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On October 24, 2019, after the 2019–20 season opener, Ayton was suspended for 25 games after testing positive for a diuretic, violating the league's anti-drug policy. He returned from his suspension on December 17 against the Los Angeles Clippers, putting up 18 points and 12 rebounds in a 120–99 loss. Ayton was later immediately sidelined for the next five games due to a sprained right ankle before returning again, this time coming off the bench, on December 30 in a 122–116 win over the Portland Trail Blazers. He returned as a starter proper, albeit as a power forward, on January 3, 2020 in a 120–112 win over the New York Knicks. After a few more games, Ayton became the team's starting center again on January 16. That night, he scored 26 points and grabbed a career-high 21 rebounds in a 121–98 win over the Knicks. He became the first Suns player since Steve Nash to put up a 20/20 kind of game for the team (first player since Amar'e Stoudemire in terms of points and rebounds specifically), as well as the youngest player to have 25+ points and 20+ rebounds in the Madison Square Garden. On January 28, Ayton scored a season-high 31 points in a 133–104 win over the Dallas Mavericks. Two days later, Ayton was announced to return to the Rising Stars Challenge for the World Team; he joined only Amar'e Stoudemire and Devin Booker as announced participants in the event for the Suns as both a rookie and sophomore, though he would not play due to a left ankle injury, eventually being replaced by Nicolò Melli. On February 8, Ayton scored 28 points and grabbed 19 rebounds in a loss to the Denver Nuggets. He became the quickest player in franchise history to reach 1,000 rebounds at 94 games, as well as the fourth-quickest player to reach 1,000 since 1992. Ayton later matched his performance of 28 points and 19 rebounds on February 22 in a 112–104 win over the Chicago Bulls.

In the days after Hurricane Dorian struck the Bahamas, Ayton donated $100,000 to various relief efforts and held a relief drive on September 10, 2019 to collect further supplies and donations to give to those affected by the hurricane.

On February 23, 2018, a reported FBI wiretap revealed Arizona's head coach, Sean Miller, allegedly talked with Christian Dawkins (a key figure involved in the 2017–18 NCAA Division I men's basketball corruption scandal) to discuss paying Ayton $100,000 to allow him to enter the university, with the monetary situation being dealt with directly to him. While Miller would not be coaching the next game a day later against Oregon (assistant coach Lorenzo Romar would replace Miller that night), Ayton would still be allowed to play that day as the starting center. In that game, Ayton would record 28 points, 18 rebounds, and 4 blocks in the overtime loss to Oregon. The wiretapped conversation reportedly occurred in 2016, when Ayton was still attending the Hillcrest Prep Academy. Later on October 11, 2018, a government official revealed a now-former Adidas consultant named T.J. Gassnola paid a currently unknown amount of money to Ayton's family via Christian Dawkins in order to attend some Adidas sponsored programs. On May 2, 2019, federal prosecutors played a wiretapped call from June 20, 2017 between Dawkins and former assistant coach Emanuel Richardson that Miller was paying Ayton $10,000 per month while enrolled at Arizona.

On March 3, 2018, after their last regular season home game against California, where he'd record 26 points and a career-high 20 rebounds in a 66–54 win over California, head coach Sean Miller honored Ayton, as well as underclassmen Rawle Alkins and Allonzo Trier, with confirmations that they'd all be entering the 2018 NBA Draft at the end of this season. On March 9, Ayton would record a career-high 32 points with 14 rebounds in a 78–67 overtime win against UCLA. He'd tie that career high for points the next day alongside grabbing 18 rebounds in the Pac-12 Championship game against USC, where the Wildcats won 75–61. Ayton would be named the Pac-12 Tournament's Most Outstanding Player during the event. At the end of the regular season, Ayton was named both the Pac-12's Player of the Year and Freshman of the Year, as well as become a member of the All-Pac-12 first team (in terms of both regular voting and voting through the Associated Press) and be named the winner of the Karl Malone Award. He was also voted a consensus first-team All-American. Furthermore, Ayton was one of three freshman to be a part of the All-American First Team, joining Marvin Bagley III and Trae Young for the most consensus freshmen First Team members in a season.

Following Arizona's upset loss to the University at Buffalo in the Round of 64 of the 2018 NCAA Men's Basketball Tournament, Ayton announced his intention to forgo his final three seasons of collegiate eligibility and declare for the 2018 NBA draft, where he was expected to be a top-tier lottery selection, if not the potential #1 draft pick. On April 26, 2018, Ayton announced he signed with agent Nima Namakian of BDA Sports.

On June 21, 2018, the Phoenix Suns selected Ayton with the first overall pick in the 2018 NBA draft. He was the franchise's first No. 1 pick in their history. Never before had the player picked with the first overall selection gone to a team from the state where he played in high school and college before entering the NBA. Ayton joined the 2018 NBA Summer League Suns squad on July 1, 2018, signing his rookie-scale contract five days later. In his Summer League debut on July 6, Ayton recorded 10 points and 8 rebounds in a 92–85 win over the Dallas Mavericks. At the end of the event, Ayton averaged a double-double of 14.5 points and 10.5 rebounds in four games played and named a member of the All-Summer League Second Team. He also averaged 18.2 points, 9.8 rebounds, 2 blocks, 1.4 assists, and 0.8 steals per game in five games during the 2018 preseason with the Suns. Near the end of the preseason, he led all NBA players in points, rebounds, blocks, free-throws, and field goal attempts.

Ayton made his NBA debut in the season opener on October 17, 2018 and earned a double-double with 18 points and 10 rebounds, as well as a season-high 6 assists, a steal, and a block with 36 minutes played as a starter in a 121–100 win over the Dallas Mavericks. It made Ayton the first player to record these stats in their debut game since Lew Alcindor in 1969, as well as the third player since Oscar Robertson in 1960. Five days later, Ayton recorded a double-double of 20 points and 14 rebounds (alongside 5 assists) in a 123–103 loss to the Golden State Warriors. On October 27, he recorded 24 points on near-perfect shooting (12/13 shots made) alongside 5 assists in a loss to the Memphis Grizzlies. He became the second rookie in 40 seasons (first being Adam Keefe) to score at least 12 shots with a 90% or higher field goal percentage. Six days later, Ayton recorded a double-double of 17 points and a season-high 18 rebounds in a 107–98 loss to the Toronto Raptors. Ayton later recorded a new career high of 33 points, alongside 14 rebounds, in a 122–118 loss to the Denver Nuggets on December 29. Through the first half of the season, Ayton started in every game for the Suns when he was healthy, save for one. On January 29, 2019, Ayton was named a member of the World Team for the Rising Stars Challenge in the 2019 NBA All-Star Weekend. On March 27, Ayton broke Alvan Adams' rookie record for most double-doubles recorded by a rookie in franchise history. However, Ayton sprained his left ankle three days later against the Memphis Grizzlies, ending his rookie season early. He became the third rookie in a decade to average a double-double in their rookie season, joining Blake Griffin and Karl-Anthony Towns. At the conclusion of the season, Ayton was named as one of three finalists for the NBA Rookie of the Year Award in the 2019 NBA Awards show. On May 21, Ayton was selected to the 2019 All-Rookie First Team.

In June 2018, it was announced he would be sponsored by Puma after the German company announced that they would be returning to the basketball market.

Ayton made his debut with the University of Arizona on November 10, 2017, recording 19 points, 12 rebounds, and 3 blocks in a 101–67 win over the Northern Arizona Lumberjacks. His 19 points was 7th most for a freshman in an Arizona debut. Throughout his college career, he was used as a power forward instead of center; Dušan Ristić was Arizona's starting center instead. On December 9, 2017, Ayton recorded what was, at the time, a season-high 29 points and 18 rebounds in an 88–82 win over the Alabama Crimson Tide. On December 30, 2017, against the in-state rival Arizona State Sun Devils, he recorded 19 rebounds, which would be a season-high at the time. On January 20, 2018, against Stanford, he blocked 6 shots, which tied him for most in Arizona freshman single game history. He had also recorded 17 20-point games and 23 double-doubles through 34 games. However, while Ayton had some great successes during his freshman season, there were also controversies mired during his last few months there.

As a senior in 2016–17, Ayton led Hillcrest to a 33–6 record and national rankings across multiple outlets while averaging 26 points, 15 rebounds and 3.5 blocks. While representing the World Select team, Ayton played at the 2016 Nike Hoop Summit, chipping in with eight points to go along with seven rebounds.

Ayton was considered one of the top prospects in the 2017 recruiting class by Scout.com, Rivals.com and ESPN. Ayton was rated as a five-star recruit and the No.3 overall recruit and No.1 center in the 2017 high school class. In 2015, he was ranked by Scout as the top prospect in all of high school in their "Ultimate 100" list. He had narrowed his choices between three schools: Arizona, Kansas and Kentucky. On September 6, 2016, Ayton committed to play for the Arizona Wildcats, and he signed his letter of intent.

Ayton represented The Bahamas in the 2016 Centrobasket, the regional basketball championship of FIBA Americas for the Central American and Caribbean subzone where he averaged a tournament-leading 11.1 rebounds per game.

Ayton, now a junior in 2015–16, transferred to Hillcrest Prep Academy in Phoenix, Arizona to play out his last two years. During this high school year, he became teammates with another top-tier Class of 2017 player in 2018's #2 pick Marvin Bagley III. Throughout his junior year, Ayton averaged 29.2 points, 16.7 rebounds, 3.8 blocks per game.

Ayton attended Balboa School in Escondido, California and started on the varsity basketball team for two years. As a sophomore in 2014–15, Ayton led Balboa to a 17–14 record, averaging 21 points, 16 rebounds and 3.8 blocks per game. He racked up double-doubles in 21 of 22 regular season games. That summer, he averaged 16.5 points, 13.5 rebounds and 2.2 blocks a game for Supreme Court AAU (California) on the Under Armour circuit. As a standout in his class, he elected to transfer from Balboa City School to explore an opportunity at a Prep Academy.

Deandre Edoneille Ayton (born July 23, 1998) is a Bahamian professional basketball player for the Phoenix Suns of the National Basketball Association (NBA). He played for the Arizona Wildcats in the Pac-12 Conference in the 2017–18 season and was a consensus five-star prospect in the Class of 2017, as well as a McDonald's All-American. Ayton was selected with the first overall pick in the 2018 NBA draft by the Suns. He was selected to the NBA All-Rookie First Team for the 2018–19 NBA season.