Dehydroepiandrosterone (DHEA) is a steroid hormone produced mainly by the adrenal glands, which sit above the kidneys. Its sulfated form, DHEA-S, is the most abundant adrenal steroid in the bloodstream and serves as a precursor for potent sex hormones like androgens and estrogens. Elevated DHEA levels in women often lead to an excess of androgens, a condition known as hyperandrogenism. This hormonal imbalance can manifest through symptoms such as acne, hirsutism (excessive hair growth), irregular menstrual cycles, and hair thinning on the scalp. Managing high DHEA levels requires restoring hormonal balance and addressing the underlying cause of the elevation.
Identifying the Root Cause of High DHEA
Determining the precise reason for elevated DHEA is the necessary first step, as the treatment strategy depends entirely on the underlying condition. DHEA-S levels are typically measured through a blood test because this form of the hormone is stable throughout the day, unlike DHEA itself, which fluctuates. Since the adrenal glands are the primary source of DHEA-S production, elevated levels often point toward an adrenal issue.
The most common cause of high DHEA levels in women is Polycystic Ovary Syndrome (PCOS). Up to 30% of women with PCOS may exhibit excess adrenal androgen production, often reflected by elevated DHEA-S. Another significant cause is Non-classical Congenital Adrenal Hyperplasia (NCAH), a genetic condition where an enzyme deficiency results in the overproduction of adrenal androgens.
High DHEA-S may also signal rarer, more serious issues, such as adrenal tumors (benign or cancerous) or Cushing’s syndrome, a disorder involving chronic cortisol overproduction. The diagnostic process is designed to differentiate these conditions, often involving additional tests like the ACTH stimulation test to specifically diagnose NCAH.
Lifestyle Changes and Stress Management
Lifestyle interventions are foundational for managing DHEA levels, particularly by modulating the hypothalamic-pituitary-adrenal (HPA) axis, which governs the body’s stress response. DHEA and the stress hormone cortisol are both secreted by the adrenal glands, and their balance is an indicator of chronic stress. Chronic stress can disrupt this delicate balance, sometimes leading to DHEA dysregulation.
Reducing chronic stress through practices like mindfulness or meditation can help stabilize the HPA axis and potentially lower DHEA-S. Stress management techniques work by preventing the sustained activation of the adrenals that drives both cortisol and DHEA production.
Adequate and consistent sleep is a powerful tool for hormone regulation, as it allows the HPA axis to reset its natural diurnal rhythm. Regular, moderate exercise supports overall metabolic health and hormone sensitivity. However, overtraining or extreme physical exertion can act as a stressor, potentially increasing cortisol and exacerbating hormonal imbalance.
Maintaining stable blood sugar levels is paramount, especially for conditions like PCOS, where insulin resistance is common. High insulin levels stimulate the ovaries and adrenals to produce more androgens. Consuming balanced meals that avoid rapid spikes in blood glucose helps to improve insulin sensitivity, thereby reducing the hormonal drive for excess androgen production.
Specific Dietary and Supplement Strategies
Targeted nutritional and supplemental strategies can offer support for lowering DHEA and managing its effects, particularly when the elevation is linked to insulin resistance or PCOS.
Key Supplements and Herbs
- Inositol: The combination of myo-inositol and D-chiro-inositol is well-studied for women with PCOS. This compound improves insulin sensitivity, which can reduce androgen levels, including DHEA-S. A common effective ratio is 40:1.
- Zinc: Supplementation has been shown to help balance testosterone levels and may reduce symptoms like hirsutism and acne.
- Omega-3 fatty acids: Found in fish oil, these contribute to reducing chronic inflammation often linked to hormonal dysfunction.
- Spearmint tea: Regular consumption has demonstrated the ability to lower free testosterone levels and may help reduce symptoms like excessive hair growth.
- Anti-androgenic herbs: Herbs such as Saw Palmetto and Nettle Root work by inhibiting the enzyme 5-alpha-reductase, which converts testosterone into the more potent androgen dihydrotestosterone (DHT).
These strategies should always be integrated with the guidance of a healthcare provider to ensure safety and effectiveness.
When Medical Intervention is Necessary
When lifestyle and dietary modifications do not sufficiently lower DHEA levels or when a specific medical condition is diagnosed, prescription medication becomes necessary. For women with NCAH, the primary treatment involves low-dose glucocorticoids, such as hydrocortisone, to suppress the overactive adrenal production of DHEA-S. This treatment requires careful and regular monitoring by an endocrinologist to ensure the lowest effective dose is used, minimizing potential side effects.
For women with high DHEA related to PCOS who are not trying to conceive, combined oral contraceptives are often the first-line medical intervention. These medications suppress the production of ovarian and adrenal androgens and increase sex hormone-binding globulin (SHBG), a protein that binds to excess androgens in the bloodstream. Anti-androgen medications like spironolactone may also be prescribed to block the effects of androgens at the receptor level, helping to alleviate symptoms like acne and hirsutism.
In cases where an adrenal tumor is the source of the high DHEA, surgical removal of the tumor is the required treatment. Regardless of the underlying cause, medical intervention necessitates regular monitoring of hormone levels and symptom management under the supervision of a specialized physician.