What are the normal DHEA (Dehydroepiandrosterone) levels in a male with hyperandrogenism (elevated testosterone)?

Normal DHEA Levels in Males with Elevated Testosterone

In males with elevated testosterone, DHEA levels should be measured as part of the hyperandrogenism workup, with DHEAS >600 µg/dL suggesting an adrenal source, while normal DHEA/DHEAS levels point toward testicular or exogenous testosterone as the cause. 1, 2

Initial Diagnostic Approach

When evaluating a male with elevated testosterone, the workup should include:

• Measure morning total testosterone between 8 AM and 10 AM and repeat if elevated to confirm the finding 1
• Obtain DHEAS assay when testosterone is twice the upper limit of normal 2
• Measure LH and FSH to distinguish primary testicular from secondary pituitary-hypothalamic causes 1
• Check free testosterone by equilibrium dialysis and SHBG, especially in obese patients 1

Interpreting DHEA/DHEAS Levels

The pattern of DHEA elevation helps identify the source of hyperandrogenism:

• DHEAS >600 µg/dL indicates an androgen-secreting adrenal cortical adenoma as the primary diagnosis 2
• Normal DHEAS with elevated testosterone suggests either ovarian hyperthecosis (in females), androgen-secreting ovarian tumor, or exogenous testosterone use 2
• In males specifically, normal DHEA with elevated testosterone most commonly indicates testicular overproduction or exogenous testosterone administration 1, 3

Normal Reference Ranges

Understanding baseline DHEA physiology is critical:

• In healthy adults aged 50-65 years, baseline DHEA and DHEAS levels are typically at or below the lower range of young adult levels 4
• A 100 mg daily dose of DHEA supplementation restores serum DHEA to young adult levels and DHEAS to levels at or slightly above the young adult range 4
• The DHEAS/cortisol ratio increases to pubertal levels (10:1) with DHEA supplementation 4

Gender-Specific Responses

Males and females respond differently to elevated androgens:

• In men receiving DHEA supplementation, serum androstenedione, testosterone, and DHT show minimal changes, unlike in women where these increase above young adult ranges 4
• Men with naturally elevated endogenous testosterone levels (>800 ng/dL) show no significant clinical morbidity compared to men with normal testosterone (300-800 ng/dL) 5
• Only 4% of men not on testosterone therapy have testosterone levels >800 ng/dL 5

Clinical Implications

The clinical significance of elevated testosterone with normal DHEA includes:

• Elevated testosterone with normal DHEA suggests the testosterone elevation is not adrenal in origin 2
• This pattern warrants investigation for exogenous testosterone use, testicular tumors, or hCG administration 1, 3
• Male hypertestosteronemia (defined as plasma testosterone >13 ng/mL or ~1300 ng/dL) requires etiological investigation even in apparently eugonadal men 3

Additional Monitoring Considerations

When elevated testosterone is confirmed:

• Measure serum prolactin, particularly with low or low-normal LH levels 1
• Check hemoglobin/hematocrit as baseline, though men with elevated endogenous testosterone show only modest hematocrit increases (regression coefficient 1.30,95% CI 0.69-1.90) that are not clinically significant 1, 5
• In men over 40, measure PSA and perform digital rectal examination 1
• Assess for cardiovascular risk factors including dyslipidemia, hypertension, and diabetes 1

Common Pitfalls

Critical considerations to avoid diagnostic errors:

• Elevated testosterone with markedly elevated SHBG may result from medications with estrogenic effects (tamoxifen, raloxifene), hyperthyroidism, or liver disease rather than true hyperandrogenism 2
• Normal DHEA does not exclude pathology—it simply localizes the source away from the adrenal glands 2
• For men interested in fertility, avoid testosterone therapy as it suppresses spermatogenesis 1