The DHEA/7-Keto DHEA Ratio: A Functional Medicine Perspective

If you’ve been battling unexplained weight gain, low energy, or persistent hormonal imbalances—whether it’s signs of early aging, PCOS, or thyroid dysfunction—you’re likely searching for answers. 

You might be experiencing stubborn belly fat that won’t budge, mood swings, acne, or even thinning hair. These symptoms can feel frustrating and isolating, especially when you’ve tried everything from diet changes to exercise and still haven’t found relief.

One of the key factors contributing to these issues may be a hormonal imbalance, particularly involving your adrenal health. The DHEA/7-Keto DHEA ratio is an often overlooked but important marker that could shed light on your hormone balance in a deeper way. 

The balance between DHEA (Dehydroepiandrosterone) and its metabolite 7-Keto DHEA plays a role in maintaining hormonal health, metabolism, and overall well-being. 

Testing this ratio can offer valuable insight into hormone balance that can otherwise go unnoticed, and how issues here impact your hormone levels, metabolism, and overall well-being.

In this article, we’ll explore the functions of DHEA and 7-Keto DHEA, the importance of their ratio, and how functional medicine practitioners use lab testing to assess and address imbalances.

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What is DHEA?

DHEA is an important hormone that has downstream effects on many other hormones, including estrogen and testosterone.

Functions of DHEA in the Body

DHEA is a steroid hormone produced primarily by the adrenal glands, although smaller amounts are made in the ovaries and testes. It is a precursor to other important sex hormones including estrogen and testosterone. 

DHEA plays a critical role in regulating energy levels, mood, immune function, and overall health. It's often called the "mother hormone" because it is converted into other vital hormones based on the body's needs. 

DHEA levels naturally decline with age, starting at around age 30, which may play a role in symptoms of perimenopause, menopause, and andropause in men.

DHEA is also considered a neurosteroid because it has actions inside the brain. 

DHEA Levels and Aging

DHEA levels peak in early adulthood and naturally decline as we age. By the time most individuals reach their 70s or 80s, DHEA levels may be only 10-20% of what they were during their 20s. 

This decline is linked to various aging processes including reduced vitality, weakened immune function, and a decrease in muscle mass and bone density. 

In functional medicine, practitioners often monitor DHEA levels to assess adrenal health, hormone balance and resiliency, particularly in individuals dealing with fatigue, stress, or age-related hormonal changes.

DHEA: An Important Neurosteroid

DHEA is also a neurosteroid, meaning a steroid hormone that has important actions in the brain.

DHEA works in the brain to help with memory and learning. It affects brain chemicals like GABA and NMDA, which are important for controlling mood and keeping the brain healthy. 

Research shows that DHEA can protect the brain, improve memory, and support learning. It may also play a role in conditions like depression, anxiety, and Alzheimer’s disease, where memory and thinking skills are affected. 

By helping certain brain pathways work better, DHEA could be useful in treating memory problems or improving overall brain health.

What is 7-Keto DHEA?

7-Keto DHEA is a metabolite of DHEA with important effects on human metabolism.

Functions of 7-Keto DHEA in the Body

While 7-Keto DHEA is a metabolite of DHEA, it does not convert into sex hormones. 

Instead, 7-Keto DHEA is known for its role in boosting metabolism, supporting fat loss, and enhancing immune function. It is often used in supplements aimed at weight loss and healthy aging because it can help increase the body's resting metabolic rate. 

7-Keto DHEA has been shown to improve thyroid function, which is part of its action in metabolic support.

While 7-Keto DHEA has been shown to boost metabolism and aid weight loss, it may be most effective in overweight or obese people when combined with exercise and calorie restriction. 

Differences Between DHEA and 7-Keto DHEA

While DHEA directly influences hormone production, 7-Keto DHEA’s primary role is metabolic. 

DHEA can be converted to estrogen and testosterone which can impact mood, libido, and energy, whereas 7-Keto DHEA is better suited for individuals looking to enhance metabolic function without influencing their hormone levels. 

This distinction is essential when considering treatments or supplements, as DHEA may not be appropriate for individuals with hormone-sensitive conditions like certain cancers, while 7-Keto DHEA may be a safer alternative.

The Importance of the DHEA/7-Keto DHEA Ratio

The DHEA/7-Keto DHEA ratio can inform hormone conversion and balance: how much DHEA is converted to 7-keto DHEA, and how much is converted to testosterone and estrogen?

Why Balance Between DHEA and 7-Keto DHEA Matters

The DHEA/7-Keto DHEA ratio is an important marker in functional medicine because it reflects both hormonal and metabolic health. A balanced ratio supports healthy aging, hormone balance, energy production, and weight management. 

An imbalance—whether it leans toward too much DHEA or too much 7-Keto DHEA—may signal underlying metabolic or hormone imbalances.

For example, high levels of DHEA relative to 7-Keto DHEA may indicate acute stress, DHEA supplementation, or an increased risk of estrogen- or testosterone-related conditions. 

Extra DHEA may be converted to testosterone and estrogen, which can alter the balance of overall hormone health. For example, excessive testosterone can contribute to conditions such as androgen excess or PCOS in women, and may increase the risk of certain cancers, cardiovascular disease, and hair loss in men.

Understanding the relative functions of DHEA and 7-keto DHEA aids in interpreting this ratio. 

Functional Medicine Lab Testing for DHEA and 7-Keto DHEA

Some companies contain the following tests as part of a comprehensive hormone panel. One example is the Saliva Steroid LC/MS Profile 23 by ZRT Laboratory.

DHEA-S (DHEA Sulfate) Test

The DHEA-S test measures the sulfate form of DHEA, which is the most stable and abundant form of the hormone in the blood. 

DHEA-S can be tested in blood, urine, or saliva.

This test is used to assess adrenal function, hormone production, and to detect imbalances that may contribute to fatigue, hormonal disorders, or age-related conditions.

7-Keto DHEA Testing
While less commonly tested than DHEA-S, 7-Keto DHEA testing is valuable for assessing metabolic health, particularly in individuals struggling with weight management or age-related metabolic decline. 

7-Keto DHEA levels can be tested in blood or saliva.

This test helps clinicians understand whether low metabolism or poor thermogenesis (heat generation, a side effect of metabolism) might be contributing to weight gain or fatigue.

When to Order The DHEA/7-Keto DHEA Ratio

Functional medicine practitioners may choose to assess both DHEA and 7-keto DHEA in certain settings:

Adrenal Function Testing

If a patient presents with chronic fatigue, low energy, or signs of adrenal burnout, testing DHEA levels can provide insight into adrenal health. 

High DHEA may indicate overactive adrenal glands, while low levels could point to adrenal insufficiency. Addressing adrenal function is often a critical step in restoring energy levels and managing stress-related hormonal issues.

7-Keto DHEA levels may provide indirect information into the person’s metabolic status and thyroid function, providing insight into causes of fatigue. 

Metabolic and Weight Issues

For patients struggling with unexplained weight gain, difficulty losing weight, or metabolic syndrome, DHEA and especially 7-Keto DHEA testing can be particularly helpful. 

DHEA promotes mitochondrial health (mitochondria are our cells’ energy factories), especially as people age. 

DHEA improves how mitochondria produce energy by increasing oxygen use and ATP production in older cells. It shifts the body's energy process from less efficient anaerobic methods to more efficient aerobic (oxygen-using) pathways, helping cells generate more energy.

Since 7-Keto DHEA can promote fat metabolism, an imbalance may contribute to stubborn weight issues. Identifying and correcting this imbalance through supplementation alongside lifestyle changes can support weight loss and improve metabolic health.

Hormonal Imbalances

In patients experiencing hormonal shifts related to menopause, andropause, or conditions like PCOS, especially those who have not found relief with treatments, testing DHEA and assessing the DHEA/7-Keto DHEA ratio can target treatment decisions. 

Balancing hormones naturally through functional medicine approaches may alleviate symptoms like mood swings, weight gain, or irregular cycles. Functional medicine practitioners often focus on addressing the root cause of these hormonal shifts, and understanding the metabolism of DHEA can be a valuable tool in that process.

Thyroid Hormone Issues

Patients with hypothyroidism who are not responding as expected to medications may also benefit from knowing their DHEA and 7-Keto DHEA levels. 

Hypothyroidism often impacts adrenal health and can lead to low DHEA, or possibly an imbalance in the DHEA/7-Keto DHEA ratio. This imbalance can further complicate weight management, fatigue, and hormone-related symptoms. 

Supplementing with 7-Keto DHEA may help optimize metabolism and improve T3 levels without influencing TSH or T4 levels, improving overall energy and well-being for those with thyroid disorders.

How to Interpret the DHEA/7-Keto DHEA Ratio

Interpretation of the DHEA/7-Keto DHEA ratio should always be done within the context of a person’s overall health history, symptoms, and a comprehensive hormone assessment.

What a High DHEA/7-Keto DHEA Ratio May Mean

A high DHEA relative to 7-Keto DHEA may indicate:

• Elevated adrenal function, potentially linked to stress, a tumor, or adrenal hyperplasia, which can increase DHEA levels

• DHEA supplementation

• Hormonal imbalances including high testosterone or estrogen, which could contribute to conditions like acne, hair loss, or menstrual irregularities

• Increased risk for hormone-sensitive conditions, such as breast or prostate cancer, especially in individuals supplementing with DHEA

What a Low DHEA/7-Keto DHEA Ratio Might Mean

A lower ratio of DHEA to 7-Keto DHEA may suggest:

• Possible adrenal insufficiency, where the body is no longer producing sufficient DHEA.

• Metabolic issues including poor fat metabolism or thermogenesis, contributing to weight gain or insulin resistance.

• Age-related declines in both DHEA and 7-Keto DHEA leading to symptoms like fatigue, muscle loss, or cognitive decline.

Clinical Applications and Treatment Options

When addressing an imbalanced ratio, functional medicine practitioners may recommend a combination of lifestyle interventions, supplements, and hormone therapies.

How to Correct an Imbalanced DHEA/7-Keto DHEA Ratio

• For a high DHEA/7-Keto DHEA ratio: reducing stress through mindfulness, exercise, and sleep optimization can help normalize adrenal function. In some cases, reducing DHEA supplementation may be necessary.

• For a low DHEA/7-Keto DHEA ratio: supplementing with DHEA may help restore balance, but this should be done under medical supervision due to the hormone’s effects on estrogen and testosterone.

Supplements to Support DHEA/7-Keto DHEA Balance

Supplementation with DHEA or 7-keto DHEA should be done under medical guidance. 

• DHEA Supplements: for patients with low DHEA levels, supplementing with DHEA can support adrenal health, energy, and hormone balance. However, caution is needed, especially in individuals with hormone-sensitive conditions.

• 7-Keto DHEA Supplements: this supplement may help those needing metabolic support without the hormonal effects of DHEA. It has been shown to increase metabolism and may promote weight loss in conjunction with diet and exercise, particularly in overweight people.

Lifestyle Modifications

• Stress Management: chronic stress depletes DHEA levels, so stress reduction through meditation, yoga, or therapy is essential for adrenal health.

• Diet and Exercise: a diet rich in whole foods, combined with regular exercise, supports healthy hormone levels and metabolism.

Other Functional Medicine Tests to Consider Alongside DHEA/7-Keto DHEA Testing

The following tests may be considered alongside the DHEA/7-keto DHEA ratio for a more comprehensive understanding of hormonal and metabolic health. 

Comprehensive Hormone Panel

Assessing a wide range of hormones including cortisol, estrogen, testosterone, and progesterone provides a thorough understanding of adrenal and hormonal health. 

This testing is essential for identifying imbalances that may contribute to symptoms like fatigue, mood swings, acne, or weight gain, guiding more precise treatment strategies.

Adrenal Stress Index (ASI) Testing

ASI testing evaluates cortisol levels throughout the day, offering insights into how well the adrenal glands are functioning. 

Since DHEA is produced in the adrenal glands, testing both DHEA and cortisol through an ASI helps to uncover patterns of adrenal fatigue, stress response, and the overall health of the hypothalamic-pituitary-adrenal (HPA) axis.

Cortisol Awakening Response (CAR) Testing

The cortisol awakening response is a specific type of cortisol test that measures the spike in cortisol upon waking. This test is especially useful when assessing HPA axis function in conjunction with DHEA levels, helping to pinpoint long-term adrenal fatigue, chronic stress, or other dysfunctions.

Organic Acids Testing

Organic acids testing provides a detailed look at metabolic function by measuring biochemical byproducts found in urine. 

This test helps uncover nutrient deficiencies, mitochondrial dysfunction, and imbalances in neurotransmitter production, all of which can impact adrenal health and hormone production, including DHEA and 7-Keto DHEA.

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Key Takeaways

• The DHEA/7-Keto DHEA ratio informs hormone health, metabolism, and weight management, making it important to test this ratio for better insight into underlying imbalances.

• DHEA is essential for hormone production, energy, and mood regulation, while 7-Keto DHEA boosts metabolism and supports fat loss without influencing sex hormones.

• Functional medicine practitioners use the DHEA/7-Keto DHEA ratio to assess adrenal and metabolic health, which can guide personalized treatment for conditions like unexplained weight gain, fatigue, and hormonal imbalances.