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.
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.
This ratio shifts with age, chronic stress, and illness. A higher cortisol : DHEA-S ratio often signals:
An elevated ratio indicates HPA-axis dysregulation, where pregnenolone is diverted from DHEA production to cortisol synthesis.
Since cortisol suppresses and DHEA-S supports immunity, a high ratio correlates with poor immune resilience and higher infection rates.
Patients with metabolic syndrome often exhibit a higher ratio, linking it to insulin resistance and cardiovascular risk.
Chronic cortisol excess is neurotoxic, contributing to memory decline, while DHEA-S provides neuroprotective effects.
Age-related decline in DHEA-S, combined with stable cortisol levels, leads to muscle wasting and mood disturbances.
Lifestyle interventions are first-line:
When necessary, tailor pharmacologic or supplemental support under professional guidance.
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.
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