DHEA: The Hormone Nobody Talks About — But Should
By Dr. Melissa Casden | Integrative Women's Health
DHEA is one of the most important hormones in the female body, particularly as we move through the second half of life. Understanding what it does, what happens when it's off, and how to address it thoughtfully is worth the time.
What Is DHEA?
DHEA (dehydroepiandrosterone) is what's called a pre-hormone — meaning it's a precursor that gets converted into more potent hormones downstream. Specifically, it's a precursor to both androgens (like testosterone) and estrogens. Most DHEA is produced in the adrenal glands, with smaller amounts from the ovaries and peripheral tissue.
DHEA circulates mostly as DHEA-S (DHEA-sulfate), which is the more stable storage form. When the body needs androgens or estrogens, it draws from this DHEA-S reserve and converts it at the tissue level.
This tissue-level conversion is particularly important after menopause. In postmenopausal women, the ovaries no longer produce significant amounts of estrogen or testosterone — but the adrenal glands continue to make DHEA. And at the tissue level, that DHEA gets converted into whatever the local tissue needs - this is why DHEA is often called the 'mother hormone' of the postmenopausal years.
What DHEA Does
DHEA has effects both through its conversion to other hormones and through its own direct activity. Adequate DHEA levels are associated with:
• Cardiovascular protection
• Immune regulation and reduced autoimmune risk
• Anti-inflammatory effects
• Bone density support
• Cognitive function and mood stability
• Energy and sense of wellbeing
• Libido and sexual function
Low DHEA: What to Watch For
Low DHEA doesn't always produce a dramatic symptom picture, which is part of why it goes unrecognized. But common presentations include:
• Fatigue and low energy that doesn't improve with sleep
• Low libido
• Difficulty building or maintaining muscle mass
• Mood changes, including depression or loss of motivation
• Decreased sense of wellbeing
Low DHEA is associated with higher rates of cardiovascular disease, inflammatory conditions, and autoimmune disorders. It's worth assessing, particularly in women over 40 or those with chronic stress, adrenal dysfunction, or a history of autoimmune disease.
High DHEA: When More Isn't Better
On the other end, elevated DHEA — usually elevated DHEA-S on labs — can drive androgen excess symptoms: acne, increased body hair, irritability, oily skin. In women, the most common driver of high DHEA is HPA axis dysregulation, particularly chronic stress. Other causes include blood sugar dysregulation, PCOS, high prolactin, and — more rarely — adrenal tumors.
Treatment
For low DHEA, the approach depends on the cause:
• If chronic stress is the driver, HPA axis support comes first — sleep, nervous system regulation, adaptogenic herbs, stress reduction
• Addressing chronic inflammation and supporting blood sugar regulation both support adrenal function
• Liver function supports appropriate DHEA metabolism
• Oral DHEA supplementation — can be used when appropriate, but should be done thoughtfully
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For high DHEA, the same principles apply: address chronic inflammation, regulate blood sugar, reduce physiological stressors, and support the parasympathetic nervous system.
