The relation between adrenal steroid hormone imbalance, as quantified by the cortisol/dehydroepiandrosterone (DHEA) ratio, and hemoglobin concentrations was appraised in 92 men with stable chronic heart failure (CHF). The cortisol/DHEA ratio was independently and inversely associated with hemoglobin concentrations, suggesting that alterations of the steroid milieu may play a role in the pathogenesis of anemia in CHF.