Androgens and Metabolites (Urine) - DUTCH
Urine
Performed by: Precision Analytical (DUTCH)
The Androgens and Metabolites section of the DUTCH test by Precision Analytical evaluates how your body produces and processes key sex hormones, particularly DHEA, testosterone, and their metabolites.
It focuses on three main areas:
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Total DHEA production
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Testosterone levels
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Metabolic pathway preference – whether your body favors 5α (alpha) or 5β (beta) metabolism
1. Total DHEA Production
DHEA (Dehydroepiandrosterone) is a precursor hormone produced by the adrenal glands and is essential for making both testosterone and estrogen.
To assess total DHEA output, the DUTCH test adds up three primary urinary metabolites:
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DHEA-S (DHEA sulfate – the storage form of DHEA)
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Etiocholanolone (a 5β metabolite)
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Androsterone (a 5α metabolite)
Looking at all three together provides a more complete picture of daily DHEA production than measuring a single marker.
Example: If total DHEA output is high but DHEA-S is low, it may indicate that inflammation or other factors are blocking the sulfation process (the conversion of DHEA into its storage form, DHEA-S). This highlights why multiple DHEA markers are evaluated rather than relying on just one.
2. Testosterone Levels
The DUTCH test measures testosterone directly in urine and also looks at three downstream metabolites:
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5α-DHT (dihydrotestosterone – a highly potent androgen)
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5α-Androstanediol
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5β-Androstanediol
These metabolites help determine how your body is processing testosterone and whether more of it is being converted into the powerful androgen DHT.
3. Metabolic Pathway Preference – 5α vs. 5β Metabolism
Your body breaks down androgens through two main pathways:
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5α pathway (alpha) → Produces androsterone and leads toward DHT formation. These metabolites are more androgenic (stronger effects).
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5β pathway (beta) → Produces etiocholanolone, which is less androgenic (weaker effects).
If androsterone is high and etiocholanolone is low, it suggests a 5α-dominant metabolism, meaning your body favors making DHT.
This can occur even if overall androgen levels are normal or low. For example, in women with PCOS, elevated insulin can push testosterone metabolism toward the 5α pathway, increasing DHT production. Because DHT is about three times more potent than testosterone, symptoms like thinning scalp hair, facial hair growth, and acne can develop.
Key Takeaways
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DHEA output is assessed by adding DHEA-S, androsterone, and etiocholanolone.
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Testosterone metabolism is tracked by measuring testosterone and its 5α and 5β metabolites.
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5α dominance means your body is more likely to produce potent androgens like DHT, which can cause stronger hormonal effects and symptoms.
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Even low overall androgen levels can result in high DHT activity if the 5α pathway is favored.
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Biomarkers included in this panel:
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 poten
Learn more5a-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 gend
Learn more5a-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 gend
Learn more5b-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-reduct
Learn more5b-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-reduct
Learn moreAndrosterone is a DHEA metabolite via the 5-alpha-reductase pathway. The 5-alpha pathway is more androgenic.
Learn moreAndrosterone and Etiocholanolone are DHEA metabolites via Androstenedione and the 5α- and 5β-reductase pathways.
Learn moreDHEA-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.
Learn moreDHEA is produced in the adrenal glands and is a precursor to both testosterone and estrogen.
Learn moreEpi-Testosterone is one of several naturally-occurring testosterone compounds in the body that act as steroids.
Learn moreEpi-Testosterone is one of several naturally-occurring testosterone compounds in the body that act as steroids.
Learn moreEtiocholanolone 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.
Learn moreEtiocholanolone is an androstenedione and testosterone metabolite that is excreted in the urine. It is produced from androstenedione and the 5-alpha and 5-beta-reductase metabolic pathways. It is helpful in evaluating adrenal and androgen function.
Learn moreTestosterone is the major androgen in the body. It is converted to dihydrotestosterone by 5-alphareductase, and to estradiol by aromatase.
Learn moreTestosterone is the major androgen in the body. It is converted to dihydrotestosterone by 5-alphareductase, and to estradiol by aromatase.
Learn moreDHEA 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.
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