DHEA-S vs cortisol — what do they each tell you about adrenal function?

Full answer

Cortisol and DHEA-S both come from the adrenal cortex but reflect different axes. Morning serum cortisol captures the HPA (hypothalamic-pituitary-adrenal) stress axis output at the start of the day and is the standard initial screen for adrenal insufficiency and hypercortisolism. DHEA-S, the sulfated long-lived form of DHEA, reflects the adrenal androgen pathway and is a stable marker of adrenal androgen reserve — it peaks in the 20s and declines steadily with age. Many functional and longevity frameworks track the cortisol-to-DHEA-S ratio as a rough index of 'adrenal resilience' or stress load: a relatively high cortisol with a relatively low DHEA-S is interpreted as a chronic-stress pattern. Provider review reads both alongside clinical context, sleep, training load, and the broader hormonal panel — never in isolation.

Educational. Not a substitute for individualized provider review.