DHEA-S: adrenal androgen number one
Dehydroepiandrosterone sulfate is the most abundant adrenal steroid and almost exclusively their product: the gonads contribute a negligible share. Its level is therefore read as a direct report on the adrenal cortex. The level predictably changes with age: a peak in youth, then a smooth decline, and laboratory references are broken down by age bands.
High DHEA-S with signs of androgen excess in a woman points to an adrenal source: this is how the picture of PCOS is separated from adrenal causes. Low DHEA-S together with low cortisol directs toward assessing adrenal insufficiency.
17-OH-progesterone: a step of cortisol synthesis
17-hydroxyprogesterone is an intermediate product on the cortisol synthesis pathway. When the enzyme of the next step works weakly (the classic variant is 21-hydroxylase deficiency), the step accumulates and spills into androgens. That is why the test is the main screen for congenital adrenal hyperplasia.
The test has accuracy rules: in women it is drawn in the morning in the early follicular phase of the cycle, because after ovulation the corpus luteum raises the level physiologically. A result against hormonal contraceptives reads differently — this is agreed with the clinician before the draw.
Testosterone, SHBG and the free fraction
Total testosterone is the sum of the bound and free fractions, and only the free one is active. The binding protein SHBG (sex hormone-binding globulin) changes the proportion: with high SHBG, total testosterone can look impressive while the free part is modest; with low SHBG, the reverse. The full picture therefore comes from a trio: total testosterone, SHBG and free testosterone or a calculated free androgen index.
In women, moderate androgen elevation is the territory of polycystic ovary syndrome guidelines: diagnostics rests on a combination of signs, and the laboratory helps separate the ovarian source from the adrenal one and exclude rare causes.
Cortisol: the adrenals' general background
Cortisol is the final hormone of the adrenal cortex with a daily rhythm: a morning maximum, a midnight minimum. A single level outside the time of day means almost nothing, so it is either drawn strictly in the morning or assessed with special tests the clinician assigns. In the androgen report cortisol is a control line: whether synthesis of the main hormone suffers while the androgen branch is overloaded.
Guidelines for primary adrenal insufficiency describe the opposite situation: low cortisol with characteristic complaints — weakness, skin darkening, salt craving. There the laboratory route is different, with ACTH and stimulation tests.
Rules for an accurate androgen block draw
- Morning, fasting: androgens and cortisol have a daily rhythm
- For women — the early follicular phase; the exact day is agreed with the clinician
- No intense workouts the day before
- Hormonal medications and contraceptives — reported before the draw
Markers covered in this article
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Frequently asked questions
How does DHEA-S differ from testosterone?
Why is 17-OH-progesterone drawn?
What does SHBG show?
Androgens are high in a woman — what next?
Why is cortisol drawn strictly in the morning?
DHEA-S declines with age — is that normal?
Sources
- DHEA-sulfate test: MedlinePlus Medical Encyclopedia — MedlinePlus, US National Library of Medicine. Accessed: August 31, 2026.
- 17-OH progesterone: MedlinePlus Medical Encyclopedia — MedlinePlus, US National Library of Medicine. Accessed: August 31, 2026.
- Polycystic ovary syndrome — clinical guideline context — Minzdrav of Russia (cr.minzdrav.gov.ru). Accessed: August 29, 2026.