What does it measure?
The calculation divides DHEA-S by cortisol using a defined unit convention. Researchers have explored related ratios in stress and mental-health studies. The measurements come from different hormone processes, and their relationship varies with age, sampling time, and the study setting. [1]
Before reading the calculation
- Inputs
- Calculated from DHEA-S and cortisol. Record the specimen type, collection time, units, and ratio direction.
- Timing
- A morning blood value should not be compared directly with an evening or saliva-based calculation.
What can the result mean?
A lower ratio may result from lower DHEA-S, higher cortisol, or both. A higher ratio has the opposite possibilities. Neither direction provides a validated personal score for resilience, recovery, or adrenal reserve. Findings in a selected research group do not establish a treatment target. [2]
Calculated from DHEA-S and cortisol. Record the specimen type, collection time, units, and ratio direction.
- Timing
- A morning blood value should not be compared directly with an evening or saliva-based calculation.
When is it useful, and how is it read?
The calculation may appear in research, but symptoms such as fatigue need their own clinical assessment. If adrenal disease is suspected, clinicians use the appropriate hormone tests and, when indicated, stimulation or suppression testing rather than treating this ratio as the answer. [2] [3] [4] [7]
What can affect it?
Cortisol changes substantially through the day, while DHEA-S is strongly age-dependent. Blood and saliva results, or a cortisol-to-DHEA-S ratio reported in the reverse direction, are not interchangeable. Steroid medicines, illness, and supplements can further affect interpretation. [1]
This is not a validated stress score
A ratio studied during a particular stress task cannot measure how much everyday stress your body can handle. It also cannot diagnose “adrenal fatigue,” a label without an established diagnostic basis. [1] [2]
Questions you might have
Can the ratio diagnose adrenal fatigue?
No. Adrenal fatigue is not an established medical diagnosis, and this calculation does not validate it. [2]
Why keep the cortisol result and time beside the ratio?
Cortisol changes through the day. The ratio can change because cortisol changed, so the original value and timing matter. [5]
What comes next?
If fatigue or stress is affecting daily life, start with your symptoms, sleep, medicines, and a clinical assessment. Suspected adrenal disease needs established hormone tests chosen by a clinician. The Endocrine Society states that “adrenal fatigue” is not a scientifically established medical condition. [2]
Is there an established test that better answers the concern behind this ratio?
The reference interval and units on your report are part of understanding your result. Understand units, reference intervals, and treatment targets.
Sources & references
Medical references & original research
- DHEA, DHEAS, cortisol, and performance during underwater navigation stress (2009)
- Endocrine Society — Adrenal Fatigue
- NIDDK — Diagnosis of Adrenal Insufficiency & Addison’s Disease
- Endocrine Society — Diagnosis of Cushing’s Syndrome Guideline Resources
- MedlinePlus — Cortisol Test
- MedlinePlus — Dhea Sulfate Test
Books we consulted
References that informed our explanations of the test and its context.
- Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic and Laboratory Test Reference. 14th ed. Elsevier; 2019.
Practical-section sources accessed: .
For general health education. Interpreting your result and deciding on tests or treatment requires your health context and a qualified clinician.
