Cortisol : DHEA-S

Introduction

The human body relies on a delicate balance of hormones to maintain homeostasis and optimal health. Among these, the Cortisol : DHEA-S Ratio is a crucial biomarker reflecting adrenal function and stress resilience. As a functional medicine nurse practitioner practicing autonomously in Florida, I emphasize the importance of understanding this ratio and its role in conditions like adrenal stress, immune dysfunction, metabolic syndrome, cognitive decline, and muscle atrophy/breakdown.

Background: Cortisol and DHEA-S

Both cortisol and DHEA-S are produced by the adrenal glands. Cortisol—the “stress hormone”—regulates metabolism, blood pressure, and immune response. DHEA-S is the sulfated form of DHEA, serving as a precursor to sex hormones. Normally, DHEA-S circulates at 5–10× the level of cortisol.

The Cortisol to DHEA-S Ratio

This ratio shifts with age, chronic stress, and illness. A higher cortisol : DHEA-S ratio often signals:

• Adrenal Stress and potential adrenal fatigue
  
• Immunosuppression, increasing infection risk
  
• Metabolic Syndrome, including hypertension and dysglycemia
  
• Cognitive Dysfunction, with memory and mood impacts
  
• Sarcopenia, due to cortisol’s catabolic effect

   

Clinical Implications

Stress and Adrenal Health

An elevated ratio indicates HPA-axis dysregulation, where pregnenolone is diverted from DHEA production to cortisol synthesis.

Immune Function

Since cortisol suppresses and DHEA-S supports immunity, a high ratio correlates with poor immune resilience and higher infection rates.

Metabolic Syndrome

Patients with metabolic syndrome often exhibit a higher ratio, linking it to insulin resistance and cardiovascular risk.

Cognitive Dysfunction

Chronic cortisol excess is neurotoxic, contributing to memory decline, while DHEA-S provides neuroprotective effects.

Aging and Sarcopenia

Age-related decline in DHEA-S, combined with stable cortisol levels, leads to muscle wasting and mood disturbances.

Interfering Factors

• Lifestyle: Poor sleep, inactivity, and unhealthy diet
  
• Medications: Glucocorticoids raise cortisol; hormone therapies may alter DHEA-S

   

Drug Associations

• Glucocorticoids ↑ cortisol levels
  
• Adrenal support therapies and HRT → optimize cortisol : DHEA-S balance

   

Managing the Ratio

Lifestyle interventions are first-line:

• Regular exercise, especially aerobic
  
• Stress reduction (mindfulness, yoga)
  
• Quality sleep
  
• Balanced nutrition

   

When necessary, tailor pharmacologic or supplemental support under professional guidance.

Conclusion

The Cortisol to DHEA-S Ratio is a powerful biomarker in functional medicine, guiding personalized strategies for stress management, immune health, metabolic balance, and healthy aging. As a functional medicine practitioner, I integrate this ratio into a holistic care plan, addressing root causes and empowering patients to achieve optimal resilience and vitality. You may also be interested in our medical weight loss programs to support metabolic health.

Further Reading

1. Kamin HS, Kertes DA. Cortisol and DHEA in Relation to Immune Function: A Review. Brain Behav Immun. 2017;64:200–211. https://pubmed.ncbi.nlm.nih.gov/28319700
   
2. Phillips AC, et al. Cortisol, DHEA, and Aging in the Vietnam Experience Study. Psychoneuroendocrinology. 2010;35(6):948–957. https://pubmed.ncbi.nlm.nih.gov/20005168
3. Yanagita I, et al. Cortisol : DHEA-S Ratio and Sarcopenia in Older Adults with Type 2 Diabetes. Endocr J. 2019;66(11):949–960. https://pubmed.ncbi.nlm.nih.gov/31558608