DHEA (Dehydroepiandrosterone)

What It Is

DHEA (dehydroepiandrosterone) is often called the "mother hormone" or "precursor hormone" because it serves as a raw material that your body converts into other hormones—primarily testosterone and estrogen. It's one of the most abundant hormones in the human body during young adulthood, but it declines steadily with age, making it a key player in the aging process and hormonal transitions like perimenopause.

Where it's produced:

• Adrenal glands → primary source (about 95% of DHEA comes from the adrenals)
• Ovaries → small amounts (about 5%)
• Brain → local production in neural tissue (supports cognitive function)
• Skin → local production (supports skin health and repair)

Primary functions:

• Hormone precursor → converted to testosterone and estrogen in peripheral tissues (fat, muscle, brain, skin)
• Energy production → supports mitochondrial function, cellular energy, stamina
• Immune function → modulates immune response, supports resilience to infection and inflammation
• Mood regulation → supports dopamine and serotonin pathways, enhances mood, motivation, well-being
• Bone health → contributes to bone density (via conversion to sex hormones and direct effects)
• Cognitive function → supports memory, focus, neuroprotection
• Stress resilience → counterbalances cortisol's effects, supports recovery from stress
• Muscle and body composition → supports muscle mass, reduces fat accumulation
• Skin health → supports collagen production, hydration, repair

What makes DHEA unique:

DHEA is a prohormone—it's not highly active on its own, but it becomes powerful once converted to other hormones. This conversion happens locally in tissues (called "intracrinology")—meaning your muscles, brain, skin, and bones convert DHEA to estrogen or testosterone as needed.

This is why DHEA is sometimes called a "buffer hormone"—it allows tissues to self-regulate their hormone levels based on local needs.

DHEA vs. DHEA-S:

When clinicians test DHEA, they usually measure DHEA-S (DHEA-sulfate), which is:

• A sulfated (stored) form of DHEA
• More stable in the bloodstream (longer half-life)
• Produced primarily by the adrenals
• A better marker of adrenal function and DHEA reserves

DHEA (non-sulfated) fluctuates throughout the day and is harder to measure accurately, which is why DHEA-S is the preferred clinical marker.

Why It Matters During Perimenopause/Menopause

DHEA declines steadily with age—peaking in your 20s and 30s, then declining by about 2% per year after age 30. By menopause, DHEA levels are often 70-80% lower than they were at their peak.

The decline accelerates during perimenopause because:

1. Ovarian DHEA production declines as ovarian function declines
2. Adrenal production may decline due to chronic stress (adrenals prioritize cortisol production over DHEA)
3. Conversion to sex hormones becomes less efficient as the body ages

Why this matters:

During reproductive years, your ovaries produce most of your estrogen and testosterone. After menopause, your adrenals become the primary source of sex hormone precursors (via DHEA conversion). If DHEA is low, your body has less raw material to make estrogen and testosterone in peripheral tissues.

The result:

• Lower energy, stamina, vitality
• Reduced muscle mass, increased fat (especially abdominal fat)
• Lower libido, reduced sexual function
• Mood changes (low motivation, reduced pleasure, mild depression)
• Reduced stress resilience (feeling "worn down" by chronic stress)
• Cognitive changes (memory issues, slower processing, brain fog)
• Immune changes (more frequent infections, slower recovery)
• Skin changes (dryness, thinning, slower wound healing)

DHEA and the stress-hormone seesaw:

DHEA and cortisol (the primary stress hormone) are both produced by the adrenal glands, and they have an inverse relationship:

• Chronic stress → adrenals prioritize cortisol production → DHEA production declines
• High cortisol, low DHEA → "stressed and depleted" state (common in perimenopause)
• DHEA helps buffer cortisol's negative effects → when DHEA is low, cortisol's impact on mood, sleep, and metabolism is more pronounced

This is why women in perimenopause often feel simultaneously wired (high cortisol) and exhausted (low DHEA)—the adrenals are stuck in crisis mode, pumping out cortisol at the expense of DHEA.

How It Works

Mechanism of action:

DHEA works through multiple pathways:

1. Conversion to sex hormones (testosterone and estrogen):

   • DHEA is converted to androstenedione (another precursor)
   • Androstenedione is converted to testosterone (in muscle, fat, brain, ovaries)
   • Testosterone can be converted to estrogen (via the enzyme aromatase)
   • This happens locally in tissues, allowing each tissue to regulate its own hormone levels

2. Direct effects on receptors:

   • DHEA binds to androgen receptors (though more weakly than testosterone)
   • DHEA binds to GABA receptors in the brain (mood and anxiety regulation)
   • DHEA binds to NMDA receptors in the brain (learning, memory, neuroprotection)
   • DHEA affects estrogen receptors indirectly (via conversion to estrogen)

3. Effects on neurotransmitters:

   • DHEA supports dopamine production → motivation, pleasure, reward, confidence
   • DHEA supports serotonin production → mood regulation, well-being
   • DHEA modulates GABA (calming) and glutamate (excitatory) balance in the brain

4. Anti-cortisol effects:

   • DHEA opposes some of cortisol's negative effects on the brain, immune system, and metabolism
   • High cortisol + low DHEA = accelerated aging, cognitive decline, immune suppression
   • Optimal DHEA = cortisol buffering, resilience to stress

DHEA's relationship with other hormones:

DHEA + Cortisol:

• Inverse relationship: chronic stress → high cortisol → low DHEA
• DHEA:cortisol ratio is often more informative than absolute DHEA levels
• Optimal ratio supports stress resilience, immune function, mood stability

DHEA + Testosterone:

• DHEA is the primary source of testosterone in women (especially after menopause)
• Low DHEA → low testosterone → reduced libido, muscle loss, low energy, reduced motivation

DHEA + Estrogen:

• DHEA is converted to estrogen in fat tissue, brain, bone, skin
• After menopause, DHEA conversion is a significant source of estrogen
• Low DHEA → lower estrogen production in tissues → symptoms of estrogen deficiency

DHEA + Thyroid:

• DHEA supports thyroid hormone conversion (T4 to active T3)
• Low DHEA can worsen thyroid-related fatigue and metabolism issues
• Both affect energy, metabolism, mood—overlapping symptoms

DHEA + Insulin:

• DHEA improves insulin sensitivity (helps cells respond to insulin)
• Low DHEA is associated with insulin resistance, metabolic syndrome, weight gain
• DHEA supplementation may improve blood sugar regulation in some women

What It Looks Like

When Optimal (Healthy DHEA Levels)

Physical:

• Good energy and stamina throughout the day
• Healthy muscle mass and body composition
• Resilient skin (good hydration, elasticity, repair)
• Strong immune function (resistance to infections, quick recovery)
• Healthy libido and sexual function
• Good bone density

Cognitive:

• Sharp memory and recall
• Good focus and concentration
• Mental stamina and resilience
• Positive, motivated mood
• Fast processing speed

Emotional:

• Sense of vitality and aliveness
• Motivation and drive
• Resilience to stress (able to bounce back)
• Pleasure and enjoyment in activities
• Confidence and self-assurance

When Low (DHEA Deficiency)

Physical:

• Chronic fatigue → low energy, exhaustion that doesn't improve with rest
• Loss of muscle mass → difficulty building or maintaining muscle
• Weight gain (especially abdominal) → metabolic changes, insulin resistance
• Reduced libido → low sex drive, reduced arousal
• Immune vulnerability → frequent colds, infections, slow recovery
• Skin changes → dryness, thinning, slow wound healing
• Joint pain → reduced tissue repair and regeneration
• Bone loss → accelerated osteopenia/osteoporosis risk

Cognitive:

• Brain fog → difficulty concentrating, slower thinking
• Memory problems → poor recall, forgetfulness
• Reduced mental stamina → exhaustion from cognitive tasks

Emotional:

• Low motivation → lack of drive, ambition, interest
• Reduced pleasure (anhedonia) → activities feel less rewarding
• Mild depression → low mood, hopelessness, emotional flatness
• Stress intolerance → feeling overwhelmed, unable to cope with demands
• Burnout → chronic depletion, feeling "used up"

The "stressed and depleted" state:

• High cortisol (wired, anxious, restless)
• Low DHEA (exhausted, depleted, no reserves)
• This combination is common in perimenopause, especially with chronic stress

When High (DHEA Excess, Usually from Supplementation)

High DHEA is rare without supplementation. When it occurs (usually from taking too much DHEA), symptoms include:

Physical:

• Acne → increased androgen activity stimulates oil production
• Oily skin
• Hair changes → increased facial hair, scalp hair thinning (androgenic effects)
• Menstrual changes → if still cycling, periods may become irregular

Emotional:

• Irritability, aggression → excess androgens can increase irritability
• Restlessness, overstimulation
• Insomnia → too much DHEA can be activating, disrupt sleep

Note: High DHEA can also indicate adrenal tumors or polycystic ovary syndrome (PCOS) in premenopausal women—this requires medical evaluation.

Phase Impact

Baseline (Regular Cycle, Pre-Perimenopause): DHEA levels are stable and relatively high (depending on age). DHEA supports energy, libido, mood, and stress resilience. DHEA:cortisol ratio is balanced, supporting overall vitality.

Electric Cougar (Early Perimenopause): DHEA may remain relatively stable, but stress (common in this phase) can shift the DHEA:cortisol ratio toward cortisol dominance. Some women notice reduced stamina, increased stress sensitivity, or slight declines in libido—early signs of DHEA decline. Adrenal support becomes important.

Wild Tide (Mid-Perimenopause): DHEA declines more noticeably. Chronic stress accelerates the decline (adrenals prioritize cortisol over DHEA). Symptoms of low DHEA become more apparent: fatigue, reduced stress resilience, mood changes, declining libido. This is a key phase for adrenal support and stress management.

Henapause (Late Perimenopause, 7-11 Months Without Period): DHEA continues to decline as ovarian function wanes. The adrenals are now the primary source of sex hormone precursors. Low DHEA contributes to fatigue, low libido, mood changes, and reduced vitality. Many women feel "burnt out" during this phase.

The Pause (Menopause, 12+ Months Without Period): DHEA stabilizes at lower levels. The adrenals are now the sole source of sex hormone precursors (via DHEA conversion). Women with healthy DHEA levels often report better energy, mood, and libido than those with depleted DHEA. Supplementation may be considered if levels are very low.

Phoenix Phase (Early Post-Menopause, 2-10 Years After Last Period): DHEA continues its age-related decline (about 2% per year). Women who prioritize adrenal health, stress management, and (if needed) DHEA supplementation often report sustained energy, mood, and vitality. Those with depleted DHEA may struggle with chronic fatigue and low motivation.

Golden Sovereignty (Established Post-Menopause, 7+ Years After Last Period): DHEA levels are significantly lower than in younger years, but some women maintain relatively healthy levels through lifestyle, stress management, and supplementation. DHEA becomes a key factor in "successful aging"—supporting energy, cognitive function, bone health, and immune resilience.

Testing & Optimization

When to Test

DHEA testing makes sense if you're experiencing:

• Chronic fatigue that doesn't improve with rest
• Low libido, reduced sexual function
• Loss of muscle mass, difficulty building muscle
• Mood changes (low motivation, reduced pleasure, mild depression)
• Stress intolerance, burnout
• Frequent infections, slow recovery
• Persistent symptoms despite HRT (if you're on estrogen/progesterone but still feel depleted)

What tests measure:

DHEA-S (DHEA-sulfate) blood test:

• Most common and reliable test
• Measures stored DHEA (more stable than free DHEA)
• Reflects adrenal function and DHEA reserves
• Normal ranges vary by age and lab; optimal levels are typically in the mid-to-upper range for your age

Salivary DHEA:

• Some functional medicine practitioners use salivary testing
• Reflects free (active) DHEA, but less standardized than blood testing

DHEA:Cortisol ratio:

• Some practitioners measure both DHEA and cortisol (often via saliva, multiple times throughout the day)
• Ratio is more informative than absolute levels → low DHEA + high cortisol = stress dominance

Best timing for testing:

• Morning is best (DHEA peaks in the morning)
• Can test anytime if using DHEA-S (more stable)

Optimization Strategies

1. DHEA Supplementation

DHEA is available over-the-counter in the United States (it's classified as a dietary supplement, not a prescription medication). This makes it accessible—but also unregulated, which raises quality and safety concerns.

What it helps:

• Energy and stamina → many women report feeling "alive again" with DHEA
• Mood and motivation → supports dopamine and serotonin, enhances pleasure and drive
• Libido and sexual function → increases testosterone production
• Muscle mass and body composition → supports muscle building, reduces fat
• Bone density → may slow bone loss (via conversion to estrogen and testosterone)
• Immune function → supports resilience, reduces inflammation
• Cognitive function → may improve memory, focus, processing speed in some women
• Skin health → supports hydration, elasticity, repair

Who benefits most:

• Women with documented low DHEA-S levels
• Women with chronic fatigue, burnout, stress depletion
• Women with low libido and low testosterone (DHEA boosts testosterone)
• Women in post-menopause who feel depleted despite HRT

Dosing:

• Typical starting dose: 5-10 mg/day
• Some women need 25-50 mg/day (especially if severely depleted)
• Start low, increase gradually based on symptoms and follow-up testing
• Take in the morning (DHEA is activating and may disrupt sleep if taken at night)

Risks and concerns:

DHEA supplementation is controversial because:

• Not regulated by FDA → quality, purity, and potency vary widely between brands
• Can convert to testosterone and estrogen → may worsen hormone-sensitive conditions (e.g., breast cancer, endometrial cancer, PCOS)
• Can cause androgenic side effects → acne, oily skin, facial hair, hair thinning
• May affect cholesterol → can lower HDL (good cholesterol) in some women
• Long-term safety unclear → limited studies on long-term use
• Can interfere with hormone testing → if you're on DHEA, it will affect testosterone and estrogen levels

Who should avoid DHEA:

• History of hormone-sensitive cancers (breast, endometrial, ovarian) without oncologist approval
• PCOS or conditions involving high androgens
• Liver disease (DHEA is metabolized by the liver)
• Pregnancy or breastfeeding

Monitoring:

• Retest DHEA-S after 6-8 weeks to ensure levels are in optimal range (not too high)
• Monitor for androgenic side effects (acne, hair changes)
• If on HRT, discuss with clinician (DHEA may affect estrogen/testosterone levels)

Quality matters:

• Choose pharmaceutical-grade DHEA from reputable brands (USP verified, third-party tested)
• Micronized DHEA is better absorbed
• Avoid "wild yam extract" marketed as DHEA (your body cannot convert wild yam to DHEA)

2. Lifestyle Strategies to Support DHEA Production

Stress management:

• Chronic stress suppresses DHEA production (adrenals prioritize cortisol over DHEA)
• Practices: meditation, breathwork, therapy, nervous system regulation, boundaries, rest
• Reducing cortisol allows adrenals to produce more DHEA

Sleep:

• DHEA is produced during deep sleep
• Poor sleep → lower DHEA, higher cortisol
• Prioritize 7-9 hours of quality sleep

Exercise (in moderation):

• Moderate exercise → supports DHEA production
• Excessive exercise → increases cortisol, suppresses DHEA (overtraining)
• Balance strength training, cardio, and recovery

Nutrition:

• Healthy fats (omega-3s, olive oil, avocado) → DHEA is made from cholesterol; healthy fats support hormone production
• Adequate protein → supports muscle mass, hormone synthesis
• Antioxidants (colorful vegetables, berries) → reduce oxidative stress, support adrenal health
• Avoid extreme calorie restriction → can suppress DHEA production

Adaptogenic herbs:

• Ashwagandha, rhodiola, holy basil → may support adrenal health and DHEA production (evidence is mixed; some women report benefit)
• Maca root → traditionally used to support energy, libido, hormonal balance

Sunlight and vitamin D:

• Vitamin D supports DHEA production
• Get sunlight exposure and/or supplement with vitamin D3 (2000-4000 IU/day, depending on levels)

3. Other Interventions

Adrenal support protocols:

• Some functional medicine practitioners recommend comprehensive adrenal support (adaptogens, B vitamins, vitamin C, magnesium, rest, stress management)
• Goal: reduce cortisol dominance, support DHEA production

Bioidentical hormone therapy (BHRT):

• Some compounding pharmacies offer prescription DHEA (higher quality, more regulated than OTC)
• May be combined with estrogen, progesterone, testosterone for comprehensive HRT

When to Review with Clinician

You should discuss DHEA testing and supplementation if:

• Chronic fatigue, burnout, or "hitting a wall" despite rest
• Low libido or sexual function issues (especially if testosterone is also low)
• Persistent symptoms despite HRT (estrogen/progesterone alone may not be enough)
• Mood changes (low motivation, reduced pleasure, mild depression)
• Loss of muscle mass or difficulty building muscle
• Frequent infections or immune vulnerability
• Stress intolerance, feeling "worn down"
• Interested in DHEA supplementation but want medical guidance

Red flags requiring medical attention:

• Very high DHEA-S levels (may indicate adrenal tumor, PCOS, or other endocrine disorder)
• New or worsening androgenic symptoms (severe acne, significant hair loss, deepening voice) → stop DHEA and consult clinician
• Symptoms of hormone-sensitive cancer (unusual bleeding, breast lumps, pelvic pain) → requires immediate evaluation

Work with a knowledgeable clinician:

• Not all doctors are familiar with DHEA testing or supplementation
• Consider working with a functional medicine doctor, integrative gynecologist, or menopause specialist
• Monitor DHEA-S levels, symptoms, and side effects regularly

Related Terms

• testosterone
• cortisol
• adrenal-health
• chronic-fatigue
• burnout
• libido-changes
• stress-resilience
• hrt-hormone-replacement-therapy
• bioidentical-hormones
• insulin-resistance
• metabolic-syndrome
• immune-function