DHEA-S: the adrenal hormone in your PCOS and acne panels.
A DHEA-S test measures dehydroepiandrosterone sulfate, an androgen that comes almost entirely from the adrenal glands rather than the ovaries. It is in acne and PCOS panels for one reason: when a woman has signs of too much androgen activity, the doctor needs to know whether the source is the ovaries, the adrenals, or both.
Two glands, two kinds of androgen
Women make androgens (the family of hormones that includes testosterone) in two places. The ovaries and adrenals each make some testosterone directly, and around half of a woman's testosterone comes from conversion of precursor hormones in fat, skin and other tissues. The adrenal glands, which sit on top of the kidneys, make DHEA and its sulfated form DHEA-S, along with smaller amounts of other androgens. DHEA-S is a weak hormone in itself, but the body can convert it into testosterone in skin, hair follicles and fat.
Because the adrenals are the main source of DHEA-S, its level in blood is a reasonably clean read of adrenal androgen output. Testosterone, by contrast, reflects a mix of ovarian and adrenal production. Measuring both lets the doctor separate the two.
Why the DHEA-S test is in the panel
Acne that persists past your twenties, excess hair on the face, chest or abdomen, thinning at the crown and irregular periods are all things that can happen when androgen activity is higher than usual. The most common reason in women of reproductive age is polycystic ovary syndrome, and in PCOS the extra androgen is mainly ovarian. But it is not the only reason.
- If testosterone is raised and DHEA-S is normal, the ovaries are the likely source, and PCOS becomes more probable (alongside the other criteria the doctor uses).
- If DHEA-S is raised, the adrenals are contributing. A mild rise is seen in a proportion of women with PCOS and is not alarming on its own. A marked rise, especially with symptoms that came on quickly, prompts the doctor to look at adrenal causes more closely.
- If both are normal but symptoms are clear, the doctor considers other explanations, including sensitivity of the skin and hair follicles to normal hormone levels, which is common.
So the DHEA-S test is there to rule things in and out. It is a signpost, not a diagnosis.
What else moves DHEA-S
- Age. DHEA-S peaks in the twenties and declines steadily afterwards. A level that is normal for a 25 year old may be high for a 50 year old, which is why laboratories publish age-related ranges and why a result should be read against the range for your age, not a single cut-off.
- Stress and illness. The adrenals respond to acute illness and to some medicines, so DHEA-S can shift temporarily.
- Certain rare conditions. Very high levels can indicate an adrenal disorder. These are uncommon, and the doctor's job is to spot the occasional result that needs further investigation.
- Supplements. DHEA is sold as a supplement in some countries (in Australia it is prescription-only). If you have taken it, the result will reflect that, so tell the doctor.
DHEA-S and the other adrenal marker
Some panels also include 17-hydroxyprogesterone, another adrenal hormone. It is measured to check for a condition called non-classic congenital adrenal hyperplasia, which can look very much like PCOS. Unlike DHEA-S it does need timing: a morning sample early in the cycle, because it rises after ovulation and later in the day. It is not common, but it is treatable in a different way, so guidelines suggest excluding it before settling on a PCOS diagnosis. If that marker is on your form, that is why.
Timing and preparation
DHEA-S is one of the easier hormones to test. It has a long half-life in blood, so it does not swing across the day the way cortisol does, and it does not track the menstrual cycle the way FSH and oestradiol do. Any day, any time is acceptable for DHEA-S alone.
In practice it is drawn with testosterone and SHBG, and those are best collected in the morning. If a full hormone panel is being done and you have cycles, the early follicular phase (days 2 to 5) is the usual window. Hormonal contraception does not suppress DHEA-S as much as it suppresses ovarian hormones, but it still affects how the whole panel reads, so mention it.
Reading your result
Laboratories report DHEA-S against age-specific reference ranges, and those ranges differ between labs. We do not quote numbers here for that reason. A result just above the range for your age, with typical PCOS features and a normal 17-hydroxyprogesterone, is usually read as part of the PCOS picture. A result well above the range, particularly if hair growth or other changes have appeared over months rather than years, is one the doctor will want to follow up.
The wider context is in PCOS and your hormones, and there is a glossary of every marker at the KnowLuna glossary.
Common questions
Is DHEA-S the same as DHEA?
They are closely related. DHEA is the hormone; DHEA-S is its sulfated form, which circulates in far larger amounts and is much more stable in blood. Laboratories measure DHEA-S for that reason. If a form says "DHEA sulfate" or "DHEAS" it is the same test.
Can a high DHEA-S cause acne on its own?
It can contribute. DHEA-S is converted to more active androgens in the skin, so adrenal androgen output is one of the inputs to hormonal acne. It is rarely the whole story, and the doctor will look at the full panel rather than one marker.
Do I need to fast?
Not for DHEA-S. If glucose, insulin or lipids are on the same request (glucose and lipids usually are in a PCOS panel) you will be asked to fast for those. The collection centre or your request form will say.
Will Medicare cover it?
When a GP orders DHEA-S to investigate symptoms, Medicare usually provides a rebate. A consumer-initiated test without a GP referral is self-pay and not rebated. You can bring your own doctor's request to KnowLuna for the test-only price, or have a KnowLuna doctor request the panel and go through the results with you by video.
General information only, not medical advice. If your symptoms are severe or sudden, see a doctor promptly.