What is the normal reference range for Dehydroepiandrosterone (DHEA) levels in the blood?

Normal Reference Ranges for DHEA in Blood

The normal reference range for DHEA-sulfate (DHEAS) varies by age and sex, with levels typically declining with age from peak values in the 20s-30s to approximately 10-20% of those values by the 8th-9th decades of life.

Age and Sex-Specific Reference Ranges

• DHEAS levels follow a characteristic pattern throughout life:

  • Decline rapidly during the first year of life and remain at minimum levels for about 5 years 1
  • Begin to increase significantly from ages 6-7 years 1
  • Reach maximum levels in women at approximately age 24 and in men at about age 30 1
  • Decline progressively thereafter, with a more rapid decline after ages 50-60 1

• Gender differences in DHEAS levels:

  • Men typically maintain 30-50% higher DHEAS levels than women throughout adulthood 2
  • This gender difference persists even into advanced age, though the gap narrows 1

Specific Reference Values

• For young adults (20s-30s):

  • Peak levels occur in this age range 3
  • Men generally have higher values than women 1

• For middle-aged adults (40s-50s):

  • Levels begin to decline more noticeably 1
  • The decline is more pronounced in men than women 2

• For older adults (60+ years):

  • Levels decrease to approximately 10-20% of young adult values 2
  • Lower DHEAS levels in elderly men (but not women) have been associated with increased short-term mortality 2

Measurement Considerations

• DHEAS circulates in the blood mostly bound to albumin with a small unbound fraction 4
• DHEAS has a much slower clearance rate than unconjugated DHEA (MCR of ~13L/day vs ~2000L/day) 4
• DHEA and DHEAS interconvert in the body - about 6% of DHEA re-enters the blood as DHEAS, while 60-70% of DHEAS re-enters as DHEA 4

Clinical Implications

• When interpreting DHEAS levels, consider:

  • Age-specific reference ranges are essential for proper interpretation 3
  • Quantile regression methods may provide more accurate reference ranges than linear regression methods 3
  • DHEA and DHEAS measurements are not interchangeable due to their different metabolism and age-related patterns 1

• In specific populations:

  • For transgender and gender-diverse individuals on gender-affirming hormone therapy (GAHT), laboratory values should be interpreted in the context of their GAHT regimen 5
  • For individuals on GAHT for more than 1 year, many laboratory values should be interpreted based on their affirmed gender 5

Measurement Methods

• Different assay methods may yield different results:
  • Direct immunoassays: Sensitivity 0.67 (95% CI: 0.48-0.82), Specificity 0.70 (95% CI: 0.46-0.86) 5
  • LC-MS/MS methods: Sensitivity 0.82 (95% CI: 0.59-0.93), Specificity 0.57 (95% CI: 0.25-0.84) 5