Dihydrotestosterone (DHT), the most powerful androgen, is generated from testosterone in target cells by the enzyme 5α reductase. Androgens are mainly inactivated by conjugation with glucuronic acid. This process increases their polarity, enabling diffusion into the blood and later secretion via the kidneys. The main metabolite of DHT in women and men is 5α-androstane-3α, 17β-diol glucuronide (3α-androstanediol glucuronide; 3α-adiol G). 3α-adiol G does not bind to sexual hormone binding globulin. 3α-adiol G is predominantly produced in target tissue such as skin, particularly near to hair follicles. It reflects androgen production in the periphery better than DHT.
High 3α-adiol G levels in blood occur in women with hirsutism, polycystic ovary syndrome (PCOS) and acne. The concentration correlates well with the Ferriman-Gallwey score for assessing the severity of hirsutism. Drug treatment of patients with hirsutism or PCOS leads to a decrease in the 3α-adiol G concentration. Halting the therapy leads to a rise in the concentration and increased hair growth.
In men, a highly significant correlation of the 3α-adiol G level in blood with growth of chest hair and acne has been observed. Low concentrations in men are associated with hypogonadism. The determination of the 3α-adiol G concentration together with the testosterone concentration is useful in the diagnosis of androgen deficiency.
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