

Published: April 23, 2026
Last updated: October 10, 2026
Read time: 9 min read
Medically reviewed by: Rhonda Collins, FNP-C

DHEA-sulfate (DHEAS) is an androgen produced almost exclusively by the adrenal cortex, making it a reliable marker of adrenal androgen output. Unlike testosterone, which comes from both the adrenals and gonads, a high DHEAS nearly always points to adrenal overactivity. In women, excess adrenal androgens cause the same clinical features as excess testosterone: acne, unwanted hair growth, and menstrual disruption. See the DHEAS biomarker overview for how it is measured and what it reflects. Treatment depends on the cause, which is covered below.

What High DHEAS Means

DHEAS is the most abundant circulating steroid hormone in the body and serves as a precursor for sex hormones in peripheral tissues. Its production is regulated by ACTH from the pituitary gland. When the adrenal cortex is overactive, from adrenal hyperplasia, excess ACTH stimulation, or a tumor, DHEAS rises above the normal age-expected range. DHEAS also declines markedly with age (peak in the mid-20s), so what counts as elevated must be interpreted against age-specific reference ranges.

Symptoms of High DHEAS

Symptoms are predominantly from excess androgen action in peripheral tissues. They are most clinically apparent in women.

In women:

Acne: persistent facial and back acne, particularly cystic or hormonal pattern in the lower face and jawline
Hirsutism: unwanted male-pattern hair growth on the face, chest, abdomen, and inner thighs
Androgenic alopecia: thinning at the crown or temples (female-pattern hair loss)
Irregular menstrual cycles or oligomenorrhea (infrequent periods)
Reduced fertility from ovulatory dysfunction
Clitoral enlargement and voice deepening in severe or long-standing cases (suggests adrenal carcinoma rather than benign causes)

In men:

High DHEAS is less likely to produce obvious symptoms because male androgen physiology is already androgen-dominant
Excessive supplemental DHEAS use may accelerate acne and scalp hair loss

What Causes High DHEAS

PCOS (polycystic ovary syndrome): the most common cause in reproductive-age women; adrenal contribution adds to ovarian androgen excess
Congenital adrenal hyperplasia (CAH), particularly non-classical 21-hydroxylase deficiency: an enzyme block diverts steroid precursors toward DHEAS and androgens
Adrenal adenoma: benign adrenal tumor with autonomous androgen secretion
Adrenal carcinoma: rare but important; very high DHEAS (above 700 µg/dL) with rapidly progressive virilization raises this concern
Excess ACTH stimulation from ectopic ACTH secretion (small cell lung cancer, carcinoid) or Cushing’s disease
Exogenous DHEA supplementation (widely sold as an over-the-counter supplement; directly raises DHEAS)
Insulin resistance and obesity: insulin stimulates adrenal androgen production

Normal DHEAS Levels

The ranges below are the typical adult ranges published by MedlinePlus, the National Library of Medicine’s consumer health reference. Ranges vary between labs and assays, so compare your result with the reference range printed on your own lab report.

Group	Typical Range (MedlinePlus)
Women 18-29	45-320 µg/dL
Women 30-39	40-325 µg/dL
Women 40-49	25-220 µg/dL
Women 50-59	15-170 µg/dL
Women 60 and older	Less than 145 µg/dL
Men 18-29	110-510 µg/dL
Men 30-39	110-370 µg/dL
Men 40-49	45-345 µg/dL
Men 50-59	25-240 µg/dL
Men 60 and older	Less than 204 µg/dL

DHEAS declines substantially with age. A value of 300 µg/dL sits inside the MedlinePlus range for a 25-year-old woman (45 to 320 µg/dL) but is above the range for a 45-year-old woman (25 to 220 µg/dL).

How High DHEAS Is Treated

High DHEAS is not treated as a number on its own. Treatment targets the cause behind it, and a clinician chooses it after the cause is confirmed. The usual causes are PCOS, non-classic congenital adrenal hyperplasia (CAH), an adrenal tumor, and DHEA supplements, and each is managed differently. The sections below describe what published guidelines say for each cause. They are not doses or regimens.

Tests that usually come next

Before treatment, a clinician works out where the extra androgen is coming from.

Testosterone. The 2023 International Evidence-based PCOS Guideline uses total or free testosterone as the first androgen tests, ideally measured by LC-MS/MS. It treats DHEAS as a second-line test with poorer specificity and a strong age-related decline.
17-hydroxyprogesterone. An early-morning 17-hydroxyprogesterone screens for non-classic CAH. The Endocrine Society recommends taking it before 8 am, because a random sample can read normal in non-classic CAH.
Other causes. The PCOS guideline also lists TSH, prolactin, and FSH, and further testing for Cushing’s syndrome or an adrenal tumor when the clinical picture suggests them.
Cortisol. Cortisol testing is added when there are features of Cushing’s syndrome, as described below.

PCOS

The 2023 International Evidence-based PCOS Guideline recommends healthy eating and physical activity for all women with PCOS, aimed at general health, body composition, and weight management, which can include modest weight loss. For hirsutism and irregular cycles, it states that a combined oral contraceptive pill could be recommended in adults. If hirsutism responds poorly after at least 6 months of the pill or cosmetic treatment, an anti-androgen could be considered, always with effective contraception, because anti-androgens can affect a male fetus. Metformin is recommended mainly for metabolic features. The guideline treats these as therapies for PCOS features such as excess hair and irregular periods. It does not set a DHEAS target.

Non-classic congenital adrenal hyperplasia

The Endocrine Society’s 2018 CAH guideline recommends against glucocorticoid treatment for people with non-classic CAH who have no symptoms and are not pregnant. For adult women with non-classic CAH who have bothersome androgen symptoms or infertility, it suggests glucocorticoid treatment. For women with non-classic CAH who are infertile or have had a miscarriage, it recommends a glucocorticoid that does not cross the placenta. Its evidence review notes that an oral contraceptive, with or without an anti-androgen, is likely the best approach for hirsutism. For most adult men with non-classic CAH, it suggests against daily glucocorticoids.

Adrenal adenoma or carcinoma

An adrenal tumor is the cause to rule out when DHEAS is very high or androgen symptoms start suddenly or worsen quickly. In a review of androgen-secreting adrenal tumors, carcinomas typically presented with DHEAS above 700 µg/dL, while adenomas more often raised androstenedione and testosterone. The 2023 PCOS guideline also notes that some androgen-secreting tumors cause only mild to moderate rises, so rapid progression of symptoms matters as much as the number.

The European Society of Endocrinology recommends that anyone with a suspected adrenocortical carcinoma has a detailed hormone work-up and adrenal-focused imaging, is discussed by a multidisciplinary expert team, and has surgery by a surgeon experienced in adrenal and cancer surgery, aiming for complete removal. For other adrenal masses, its 2023 guideline says the decision to operate depends on the likelihood of cancer, how much hormone the mass makes, age, general health, and patient preference.

DHEA supplements

DHEA is sold over the counter, and taking it raises DHEAS directly. In a controlled trial in women with adrenal insufficiency, daily oral DHEA raised DHEAS, androstenedione, and testosterone. The PCOS guideline lists iatrogenic causes, meaning androgen excess from medicines or other treatments, among the causes to rule out. If you take DHEA, stopping it with your clinician’s input and retesting shows whether the supplement explains the high DHEAS.

Can you lower DHEAS naturally?

Only within limits. If you take DHEA, stopping it is the most direct step. For PCOS, the 2023 guideline recommends healthy eating, physical activity, and modest weight loss where relevant, but it frames these as improving overall health and PCOS features rather than lowering DHEAS to a set level. The same guideline found that inositol offers limited clinical benefit in PCOS. None of the guidelines cited on this page recommends a diet or supplement specifically to lower DHEAS.

Does high DHEAS mean high cortisol?

Not by itself. DHEAS and cortisol are separate hormones from the adrenal cortex, and each is measured with its own test. Both are driven by ACTH, so an ACTH-driven condition such as Cushing’s disease can raise both, but a high DHEAS does not show that cortisol is high. A review in American Family Physician advises testing for Cushing’s syndrome in women with features of it. The Endocrine Society recommends starting with one of a 24-hour urine free cortisol, a late-night salivary cortisol, or an overnight dexamethasone suppression test, after excluding glucocorticoid medicines. See high cortisol symptoms and whether PMOS can cause high cortisol for more.

When to See Your Care Team

Book a 1:1 consultation with a licensed clinician for DHEAS above the age-specific upper limit on your lab report. The first evaluation step is to determine whether the elevation is adrenal in origin and to rule out non-classical CAH (with a morning 17-hydroxyprogesterone) and adrenal tumor (with adrenal imaging if DHEAS is markedly elevated). DHEAS above 700 µg/dL without an obvious cause (supplementation, CAH) should prompt adrenal imaging to rule out carcinoma. Mito’s DHEA-S blood test measures DHEAS, and total testosterone is usually checked alongside it.

Frequently Asked Questions

Is DHEAS the same as DHEA?

DHEA (dehydroepiandrosterone) and DHEAS (DHEA-sulfate) are closely related. DHEAS is the sulfated, water-soluble storage form that circulates at much higher concentrations and has a longer half-life. When labs measure “DHEA-S” or “DHEAS,” they are measuring the sulfate form. The two are interconvertible, and most clinical labs prefer DHEAS because its serum concentration is more stable than free DHEA.

Can PCOS cause high DHEAS?

Yes. Many women with PCOS have modest DHEAS elevation from adrenal contributions to their overall androgen excess. However, DHEAS in PCOS is usually mildly elevated (within 1.5x the upper limit of normal) rather than markedly high. Significantly elevated DHEAS (above 2x ULN) in a PCOS presentation should prompt evaluation for non-classical CAH or adrenal tumor.

Does DHEA supplementation raise DHEAS?

Yes, directly. DHEA sold as a dietary supplement is converted to DHEAS and other sex hormones. In a controlled trial in women with adrenal insufficiency, oral DHEA raised DHEAS, androstenedione, and testosterone. If DHEAS comes back high while you take DHEA, the supplement is the first explanation to check.

Can high DHEAS affect fertility?

In women, excess androgens from high DHEAS can disrupt ovulation through effects on follicular development and by competing with estrogen signaling in the ovary. This is one mechanism by which non-classical CAH and PCOS reduce fertility. Treatment that lowers DHEAS (managing insulin resistance, low-dose glucocorticoid for CAH) often partially restores ovulation.

References

Popular lab tests

Comprehensive Metabolic Panel (CMP)
A 14-marker snapshot of kidney function, liver function, electrolytes, and blood sugar in one draw.
Complete Blood Count (CBC) with Differential and Platelet Count Test
A broad screen of red cells, white cells, and platelets that anchors most checkups.
Lipid Panel
The standard cholesterol workup for cardiovascular risk, and the baseline for tracking diet, exercise, or statin response.
Vitamin D, 25-Hydroxy (Calcidiol) Blood Test
The standard measure of vitamin D status, reflecting what you build from sun, diet, and supplements.

High DHEAS Symptoms: Causes, Signs & What to Do

What High DHEAS Means

Symptoms of High DHEAS

What Causes High DHEAS

Normal DHEAS Levels