DUTCH Androgens & Metabolites (Urine): Results

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:

1. Total DHEA production

2. Testosterone levels

3. 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:

• DHEA-S (DHEA sulfate – the storage form of DHEA)

• Etiocholanolone (a 5β metabolite)

• 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:

• 5α-DHT (dihydrotestosterone – a highly potent androgen)

• 5α-Androstanediol

• 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:

• 5α pathway (alpha) → Produces androsterone and leads toward DHT formation. These metabolites are more androgenic (stronger effects).

• 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

• DHEA output is assessed by adding DHEA-S, androsterone, and etiocholanolone.

• Testosterone metabolism is tracked by measuring testosterone and its 5α and 5β metabolites.

• 5α dominance means your body is more likely to produce potent androgens like DHT, which can cause stronger hormonal effects and symptoms.

• Even low overall androgen levels can result in high DHT activity if the 5α pathway is favored.