Assessment of 5 Alpha-Reductase Activity in Hirsute Women: Comparison of Serum Androstanediol Glucuronide With Urinary Androsterone and Aetiocholanolone Excretion

Clin Endocrinol (Oxf). 1994 Apr;40(4):459-64. doi: 10.1111/j.1365-2265.1994.tb02484.x.


Objective: Recent evidence suggests that androstanediol glucuronide (AG), a metabolite of dihydrotestosterone (DHT) formed in skin, is frequently elevated in hirsute women, presumably reflecting enhanced 5 alpha-reductase activity. An alternative method of demonstrating 5 alpha-reductase activity is the androsterone (A)/aetiocholanolone (E) ratio in urine. A and E are the 5 alpha- and 5 beta-reduced metabolites, respectively, of androstenedione, which is the principal metabolite of dehydroepiandrosterone (D). Although serum AG and the urinary A/E ratio have both been considered valid methods for assessing 5 alpha-reductase activity, the two have not been previously compared in hirsute women. The present study was undertaken to assess 5 alpha-reductase activity in hirsute patients as determined by these two different methods.

Patients and measurements: We surveyed 47 untreated women (ages 17-33) with various degrees of hirsutism. Serum testosterone, bioavailable testosterone, dehydroepiandrosterone sulphate, and AG were determined. Additionally, A, E and D were measured in 24-hour collections of urine.

Results: For the 47 women, 37 had elevated blood levels of AG (17.4 +/- 2.2, mean +/- SEM; normal < 8 nmol/l), but only 18 of these had an increased urinary A/E ratio (> 1.5). All but one of the remainder had elevated urinary and/or serum androgen levels. Overall, no significant correlation between AG and A/E was observed. There was a highly significant correlation between AG in serum and A in urine (r = 0.82, P < 0.001). AG was also positively related to dehydroepiandrosterone sulphate (r = 0.64; P < 0.005), bioavailable testosterone (r = 0.6; P < 0.001), aetiocholanolone (r = 0.58; P < 0.001) and total testosterone (r = 0.52; P < 0.01). In contrast, A/E was not significantly related to androgen production.

Conclusions: There is a poor correlation between AG and the A/E ratio in hirsute women. Although AG may be raised by increased 5 alpha-reductase activity, it is probably also affected by the presence of elevated androgens regardless of 5 alpha-reductase activity.

Publication types

  • Comparative Study

MeSH terms

  • 3-Oxo-5-alpha-Steroid 4-Dehydrogenase / metabolism*
  • Adolescent
  • Adult
  • Androstane-3,17-diol / analogs & derivatives*
  • Androstane-3,17-diol / blood
  • Androstanols / urine*
  • Androsterone / urine
  • Dehydroepiandrosterone / analogs & derivatives
  • Dehydroepiandrosterone / blood
  • Dehydroepiandrosterone / urine
  • Dehydroepiandrosterone Sulfate
  • Etiocholanolone / urine
  • Female
  • Hirsutism / blood
  • Hirsutism / enzymology*
  • Hirsutism / urine
  • Humans
  • Testosterone / blood


  • Androstanols
  • Androstane-3,17-diol
  • androstane-3,17-diol glucuronide
  • Testosterone
  • Dehydroepiandrosterone
  • Dehydroepiandrosterone Sulfate
  • Etiocholanolone
  • Androsterone
  • 3-Oxo-5-alpha-Steroid 4-Dehydrogenase