Dehydroepiandrosterone (DHEA) is a natural steroid hormone produced primarily by the adrenal glands. It serves as a precursor to other hormones, including androgens like testosterone and estrogens. While DHEA is important, elevated levels in males can indicate underlying health issues requiring medical attention. This article explores what high DHEA levels signify and how these conditions are typically addressed.
DHEA and Elevated Levels
“High” DHEA levels in males vary, as normal ranges depend on age and the specific laboratory conducting the test. Generally, DHEA levels decrease with age, so what is elevated in a younger male might be within range for an older individual. For DHEA-sulfate (DHEA-S), the most commonly measured form, levels significantly above the age-specific reference range (e.g., exceeding 700-800 µg/dL in adult males) are often considered elevated.
The adrenal glands are the primary source of DHEA, contributing over 90% of circulating DHEA-S. Therefore, elevated DHEA levels often originate from these glands.
One common cause is congenital adrenal hyperplasia (CAH), a genetic disorder where an enzyme deficiency, such as 21-hydroxylase deficiency, impairs cortisol production. This leads to an overproduction of DHEA as the adrenal glands attempt to compensate. Even a non-classical form of CAH might not present until later in life, manifesting as elevated DHEA without severe symptoms in infancy.
Adrenal tumors, both benign (adenomas) and malignant (carcinomas), can also lead to increased DHEA production by autonomously secreting hormones. In rare instances, certain medications or supplements containing DHEA can contribute to elevated levels, so reviewing a patient’s medical history and supplement use is important. High DHEA is often a symptom, not the primary condition, and effective management requires identifying and addressing the underlying cause.
Symptoms and Diagnosis
Elevated DHEA levels in males can manifest through symptoms often related to DHEA’s conversion into more potent androgens like testosterone. Common skin-related signs include severe acne, particularly adult-onset acne, and excessively oily skin. Individuals may also experience male-pattern hair loss (androgenic alopecia), characterized by thinning hair at the temples and crown. An increase in body hair, known as hirsutism, can also occur.
Beyond physical symptoms, some males might report mood changes, such as increased irritability or aggression, though these are less specific. In some cases, elevated DHEA might contribute to gynecomastia, the enlargement of breast tissue in males. These symptoms can vary in severity and may overlap with other medical conditions, making accurate diagnosis by a healthcare professional important.
The diagnostic process typically begins with blood tests to measure DHEA-S levels and other related hormones like total and free testosterone, cortisol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). If DHEA-S levels are significantly elevated, further investigations are necessary to pinpoint the underlying cause. These might include specialized dynamic tests, such as an ACTH stimulation test, which helps diagnose forms of congenital adrenal hyperplasia. Imaging studies, such as CT or MRI scans of the adrenal glands, are often performed to check for tumors or other structural abnormalities.
Approaches to Treatment
Treating elevated DHEA levels in males primarily involves addressing the specific underlying cause identified through diagnostic testing, rather than directly targeting DHEA itself. For conditions like congenital adrenal hyperplasia, treatment typically involves lifelong glucocorticoid replacement therapy, often with hydrocortisone. These medications suppress excessive ACTH production from the pituitary gland, which reduces the adrenal glands’ overproduction of DHEA and other adrenal hormones. The dosage is carefully adjusted to normalize hormone levels and manage symptoms.
When an adrenal tumor is identified as the cause, surgical removal (adrenalectomy) is often the recommended course of action. This applies to both benign adenomas and malignant carcinomas, especially if actively secreting hormones. For malignant tumors, additional treatments like chemotherapy or radiation therapy may be necessary following surgery, depending on the tumor’s type and stage. If certain medications contribute to high DHEA, a healthcare provider may adjust the dosage or recommend an alternative, weighing benefits and risks.
Beyond specific medical interventions, certain lifestyle modifications can support overall hormonal balance and well-being, though they are not a direct cure for pathologically high DHEA levels. Stress management techniques, such as mindfulness, meditation, or yoga, can help mitigate chronic stress’s impact on the adrenal glands. Regular physical activity and a balanced diet rich in whole foods while limiting processed foods and refined sugars can also contribute to better health. These measures serve as supportive strategies alongside primary medical treatment.
Monitoring is an important part of managing elevated DHEA levels and associated underlying conditions. This involves regular follow-up appointments with a healthcare provider to assess DHEA-S levels and other relevant hormone markers. Continued monitoring helps ensure treatment plan effectiveness and allows for timely adjustments, contributing to sustained health outcomes. Regular imaging may also be necessary for individuals with adrenal tumors to monitor for recurrence or changes.
Seeking Professional Medical Advice
Consulting a healthcare professional is necessary for accurate diagnosis and appropriate treatment of elevated DHEA levels. Self-diagnosis or self-treatment can be dangerous, as high DHEA can signal serious underlying conditions requiring specific medical intervention. A medical professional, such as an endocrinologist, possesses the expertise to conduct tests, interpret results, and develop a personalized treatment plan. They determine the exact cause of elevated DHEA and guide the most effective course of action. Discussing symptoms with a doctor ensures proper medical care, leading to better health outcomes.