Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder among women of reproductive age. While PCOS presents differently in different women, many experience hormone imbalance, insulin resistance, and fertility challenges.
PCOS also has an adrenal component involving DHEA, which is the focus of this article. We’ll cover high DHEA levels, symptoms, causes (including PCOS), and, most importantly, how to lower DHEA levels naturally.
If high DHEA levels are a part of your PCOS picture, you may need extra adrenal support and attention through diet, lifestyle changes such as managing stress, and targeted PCOS supplements.
The beauty of the lifestyle and nutrition approaches discussed in this article is that they can be used alongside medication interventions, in many cases, to guide the body back to balance. PCOS is a condition that often responds well to nutrition, supplements, and tools from nature. Let’s dive in.
In this article
What is DHEA?
DHEA and DHEA-S (dehydroepiandrosterone and dehydroepiandrosterone-sulfate) are the most abundant steroid hormones in the body, converting to testosterone and estrogen. DHEA is made in the ovaries, adrenal glands, and brain, although the adrenal glands are the most significant source. .
DHEA-S is the primary circulating form, accounting for over 95%, typically measured in a blood test. The two forms, DHEA and DHEA-S, convert back and forth.
DHEA levels rise during puberty, peak during the reproductive years, and then decline with age1. If you’re curious about low DHEA and supplementation, please read What Does DHEA Do and When Should You Take It. The focus of this article is elevated DHEA and PCOS.
Symptoms of High DHEA
Because DHEA is the precursor to both testosterone and estrogen, elevated DHEA or DHEA-S often leads to symptoms of elevated androgens, including testosterone. Levels of DHEA-S correlate well with androgen excess and deficiency, which is why it is an important hormone to evaluate. PCOS often presents with both elevated androgens and estrogen dominance, the latter due to the lack of progesterone production.
Symptoms of high DHEA include:
- Irregular or missing periods
- Anovulatory cycles (menstrual cycles without ovulation)
- Oily skin and acne
- Hair loss on the head
- Hair growth on the face and chest (hirsutism)
- Irritability, anger, and mood swings
- Depression
- Fatigue
- Weight gain
- High blood sugar and insulin resistance
- Fertility challenges
Many symptoms of high DHEA levels overlap with PCOS symptoms. Next, let’s talk about the causes of high DHEA levels in females.
Causes of High DHEA Levels in Females
Uncovering the root cause and asking why DHEA is elevated is important. By discovering what’s driving the overproduction of DHEA, you’ll be able to target effective interventions.
PCOS
PCOS is one of the more common causes of elevated DHEA in women. Around 20 to 30% of women2 with PCOS have excess DHEA-S production from the adrenal glands, leading to hyperandrogenism or high androgen hormones, including testosterone and the potent androgen dihydrotestosterone (DHT). DHT, as we’ll discuss, can be the reason why some with PCOS experience hair loss, oily skin, and acne.
In one study3 of almost 650 women with PCOS, 33% exhibited higher DHEA-S levels that correlated with higher testosterone levels.
Women with PCOS and elevated DHEA-S levels may need interventions to lower DHEA levels, in addition to addressing insulin resistance and imbalances in sex hormones.
Adrenal Hyperplasia
Congenital adrenal hyperplasia4 is a genetic disorder that affects the adrenal glands. It causes over production of adrenal hormones, leading to androgen excess.
Although adrenal hyperplasia is much less common than PCOS, it presents with similar symptoms to PCOS and elevated DHEA. If PCOS-type symptoms show up with puberty, it’s essential to rule out the possibility of adrenal hyperplasia.
An ACTH stimulation test is used to differentiate congenital adrenal hyperplasia from PCOS.
Chronic Stress
Chronic stress is another possible root cause of elevated DHEA. The adrenal glands, specifically the adrenal cortex make DHEA-S and cortisol, a primary stress hormone.
When the brain interprets stress, it signals the adrenal cortex to increase hormone production as part of the stress response. This system is called the hypothalamic-pituitary-adrenal (HPA) Axis.
Testing DHEA-S levels alongside cortisol provides clues to HPA-axis function or dysfunction. When DHEA declines after long periods of stress, cortisol remains a constant. In this situation, the result is an unbalanced relationship between cortisol and DHEA. This can be seen by an elevated cortisol to DHEA ratio. .
However, stress may be a driver when DHEA levels are out of range for age. In acute stress, DHEA and cortisol levels may be elevated. However, when we’re under long term stress our DHEA levels will decline. Recent research5 suggests that DHEA-S levels are about 40% lower in people with prolonged stress.
In order to have a clear picture of what is happening, testing DHEA levels is essential.
Adrenal Tumors
In both benign and malignant tumors, DHEA and androgen elevations can be seen. This is why it is important to work with a licensed medical provider when evaluating DHEA.
Hyperprolactinemia
In rare cases, elevations in prolactin caused by a benign brain tumor can lead to increased levels of DHEA, DHEA-S, and androstenedione. Symptoms similar to PCOS such as irregular periods or cycles longer than 35 days (oligomenorrhea), missing periods (amenorrhea), and hirsutism (unwanted hair growth) may be present. In addition, lactation may also be apparent, which is not a symptom of PCOS.
DHEA Supplementation
While it is a hormone, DHEA is over-the-counter in the United States. Supplementing with DHEA can be a cause of elevated levels. Learn more about DHEA supplementation here.
Importance of Testing DHEA Levels
Normal DHEA levels vary by age, with younger women naturally experiencing higher levels. DHEA testing can use blood, urine, or saliva. Typically, tests measure DHEA-S levels.
Here are the standard reference ranges for a DHEA-S blood test in women by age6:
DHEA-S Levels by Age
| Age | Range |
| Ages 18-19 | 145 to 395 micrograms per deciliter (µg/dL) or 3.92 to 10.66 micromoles per liter (µmol/L) |
| Ages 20-29 | 65 to 380 µg/dL or 1.75 to 10.26 µmol/L |
| Ages 30-39 | 45 to 270 µg/dL or 1.22 to 7.29 µmol/L |
| Ages 40-49 | 32 to 240 µg/dL or 0.86 to 6.48 µmol/L |
| Ages 50-59 | 26 to 200 µg/dL or 0.70 to 5.40 µmol/L |
| Ages 60-69 | 13 to 130 µg/dL or 0.35 to 3.51 µmol/L |
| Ages 69+ | 17 to 90 µg/dL or 0.46 to 2.43 µmol/L |
Remember that normal lab ranges don’t always mean optimal. If you are at the high or low end for your age, but still have symptoms, work with your naturopathic doctor to optimize your levels.
How to Lower DHEA Levels Naturally
As a board certified naturopathic endocrinologist, I use many options to support PCOS and reduce DHEA levels, allowing for more hormone balance, fewer symptoms, and better health. Nutrition and lifestyle change build the foundation, and supplements target pathways to influence hormone production.
Your doctor may also recommend medications or other interventions, depending on the cause of the DHEA elevation. But in the case of PCOS, we can focus on the things you can do at home in order to optimize your hormones.
Read more about natural treatment strategies for PCOS here.
Nutrition
In many cases of PCOS, women experience elevated blood sugar, insulin resistance, and inflammation. These can be drivers of high androgens, including DHEA. Diet is the most powerful strategy for addressing these underlying drivers of the syndrome. Many of the same diet strategies for balancing blood sugar also support adrenal health and sex hormone balance.
I’ve made a hormone balancing meal plan and recipes that you can grab for free to help you get started.
To balance your blood sugar for PCOS, eat regular balanced meals containing protein, healthy fats, and lots of veggies. Include fruit and starches moderately, as tolerated. Choose whole, unprocessed, high-quality options and limit or eliminate processed food.
In addition, add in anti-inflammatory foods like cold water fish, olive oil, green tea, and a variety of polyphenol-rich colorful produce.
As I share in my book, Is This Normal, eating fiber, fat, and protein at every meal helps optimize insulin. The adrenal glands love balanced blood sugar, as any swings in blood sugar are a source of stress. If you want DHEA in check, nutrition cannot be overlooked.
For more tips and resources, check out these articles:
- The Best Diet for PCOS
- Is a Low Carb Diet Good for PCOS
- Five Blood Sugar Balancing Strategies for PCOS
What is the Best Supplement to Lower DHEA?
There are many supportive supplements to lower DHEA, lower testosterone, balance blood sugar, nourish the adrenals, and support other root causes or symptoms of PCOS. Unlike a medication, they work in aiding your body in finding balance. Let’s cover a few of my favorite options next, but if you need more ideas, please read 10 Best Supplements for PCOS.
Myo-inositol and D-Chiro Inositol
Inositol, vitamin B8, is a popular and highly effective PCOS supplement. In fact, it’s one of my go-to strategies for PCOS support because it may help support healthy insulin levels7, ovarian health and ovulation8, and lower androgen levels9. In fact, some research10 has suggested myoinositol may aid women with PCOS in lowering their DHEA levels.
Inositol comes in several forms, but myo- and d-chiro-inositol in an optimal 40:1 ratio is the most effective combination for PCOS11. A therapeutic dose is 2,000mg of myo-inositol and 50mg of d-chiro-inositol per day. This is precisely the ratio and quantity you’ll find in Myoinositol Plus.
Ashwagandha and Rhodiola
Ashwagandha and rhodiola are adaptogenic herbs that support the adrenal glands and help the body adapt to stress. In addition, adaptogens support blood sugar balance. Adrenal support and blood sugar balance are essential for addressing PCOS and DHEA imbalances.
You’ll find ashwagandha, rhodiola, other adaptogens, B vitamins, and vitamin C in Adrenal Support.
Phosphatidylserine
Phosphatidylserine is a natural phospholipid found in every cell membrane of the body and is involved in adrenal health. As a supplement, it can be used during times of acute stress and is particularly helpful for supporting the natural lowering of cortisol at night to help with sleep. As a bonus, phosphatidylserine may reduce PMS symptoms12, which are common in women with PCOS.
In athletes, phosphatidylserine has been shown13 to be beneficial in modulating the exercise induced stress response. This is important in women with PCOS who have concerns about the effect of exercise on their cortisol response.
Saw Palmetto and Nettle
Saw palmetto is an anti-androgenic herb that helps reduce symptoms such as acne and unwanted body hair. Specifically, saw palmetto supports the body in balancing the enzyme responsible for the conversion of testosterone to its potent metabolite DHT. DHTis responsible for some high androgen symptoms. This is good news since high DHEA can lead to increased testosterone and DHT, which many women with PCOS experience.
Nettle root, or stinging nettle root, is another helpful herb for PCOS and high DHEA. It works by inhibiting 5-alpha-reductase, the enzyme that converts testosterone to DHT. In addition, research suggests that nettle root, as part of an herbal formula, helps decrease insulin levels14 in women with PCOS.
You’ll find saw palmetto and nettle root in Saw Palmetto Plus, along with other androgen support including vitamin B6 and zinc.
One of the best well-rounded supplement strategies for PCOS is my PCOS Plus Kit. This kit is specially formulated with 4 key supplements: Adrenal Support, Saw Palmetto Plus, Balance Women’s Hormone Support and Myoinositol Plus for well-rounded adrenal and ovarian hormone support.
Reduce Stress
Managing stress is essential for supporting healthy adrenal function, blood sugar balance, and ovarian hormone balance. Reducing and managing stress helps address several imbalances you may experience with PCOS while creating the ideal conditions for healing.
Consider both emotional stresses, like financial or relationship stress, and physical stresses, such as undereating, dehydration, and toxin exposures.
Exercise, mindfulness practices, prioritizing sleep, and learning to say “no are all helpful habits to cultivate.
You can read more about techniques to reduce stress and manage stress here.
Takeaway
PCOS is one of the most common causes of elevated DHEA, associated with elevated testosterone, adrenal dysfunction, and other metabolic and hormonal imbalances. Addressing elevated DHEA with foundational support, like a blood sugar balancing diet, stress management, and targeted supplements can help get your hormones to a state where they work for you, rather than feeling like they work against you.
References
- https://pubmed.ncbi.nlm.nih.gov/30029723/ ↩︎
- https://www.sciencedirect.com/science/article/abs/pii/S0960076014001174?via%3Dihub ↩︎
- https://www.mdpi.com/2073-4409/11/20/3255 ↩︎
- https://pubmed.ncbi.nlm.nih.gov/28450075/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/35037820/ ↩︎
- https://www.mountsinai.org/health-library/tests/dhea-sulfate-test ↩︎
- https://pubmed.ncbi.nlm.nih.gov/34407851/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/33260918/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/18854115/ ↩︎
- https://www.europeanreview.org/wp/wp-content/uploads/3105-3115.pdf ↩︎
- https://www.hindawi.com/journals/ije/2020/6461254/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/29576358/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503954/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/34466504/ ↩︎
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