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.
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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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11-Hydroxy-androsterone (FMV urine, menopause), 11-Hydroxy-etiocholanolone (FMV urine, menopause), 11-Keto-androsterone (FMV urine, menopause), 11-Keto-etiocholanolone (FMV urine, menopause), 16a-Hydroxyestrone (16a-OH E1) / Menopause, 17 - Hydroxysteroids Total (FMV urine, menopause), 17 - Ketosteroids Total (FMV urine, menopause), 17-Hydroxysteroids, Total (menopause), 17-Ketosteroids, Total (FMV urine, menopause), 2-Hydroxyestrone + 2-Hydroxyestradiol [2-OH(E1+E2)] / Menopause, 2-Methoxyestrone+2-Methoxyestradiol [2MeO(E1+E2)] / Menopause, 2-OH(E1+E2) / 16a-OHE1 (Menopause), 2-OH(E1+E2) / 2-MeO(E1+E2) / Menopause, 4-Hydroxyestrone+4-Hydroxyestradiol [4-OH(E1+E2)] / Menopause, 4-Methoxyestrone+4-Methoxyestradiol [4MeO(E1+E2)] / Menopause, allo-Tetrahydrocortisol, a-THF (FMV urine, menopause), Anabolic/Catabolic Balance (FMV), Anabolic/Catabolic Balance (FMV, menopause), Androstanediol (FMV urine, menopause), Androsterone (FMV urine, menopause), DHEA (FMV urine, menopause), E/A: 5b/5a Ratio (FMV urine, menopause), Estradiol (FMV urine, menopause), Estriol (FMV urine, menopause), Estrone (FMV urine, menopause), Etiocholanolone (FMV urine, menopause), Pregnanediol (FMV urine, menopause), Pregnanetriol (FMV urine, menopause), Testosterone (FMV urine, menopause), Tetrahydrocortisol, THF (FMV urine, menopause), Tetrahydrocortisone, THE (FMV urine, menopause), Tetrahydrodeoxycortisol (FMV urine, menopause)