ANDROGENS such as DHEA, testosterone, and androstenedione tend to be extensively metabolized into downstream androgen compounds. As a result, the levels of testosterone along with “Total 17-ketosteroids” (DHEA plus metabolites) should be used to assess androgen status and/or efficacy of androgen replacement.
Total 17-ketosteroids include the following:
- DHEA (24hr urine)
- Androsterone (24hr urine)
- Etiocholanolone (24hr urine)
- 11-Keto-androsterone (24hr urine)
- 11-Keto-etiocholanolone (24hr urine)
- 11-Hydroxy-androsterone (24hr urine)
- 11-Hydroxy-etiocholanolone (24hr urine)
Lower level of Total 17-Ketosteroids may be associated with:
- Acute or chronic stress (check Total 17-Hydroxy-corticosteroids)
- Aging, DHEA deficiency
- Excessive conversion of androgens to estrogens (see “Aromatase activity” below)
- High estrogen level or estrogen replacement including oral contraceptives (can increase sex-hormone binding globulin, which reduces the amount of bioavailable androgens)
- Smoking, chronic alcohol ingestion
- Diabetes mellitus
- Ketoconazole, metformin, troglitazone
TREATMENT OPTIONS to increase Total 17-Ketosteroids:
- Stress management (see section for Total 17-Hydroxy-corticosteroids)
- Increase dietary protein.
- Address aromatase imbalances.
- Consider supplementation with DHEA (15-100 mg/day) or other androgens.
Higher level of Total 17-Ketosteroids may be associated with:
- DHEA, androstenedione, or testosterone supplementation
- High protein- or high calorie diet
- PCOS (especially with obesity) and/or hirsutism and/or acne
- Low sex-hormone binding globulin (e.g., from hyperinsulinemia or hypothyroidism)
- Aromatase inhibitors
- Congenital adrenal hyperplasia
- Tumors of adrenals, ovaries, or testes
TREATMENT OPTIONS to decrease Total 17-Ketosteroids:
- Improve insulin sensitivity.
- Correct thyroid imbalances.
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