The Etiocholanolone/Androsterone (E/A) Ratio assesses androgen metabolism by comparing the enzymatic activity of 5β-reductase/5α-reductase. Etiocholanolone is produced via the 5β-reductase pathway, and androsterone is produced via the 5α-reductase pathway. The ratio aids in assessing dihydrotestosterone (DHT) production from testosterone. While DHT is measurable in serum, it is not measurable in urine. However, biomarkers that provide insight into 5α-reductase activity in the urine give an approximation of the level of production of DHT in the body.
A low E/A ratio indicates more 5a-reductase activity and greater production of DHT from testosterone.
- Symptoms in a male might include BPH and lower urinary tract symptoms.
- Symptoms in a female might include hirsutism, acne, infertility, polycystic ovary syndrome (PCOS), and oily skin.
Both men and women may experience androgenic alopecia as a result of higher DHT production. Therapeutic strategies for 5α-reductase inhibition may be considered, and include pharmaceutical intervention with 5α-reductase inhibitors (such as Finasteride) or botanical inhibitors (such as saw palmetto).
An elevated E/A ratio indicates less 5α-reductase activity, which is not thought to be a clinically relevant finding – though physiologically induced 5α-reductase blockade states via pharmaceuticals (such as Finasteride) may be associated with side effects such as impotence, decreased libido, depression and anxiety in men. Robust inhibition of 5α-reductase activity decreases the production of DHT, resulting in increased levels of testosterone - and subsequently estradiol (via aromatization pathways). As a result of increased substrate flow through the aromatization pathways, gynecomastia has also been described in men.
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