Dehydroepiandrosterone Sulphate

When high

When HIGH (>15.2 umol/L):

• Uncommon unless supplementing DHEA exogenously
• Can indicate: adrenal hyperplasia (congenital or late-onset), adrenal tumour (rare), PCOS-related (not applicable in males)
• High DHEA-S can increase conversion to estradiol and DHT -- may worsen androgenic side effects (acne, hair loss)
• If elevated without supplementation: investigate adrenal function (17-hydroxyprogesterone, cortisol, ACTH)
• Reduce or stop DHEA supplementation if levels are above range

Pharmacological options:

• When elevated without exogenous DHEA use, investigate adrenal function (17-hydroxyprogesterone, ACTH stim, morning cortisol, ACTH) before any pharmacological intervention; persistent elevation warrants endocrinology referral to exclude adrenal hyperplasia or adrenal adenoma

When low

When LOW (<2.2 umol/L):

• May indicate: adrenal insufficiency, chronic stress/cortisol elevation, ageing (DHEA-S peaks at 20-30 and declines ~2% per year), overtraining
• DHEA-S is the most abundant circulating steroid and serves as a precursor to both androgens and estrogens

Supplementation (for low DHEA-S):

• DHEA -- 25-50mg/day (morning, with fat-containing meal)
• Start at 25mg/day and retest after 6-8 weeks; increase to 50mg only if still low
• Higher doses (>50mg/day) can elevate estradiol and DHT -- monitor E2 and DHT if using >25mg
• DHEA converts to androstenedione, then to testosterone and estradiol -- can raise both
• In PCT: 25-50mg/day may provide mild androgenic support while HPTA recovers

Supporting supplements:

• Vitamin C -- 1-2g/day (supports adrenal function)
• Pantothenic Acid (Vitamin B5) -- 500mg/day (adrenal support)
• Ashwagandha -- 300-600mg/day (adaptogen; reduces cortisol which may preserve adrenal DHEA output)
• Pregnenolone -- 25-50mg/day (upstream precursor to DHEA; can support both cortisol and DHEA pathways)

Lifestyle:

• Manage chronic stress (elevated cortisol "steals" pregnenolone from the DHEA pathway -- pregnenolone steal)
• Adequate sleep (7-9h) -- adrenal recovery depends on sleep quality
• Avoid overtraining -- excessive training volume with inadequate recovery depletes adrenal reserves

Pharmacological options:

• DHEA -- 25-50mg/day; over-the-counter in the US and many EU regions; prescription-only in Australia (listed as a Schedule 4 drug), Canada, and the UK; sourcing may require compounding pharmacy or international order in AU/UK
• 7-Keto-DHEA -- 100-200mg/day; non-aromatisable DHEA metabolite; supports thermogenesis and adrenal markers without raising estradiol or DHT; preferred option when running aromatising AAS concurrently and cannot tolerate further E2/DHT conversion

Clinical context:

• DHEA-S is primarily adrenal, not gonadal -- it is NOT directly suppressed by AAS/TRT (unlike LH/FSH/testosterone)
• However, chronic AAS use with elevated cortisol (common with trenbolone, heavy training) can indirectly lower DHEA-S over time
• Useful marker for overall adrenal health and stress status in athletes