In premenopausal women about half of the androstenedione is derived from the ovaries and the other half from the adrenals. At menopause, most of the androstenedione derives from DHEA(S) produced by the adrenal glands. DHEA is synthesized in the adrenal glands and is rapidly sulfated to DHEA-sulfate (DHEAS) to extend its half-life in blood. Androstenedione, the down-stream metabolite of DHEA, is further converted into testosterone and Epi-testosterone in near equal amounts in most individuals, or into estrone. More conversion to the estrogen, estrone, occurs in individuals with higher amounts of adipose (fat) tissue.

Low levels of these androgen precursors are associated with self-reported symptoms of low androgens. DHEA is commonly used as a supplement to raise testosterone levels in women. If low androgen symptoms persist, consider supplemental DHEA to raise testosterone levels, particularly if testosterone, or its down-stream and more potent metabolite DHT, are within mid range or lower.

- Elevated androstenedione levels can cause symptoms or signs of hyperandrogenism in women.

- Significant elevations of androstenedione may be indicative of androgen-producing adrenal or gonadal tumors.

DHEA(S), as well as its down-stream metabolites, androstenedione and testosterone, is more commonly found to be elevated in women with insulin resistance and polycystic ovarian syndrome (PCOS). These individuals usually have higher levels of insulin and LH (LH/FSH ratio is usually > 2.5 in 75% of women with PCOS), which stimulates high adrenal synthesis of DHEA(S), and high ovarian synthesis of testosterone.