Low DHEA is most commonly caused by normal aging. Your adrenal glands produce peak levels of this hormone in your mid-20s, and production drops steadily after that, falling by roughly 10% to 20% per decade. By age 70 or 80, most people have only 10% to 20% of the DHEA they had at their peak. But aging isn’t the only explanation. Adrenal disorders, chronic stress, certain medications, and chronic inflammation can all drive levels down faster or further than expected for your age.
How Aging Affects DHEA Production
DHEA and its storage form, DHEA-S, are the most abundant steroid hormones in the human body, produced almost entirely by the adrenal glands. Production ramps up during puberty, peaks between ages 20 and 30, then begins a long, steady decline that continues for the rest of your life. This decline is so predictable that researchers sometimes use DHEA-S as a biomarker of biological aging.
The normal reference ranges reflect this drop clearly. For women ages 18 to 29, a typical DHEA-S level falls between 45 and 320 µg/dL. By ages 50 to 59, the range shrinks to 15 to 170 µg/dL. For men, the pattern is similar: 110 to 520 µg/dL in the late teens and twenties, dropping to 25 to 240 µg/dL by the fifties. After age 59, both sexes see even lower ceilings. A level that would be flagged as low in a 25-year-old may be perfectly normal in a 60-year-old, which is why any blood test result needs to be interpreted against age-specific ranges.
Adrenal and Pituitary Disorders
The adrenal glands sit on top of your kidneys and produce DHEA in their outermost layers. Any disease that damages or destroys those layers will reduce DHEA output. In primary adrenal insufficiency (Addison’s disease), the immune system gradually attacks the adrenal cortex, leading to inadequate production of cortisol, aldosterone, and adrenal androgens including DHEA. The result is a direct loss of the tissue that makes the hormone.
DHEA production also depends on a signaling hormone from the pituitary gland called ACTH. When the pituitary is damaged or underactive, a condition called hypopituitarism, ACTH output falls, and the adrenal glands lose the stimulus they need to produce DHEA. This is called secondary or central adrenal insufficiency. The adrenal glands themselves are intact, but without that signal from the brain, they scale back production. In women, both primary and central adrenal insufficiency can cause noticeably low DHEA-S, sometimes accompanied by thinning pubic and underarm hair and reduced sex drive.
Chronic Stress and the Cortisol-DHEA Balance
Your adrenal glands produce both cortisol and DHEA in response to stress, and the two hormones normally work in a kind of balance. DHEA has anti-inflammatory and neuroprotective properties that help offset cortisol’s more damaging effects. When this balance tips, problems follow.
Under prolonged stress, the adrenal system can shift its resources toward cortisol at the expense of DHEA. Researchers have found that women with chronically disrupted stress responses had lower levels of both cortisol and DHEA compared to controls, suggesting the entire adrenal output can become depleted over time. The ratio of cortisol to DHEA is increasingly used as a marker of how well your stress system is functioning. A high ratio, meaning too much cortisol relative to DHEA, is associated with greater vulnerability to the physical and mental effects of chronic stress, including mood disruption, cognitive problems, and increased inflammation.
Medications That Suppress DHEA
Two classes of medication are especially likely to lower DHEA levels: corticosteroids and opioids.
- Corticosteroids: Drugs like prednisone flood the body with synthetic versions of cortisol, which signals the adrenal glands to scale back their own production. Research shows that both daily and alternate-day prednisone suppress DHEA and DHEA-S to a greater degree than they suppress cortisol itself. Even low-dose regimens cause measurable drops. If you’ve been on corticosteroids for weeks or months, your DHEA levels are likely lower than they would otherwise be.
- Opioids: Chronic opioid use is well documented to suppress sex hormones, and DHEA is part of that picture. A study of patients on sustained-action prescription opioids found widespread DHEA-S deficiency. Interestingly, their ACTH levels were normal, meaning the usual pituitary signal was still present. This suggests opioids suppress adrenal androgen production through a different mechanism than simply reducing ACTH, possibly by acting directly on the adrenal gland’s ability to make DHEA.
Chronic Inflammation
Ongoing inflammation, whether from an autoimmune condition, a chronic infection, or another source, can actively suppress DHEA production. Elevated levels of the inflammatory signaling molecules TNF-alpha and IL-6 are consistently associated with lower circulating DHEA and DHEA-S. This isn’t just a correlation. Laboratory studies using human adrenal cells have shown that immune signals produced during chronic infection can directly inhibit those cells from making DHEA. When researchers blocked one of those signals (a growth factor called TGF-beta), DHEA production recovered.
This creates an unfortunate feedback loop. DHEA itself has anti-inflammatory properties, so as inflammation drives DHEA down, the body loses one of its natural tools for keeping inflammation in check. Conditions like rheumatoid arthritis, lupus, and chronic infections are all associated with lower-than-expected DHEA levels, and this hormonal shift may contribute to the fatigue and immune dysfunction that often accompany them.
Diet and Metabolic Health
What you eat can influence your DHEA levels in ways that are distinct from aging. DHEA is involved in glucose metabolism, and extreme dietary changes, particularly severe calorie restriction or strict blood sugar control, can lower circulating DHEA-S independently of age. Short-term changes in diet alone have been shown to alter both blood and urine levels of DHEA-S in humans.
Part of the explanation is enzymatic. The enzyme that converts DHEA into its storage form, DHEA-S, is sensitive to glucose levels. When glucose availability shifts dramatically, as it does during prolonged calorie restriction or intensive diabetes management, the conversion process can be disrupted. Animal studies in primates have confirmed that calorie restriction alters the expression of genes involved in DHEA metabolism, particularly in the liver. This means that very low-calorie diets or aggressive blood sugar management could contribute to lower DHEA-S readings on a blood test, even in someone whose adrenal glands are working normally.
Insulin resistance and type 2 diabetes are also linked to lower DHEA. Research in men with type 2 diabetes has found that low serum DHEA is associated with worse lipid profiles, and some researchers believe DHEA’s ability to improve insulin sensitivity is part of what explains that connection.
How Low DHEA Is Measured
Doctors typically test DHEA-S rather than DHEA itself, because DHEA-S levels are much more stable throughout the day. DHEA fluctuates with your body’s daily cortisol rhythm, rising in the morning and dipping in the evening, while DHEA-S stays relatively constant, making it a more reliable snapshot.
A single low reading doesn’t necessarily point to a specific cause. Your doctor will interpret the result alongside your age, sex, symptoms, and other lab work. If DHEA-S is low along with cortisol, that points toward an adrenal or pituitary problem. If DHEA-S is low but cortisol is normal or high, chronic stress, medication effects, or inflammation become more likely explanations. In many cases, especially for people over 40 with no other symptoms, a low-normal DHEA-S level simply reflects the natural aging process and doesn’t require treatment.