In the Androgens and Metabolites section of the DUTCH test we are looking at essentially three main things:
1. Total DHEA production
2. Testosterone levels
3. Metabolic preference (5a versus 5b metabolism)
– If androgens are heading down the alpha pathway, there is more of a preference for making DHT, which is highly androgenic
1. Total DHEA production
To look at the total DHEA production we are adding up the three primary DHEA metabolites:
– DHEA-S (The “S” stands for sulfate)
– Etiocholanolone
– Androsterone
If you are adding those 3 metabolites of DHEA together we are getting a good picture of the Total DHEA production for the day.
Why are we looking at those 3 metabolites? If, for example, overall DHEA levels and Etiocholanolone + Androsterone are high, why could DHEA-S levels be low? Inflammation could be blocking the sulfation of DHEA. So, it’s good to look at the various DHEA markers instead of just looking at one overall DHEA level.
2. Testosterone levels
There is simply a single measurement of testosterone. The measurements also include 3 downstream metabolites of testosterone:
– 5a-DHT
– 5a-Androstanediol
– 5b-Androstanediol
3. Metabolic preference (5a versus 5b metabolism)
– Androsterone is a 5a-metabolite
– Etiocholanolone is a 5b-metabolite
If Androsterone is elevated and Etiocholanalone is relatively low, the metabolism will tend to favor towards the alpha side. Alpha metabolites are more androgenic and beta metabolites are less androgenic.
When testosterone pushes towards DHT it has to go down the 5-alpha metabolite pathway. This can be the case in a female with, for example, PCOS. In this situation there is typically an insulin issue which pushes towards 5-alpha. When testosterone gets into the cellular space (ex. hair follicle or skin) it will shift towards DHT (via the 5-alpha pathway). DHT happens to be 3-times more potent than testosterone. In these women symptoms of high androgen, such as thinning scalp hair, facial hair growth or acne can often show.
To summarize, in this category we have to look at the overall DHEA levels, Testosterone levels and the metabolic preference (alpha versus beta). If androgens are heading down the 5a pathway, there is more of a preference for making DHT (very androgenic). This can even happen if overall androgen levels are low.
5a-Androstanediol is a testosterone metabolite that is more androgenic than b-Androstanediol. It is metabolized via the 5-alpha metabolic pathway (= increased 5α-reductase activity). In contrast, the 5-beta metabolism makes androgens less potent.
Increased 5a-reductase activity may be accompanied by clinical signs of androgenicity (excess facial hair growth, scalp hair loss, acne, irritability, oily skin, prostate issues in men…etc).
5a-DHT is a testosterone metabolite.
5a-DHT is essential for the development of the male sex characteristics before birth, particularly the formation of the external genitalia. In the adult, 5a-DHT is needed to develop and maintain male gender characteristics, such as facial hair, deep voice, and muscle growth. In women, 5a-DHT may induce the onset of puberty and causes the body and pubic hair growth.
Increased 5a-DHT levels are found in about 40% of patients with idiopathic hirsutism and 35% of patients with polycystic ovarian syndrome (=PCOS).
5b-Androstanediol is a testosterone metabolite that is less androgenic than 5a-DHT and 5a-Androstanediol. It is metabolized via the 5-beta metabolic pathway. In contrast, the 5-alpha metabolism makes androgens more potent (= increased 5α-reductase activity).
Androsterone is a DHEA metabolite via the 5-alpha-reductase pathway. The 5-alpha pathway is more androgenic.
DHEA-S is the sulfate ester of DHEA and only a part of DHEA testing. If this marker was low it would mean that there is potential inflammation blocking DHEA being converted to DHEA-S.
Epi-Testosterone is one of several naturally-occurring testosterone compounds in the body that act as steroids.
Etiocholanolone is a DHEA metabolite that is excreted in the urine. It is produced from androstenedione and the 5-beta-reductase metabolic pathway. It is helpful in evaluating adrenal and androgen function.
Testosterone is the major androgen in the body. It is converted to dihydrotestosterone by 5-alphareductase, and to estradiol by aromatase.
Total DHEA Production
Optimal range: 400 – 3000 ng/mg
DHEA is often called the anti-aging hormone. It’s made in the adrenal glands naturally and levels hit their peak in your 20s. They start to dwindle after you hit 30. Estrogen and testosterone are created from DHEA.
Disclaimer:
Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you.
The information on healthmatters.io is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.
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