DHEA-S is the sulfate ester of DHEA and only a part of DHEA testing.
Understanding DHEA:
- DHEA (Dehydroepiandrosterone) is an endogenous steroid hormone made by both men and women in the adrenal gland, predominantly, and to a lesser degree in the brain and gonads.
- DHEA helps produce other hormones, including testosterone and estrogen. Natural DHEA levels peak in early adulthood and then slowly fall as you age.
- You will see that the three big DHEA urine markers are: DHEA-S, Etiocholanolone (metabolite) and Androsterone (metabolite).
- It is important to note that DHEA and not DHEA-S makes testosterone and/or estrone (E1)
DHEA is converted to A4 by the enzyme 3 beta-hydroxysteroid dehydrogenase, and then in near equal amounts to testosterone (T) via 17-beta hydroxysteroid dehydrogenase, and to Epi-testosterone (Epi-T) via 17-alpha hydroxysteroid dehydrogenase. A4 also converts to the weak estrogen, estrone (E1), via aromatase, and to the more potent estrogen, estradiol (E2) via 17-beta hydroxysteroid dehydrogenase. Adipose (fat) tissue contains more aromatase, the activity of which is further stimulated by high levels of the stress hormone cortisol. Thus, excessive adipose tissue in the waist (belly fat), in combination with excessive stressors that raise cortisol, can lead to disproportionate conversion of androgen precursors (DHEA and A4) to estrogens (E1 and E2) instead of androgens (T and DHT). High estrogens can lead to weight gain in the breasts and hips.
Higher levels of the more potent estrogen (estradiol) and androgen (DHT) would indicate that high levels of enzymes (aromatase and 5-alpha-reductase) are present. In women with PCOS this is closely associated with insulin resistance/metabolic syndrome. Strategies to treat insulin resistance (diet lower in carbohydrates, gentle exercise, stress reduction, natural and pharmaceutical medications) will often lower estrogens and androgens, and symptoms associated with their excess.
What does it mean if your DHEA result is too high?
DHEA-S levels can be high because overall DHEA levels are high.
- Stress: DHEA will also increase in response to cortisol. DHEA can counter the effect of cortisol in the brain. So if you have a lot of stress in your life the high DHEA level might be lowered by reducing overall stress and potentially supplements to get the cortisol back into the normal range. Once the cortisol issue has been addressed the DHEA might come down as well if it was related.
- In addition, medications such as Ritalin, Xanax (alprazolam), Wellbutrin (bupropion), Arimidex, Norvasc (amlodipine), Procardia, diltiazem, and alcohol will raise DHEA levels.
- High DHEA levels can be associated with PCOS.
- DHEA supplementation. If your androgenic metabolism favors the 5-alpha pathway, you might get androgenic side effects (irritation, facial hair, losing scalp hair, angriness, etc). Look at the downstream metabolites to see if you favor the alpha pathway.
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What does it mean if your DHEA result is too low?
Possible scenarios:
DHEA-S low / Androsterone low / Etiocholanolone low:
--> Overall DHEA production is low. Look at the main DHEA marker for more details.
DHEA-S low / Androsterone normal / Etiocholanolone normal:
- Because inflammation blocks DHEA being converted to DHEA-S, consider inflammation as a potential part of the overall picture when DHEA-S is significantly lower than the downstream metabolites of DHEA (Androsterone, Etiocholanolone). Look at actue and chronic inflammation disorders (e.g. Rheumatoid arthritis).
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