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What is the Cortisol:DHEA-S Ratio?

Your adrenal glands sit atop your kidneys and serve as powerful regulators of your body’s stress response. Two of the most important hormones they produce are cortisol, your primary stress hormone, and DHEA-S (dehydroepiandrosterone sulfate), an anabolic hormone that helps build resilience. The cortisol:DHEA-S ratio provides a critical lens into how your body balances breakdown and repair.

Why This Ratio Matters

Both cortisol and DHEA-S play essential roles, but they operate in opposite directions:

  • Cortisol is catabolic, breaking down tissue for immediate energy during stress.
  • DHEA-S is anabolic, supporting tissue repair, immune function, and mood stability.

Maintaining balance between the two is key. When cortisol is consistently high and DHEA-S declines (as it does with age or chronic stress), the cortisol:DHEA-S ratio increases, tipping the body toward a catabolic, inflammation-prone state. This imbalance is associated with fatigue, poor recovery, mood issues, immune dysfunction, and even premature aging.

How the Ratio Is Measured

The cortisol:DHEA-S ratio is calculated by dividing your morning fasting cortisol (measured in µg/dL) by serum DHEA-S (also in µg/dL). Because DHEA-S has a stable daily rhythm and cortisol peaks in the morning, early morning blood draws offer the most consistent results.

Example:

If your cortisol is 8 µg/dL and DHEA-S is 160 µg/dL, your ratio is 0.05.

What Does a Healthy Cortisol:DHEA-S Ratio Look Like?

The following interpretation ranges are based on research in healthy adult populations and linked to physiological aging and stress adaptation:

  • Optimal (0.03–0.07): Strong anabolic dominance, robust stress resilience
  • Good (0.07–0.10): Healthy adrenal balance in mid-life
  • Fair (0.10–0.14): Declining DHEA-S or elevated cortisol; early signs of stress load
  • Pay Attention: >0.14 (high cortisol dominance) or <0.02 (possible adrenal suppression or excessive DHEA-S)

 

Why These Cutoffs Matter

  • Ratios above 0.14 have been associated with increased risk of sarcopenia, metabolic syndrome, and immune dysfunction.
  • Ratios below 0.02, while rare, may reflect suppressed cortisol or excessive DHEA-S (e.g., from supplementation).

The Science Behind the Ratio

Aging and Hormonal Shift

DHEA-S levels peak in your 20s and decline by over 80% by your 70s, while cortisol stays relatively constant. This causes the cortisol:DHEA-S ratio to increase naturally with age, contributing to a more catabolic internal environment.

Chronic Stress and Burnout

Studies show that individuals with chronic stress or PTSD often have elevated cortisol:DHEA-S ratios. A high ratio indicates the body is prioritizing short-term survival over long-term repair. Over time, this can lead to inflammation, reduced immunity, and cognitive decline.

Metabolic and Immune Implications

Elevated cortisol:DHEA-S has been linked to:

  • Increased insulin resistance
  • Abdominal fat accumulation
  • Higher blood pressure
  • Reduced muscle mass and strength
  • Lower immune cell activity

How to Improve Your Cortisol:DHEA-S Ratio

Improving your ratio means lowering excessive cortisol or raising low DHEA-S, ideally both. Here are evidence-backed strategies:

1. Manage Stress Effectively

  • Meditation, breathwork, and yoga have been shown to reduce cortisol levels.
  • Short mindfulness sessions (10–15 min/day) can make a measurable difference.

2. Optimize Your Sleep

  • Prioritize 7–9 hours of high-quality sleep.
  • Poor sleep increases cortisol and decreases DHEA-S.
  • Stick to consistent sleep/wake times and reduce blue light exposure at night.

3. Exercise Smart

  • Moderate-intensity exercise (e.g., walking, cycling) supports hormonal balance.
  • Excessive high-intensity training can elevate cortisol long-term. Recovery is key.

4. Nutrition for Hormonal Health

  • Eat balanced meals with adequate protein, healthy fats, and complex carbs.
  • Include nutrients that support adrenal health: vitamin C, magnesium, zinc, and B vitamins.
  • Avoid frequent spikes in blood sugar and limit stimulants like caffeine.

5. Consider Adaptogens (With Medical Supervision)

  • Ashwagandha and rhodiola have been shown to modulate cortisol responses.
  • DHEA supplementation may be appropriate for some individuals under professional guidance, especially in cases of low DHEA-S.

Why This Ratio Deserves Your Attention

The cortisol:DHEA-S ratio is a powerful reflection of how your body is navigating the demands of modern life. High cortisol paired with low DHEA-S tips the scale toward inflammation, aging, and burnout. A low ratio, on the other hand, supports resilience, muscle preservation, and immune function.

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