Dehydroepiandrosterone (DHEA) and its sulfated form, DHEA-S, are abundant circulating steroid hormones that function as precursors to more potent sex steroids, such as testosterone and estrogen. In women with Polycystic Ovary Syndrome (PCOS), elevated androgens, particularly DHEA-S, are common. DHEA-S is primarily produced by the adrenal glands, and this excess production often contributes to symptoms of hyperandrogenism, including hirsutism and acne. Strategies to address this hormonal imbalance focus on normalizing the body’s internal environment to reduce the stimulus for DHEA production.
Understanding DHEA Elevation in PCOS
The excess androgen production seen in PCOS is often a combination of ovarian and adrenal hyperandrogenism. While the ovaries produce potent androgens like testosterone, the adrenal glands are the main source of DHEA and DHEA-S, supplying over 95% of the latter to the bloodstream. Approximately 20% to 30% of women with PCOS exhibit this excess adrenal precursor androgen production. The adrenal glands are highly sensitive to the hypothalamic-pituitary-adrenal (HPA) axis, the body’s primary stress response system. Chronic psychological or physical stress results in sustained high levels of cortisol, which indirectly stimulates the adrenal glands to overproduce DHEA.
Insulin resistance, a common feature of PCOS, also contributes to hormonal dysregulation. Elevated insulin levels encourage the adrenal glands to increase their output, although its direct effect on adrenal DHEA is less clear than its effect on ovarian androgens. Addressing the root causes of chronic stress and insulin resistance is necessary for reducing DHEA levels.
Foundational Lifestyle Interventions
Managing the body’s response to stress is a primary strategy for lowering DHEA-S due to its adrenal origin. Consistent practice of techniques like mindfulness meditation and deep breathing exercises helps regulate the HPA axis. These practices promote a calmer nervous system state, reducing the chronic signaling that drives the adrenal glands to produce excess cortisol and DHEA.
Achieving adequate and restorative sleep is necessary for supporting adrenal health. Poor sleep quality or insufficient duration disrupts the natural diurnal rhythm of cortisol release, which perpetuates HPA axis dysfunction and elevated DHEA levels. Aiming for seven to nine hours of consistent, high-quality sleep allows the adrenal glands to reset.
Dietary strategies should focus on stabilizing blood glucose levels to improve insulin sensitivity. A low-glycemic load diet, rich in fiber and lean protein, minimizes sharp spikes in blood sugar that can trigger hormonal cascades. Prioritizing whole foods and limiting refined carbohydrates and sugars helps reduce metabolic stress on the body.
Exercise selection also influences DHEA levels through its effect on cortisol. While regular physical activity benefits insulin sensitivity, excessive or high-intensity training can be a physical stressor that increases cortisol and DHEA production. Low-impact activities, such as yoga, Pilates, or moderate-paced walking, are preferable as they support cardiovascular health without significantly elevating stress hormones. Sustained, moderate activity fosters metabolic health without overtaxing the adrenal system.
Targeted Nutritional and Herbal Support
Specific nutritional supplements and herbal compounds can offer targeted support for managing adrenal function and androgen levels. The adaptogenic herb Ashwagandha is often used to help the body adapt to stress and has been shown to reduce cortisol levels, which can indirectly lead to a reduction in DHEA-S. Other adaptogens like Rhodiola can similarly support adrenal resilience.
Inositol, typically used as myo-inositol and D-chiro-inositol, helps improve insulin signaling within the body’s cells. Since insulin resistance drives PCOS, improving this sensitivity normalizes the hormonal environment, reducing the stimulus for androgen production, including DHEA. A common therapeutic ratio is 40:1 myo- to D-chiro-inositol.
Certain vitamins and minerals are necessary cofactors for healthy adrenal hormone metabolism. Magnesium is involved in regulating the stress response, and its supplementation can be beneficial for those with high DHEA. Furthermore, the consumption of spearmint tea has demonstrated anti-androgenic effects in some studies, potentially helping to lower circulating androgen levels. Always consult with a healthcare professional before beginning any new supplement regimen.
Pharmaceutical Strategies for Reduction
Medical intervention is sometimes necessary to effectively reduce elevated DHEA-S levels, and these treatments must be monitored by a healthcare professional. Oral contraceptives (OCs), specifically those containing estrogen and low-androgen progestins, are a common treatment option. They work by suppressing ovarian and adrenal androgen production and increasing Sex Hormone-Binding Globulin (SHBG), which binds to free androgens, reducing their active effects in the body.
Insulin-sensitizing medications, such as Metformin, are frequently prescribed when insulin resistance is identified as a contributing factor. By improving the body’s response to insulin, these drugs decrease the hyperinsulinemia that stimulates androgen overproduction. Clinical studies have shown that Metformin can reduce DHEA-S levels by 20% to 30% in women with PCOS who are insulin-resistant.
For cases where adrenal hyperactivity is severe or confirmed through specialized testing, low-dose glucocorticoids, such as Dexamethasone, may be used. This class of medication works by suppressing the production of hormones from the adrenal glands through a negative feedback loop in the HPA axis. Such treatment is generally reserved for clear cases of adrenal-driven hyperandrogenism and requires careful monitoring to avoid side effects.