What is DHEAS?
💡 DHEAS = adrenal androgen marker. Normal female: 1.0–10.0 µmol/L (age-dependent). Elevated DHEAS in women: adrenal androgen excess — investigate for CAH (congenital adrenal hyperplasia), adrenal tumour, or PCOS adrenal component. DHEA supplement (25–75mg/day): used in poor IVF responders to improve follicle recruitment — controversial, some RCT evidence.
DHEAS (dehydroepiandrosterone sulphate) is an androgen produced almost exclusively by the adrenal cortex. Unlike testosterone (which has both ovarian and adrenal sources), an elevated DHEAS specifically points to adrenal androgen excess. In fertility medicine, DHEAS is measured as part of the hyperandrogenism workup (PCOS, congenital adrenal hyperplasia) and in some centres as a supplement before IVF in poor responders.
🇮🇳 India Context: DHEAS is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of DHEAS?
- DHEAS is sulphated DHEA — produced 95% by adrenal zona reticularis; unlike testosterone, minimal ovarian contribution → elevated DHEAS = adrenal source
- Normal female range (20–39 years): 1.5–9.0 µmol/L (varies by lab and age; declines with age)
- Mildly elevated DHEAS (10–15 µmol/L): often seen in PCOS with adrenal hyperandrogenism; less likely pathological
- Markedly elevated DHEAS (>15 µmol/L): investigate for adrenocortical adenoma/carcinoma, non-classic congenital adrenal hyperplasia (NCCAH)
- Congenital adrenal hyperplasia (CAH/NCCAH): 21-hydroxylase enzyme defect → excess DHEAS + elevated 17-OH progesterone; mimics PCOS biochemically; differentiated by 17-OHP test
- PCOS + high DHEAS: mixed gonadal + adrenal androgen pattern; anti-androgen therapy + adrenal suppression may be needed
- DHEA supplementation (exogenous): some IVF centres use 25–75mg/day DHEA for 6–12 weeks before IVF in poor responders; proposed to improve antral follicle recruitment via androgen-driven follicle sensitivity
- Male DHEAS: rarely measured in male fertility; adrenal androgen excess in men does not typically affect spermatogenesis significantly
How does DHEAS work?
Why does DHEAS matter in fertility?
DHEAS has two distinct clinical roles in fertility. First, diagnostically: elevated DHEAS in a woman with hyperandrogenism distinguishes adrenal from ovarian androgen excess — critical because congenital adrenal hyperplasia (NCCAH) can masquerade as PCOS and is treated differently (corticosteroid suppression rather than OCP). Second, therapeutically: DHEA supplementation before IVF in poor ovarian responders (low AMH, high FSH, low AFC) is used at many centres to improve follicle recruitment. Systematic reviews show modest improvement in ovarian response and some improvement in live birth rates in poor responders, but evidence is not yet definitive — POSEIDON group classification guides its use. DHEA should not be used in PCOS (already hyperandrogenic) and can worsen androgen-related symptoms if dose is too high.
What are related terms to DHEAS?
Testosterone
Testosterone is an androgen hormone measured in fertility evaluations for both s…
SHBG (Sex Hormone-Binding Globulin)
SHBG (sex hormone-binding globulin) is a protein produced by the liver that bind…
PCOS (Polycystic Ovary Syndrome)
PCOS is a common hormonal disorder where the ovaries produce too many male hormo…
Low Ovarian Reserve (Diminished Ovarian Reserve)
Low Ovarian Reserve means a woman has fewer eggs than expected for her age. It i…
AMH Test (Anti-Müllerian Hormone)
The AMH Test is a simple blood test that measures the level of Anti-Müllerian Ho…
FAQs about DHEAS
What is DHEAS in a fertility blood test?
DHEAS (dehydroepiandrosterone sulphate) is an androgen produced almost entirely by the adrenal glands. In a fertility blood panel, it helps identify whether androgen excess is of adrenal origin (elevated DHEAS) or ovarian origin (elevated LH-driven testosterone with normal DHEAS). Normal female range: 1.5–9.0 µmol/L (age-dependent). Elevated DHEAS >10–15 µmol/L warrants investigation for congenital adrenal hyperplasia or adrenal tumour.
What does elevated DHEAS mean in a woman with PCOS?
In PCOS, DHEAS is elevated in ~20–30% of cases — indicating a mixed adrenal + ovarian androgen pattern. Mildly elevated DHEAS (10–15 µmol/L) in PCOS does not indicate a separate adrenal pathology. However, very high DHEAS (>15 µmol/L) requires 17-OH progesterone testing to rule out non-classic congenital adrenal hyperplasia (NCCAH), which mimics PCOS but is treated with low-dose corticosteroids rather than OCP.
Should I take DHEA supplements before IVF?
DHEA supplementation (25–75 mg/day for 6–12 weeks before IVF) is used at many centres for poor ovarian responders (low AMH, high FSH, AFC <5). The proposed mechanism: DHEA increases intra-follicular androgen, which enhances FSH receptor sensitivity and promotes antral follicle recruitment. Evidence: multiple studies show modest improvement in egg numbers and some improvement in live birth rates in poor responders. Not appropriate for PCOS (already hyperandrogenic). Discuss with your IVF specialist.
What is congenital adrenal hyperplasia (NCCAH) and how is it different from PCOS?
Non-classic congenital adrenal hyperplasia (NCCAH) is a 21-hydroxylase enzyme deficiency causing excess adrenal androgen production. Clinically it mimics PCOS: irregular periods, hirsutism, anovulation. Distinguished from PCOS by: elevated 17-OH progesterone (>6 nmol/L fasting or >30 nmol/L post-ACTH stimulation) + elevated DHEAS + positive ACTH stimulation test. Treatment: low-dose prednisolone/dexamethasone to suppress adrenal androgens — NOT OCP + metformin (used in PCOS). Correct diagnosis is essential.
Is DHEA safe to take for fertility?
DHEA supplementation at 25–75 mg/day for a limited period (6–12 weeks) before IVF is generally well-tolerated. Side effects: mild androgenic symptoms (acne, oily skin, mild hair changes) — dose-dependent. Monitor with DHEAS blood test at 6 weeks to avoid over-supplementation (target DHEAS 5–8 µmol/L during treatment). Stop immediately on positive pregnancy test. Not recommended in: PCOS, women with active hyperandrogenism, or without specialist guidance.
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