The DUTCH test measures the total of testosterone glucuronide and testosterone sulfate. These conjugates of testosterone are formed mostly from bioavailable testosterone that undergoes phase 2 metabolism to make it ready for urine excretion.
Testosterone glucuronide is mostly made by the UGT2B17 enzyme, which also makes the glucuronide forms of 5a-DHT and 5b-androstanediol. Genetic variants of this enzyme reduce the urinary levels of these hormones without affecting serum levels. The genetic variants of UGT2B17 vary in the population from 7-80% (variation dependent on genetic ancestry, with the highest rates in those of Asian descent). Heterozygous individuals show milder reductions in urinary testosterone than homozygous. For this reason, low and very low levels of urinary testosterone should be confirmed with serum testing before treatment is applied. Serum testing can include free and total testosterone and SHBG.
The testes make most of the male's testosterone. Levels tend to be their highest at around 20 years of age and start to decline when men get into their 30's. Levels continue to drop as men age. Testosterone is needed for building bones and muscle mass, regulating body fat distribution and in the production of sperm and red blood cells. Testosterone is also important for libido and downstream production of modest amounts of estrogen.
Testosterone levels in healthy men vary widely so it is suggested that these ranges be interpreted with caution and consideration of symptoms. In addition, because estrogen also supports libido, erections and healthy weight management, estrogen levels should be considered along with the testosterone levels when assessing symptoms.
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Testosterone in Women
The main male sex hormone, testosterone is also important for women. Optimizing testosterone in women with low or low-normal levels may improve poor libido, vaginal dryness, muscle mass, and overall sense of optimism and well-being. Low levels may be due to low DHEA precursor or adrenal stress. High levels are common in PCOS or may be a sign of over-supplementation.
Testosterone in Men
Lower levels in men are increasingly common and can lead to fatigue, apathy, loss of muscle mass and strength. Low or low normal levels in young to middle aged men can be an indicator of environmental toxicity. High levels are rarely seen except in cases of over-supplementation. Testosterone metabolizes to more potent androgens via 5α-reductase and aromatizes to estradiol. Testosterone in men should be evaluated in relationship to estrogens in order to evaluate possible over-aromatization.
Testosterone (DUTCH) (male)
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