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Monitoring DHT metabolism and 5 alpha reductase activity

Discussion in 'Male Health & HRT' started by JanSz, Oct 23, 2009.

  1. JanSz

    JanSz Well-Known Member

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    On my next blood test I am testing together:

    Dihydrotestosterone
    3a-Androstanediol Glucuronide

    Per statement on Mayo site this may be a better way to asses DHT activity.
    .......
     
    Last edited: Oct 25, 2009
  2. 00slotiv

    00slotiv Active Member

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    Re: Surprising cholesterol results and a few others

    Let us know how that turns out JanSz.


    Bob
     
  3. JanSz

    JanSz Well-Known Member

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    Re: Surprising cholesterol results and a few others

    ...
     
    Last edited: Oct 25, 2009
  4. chilln

    chilln Banned

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    Re: Surprising cholesterol results and a few others

    The reason why assessing the T (testosterone) : DHT (dihydrotestosterone) ratio, or even absolute serum DHT metrics, are not a reliable way to monitor DHT metabolism (the rate at which DHT is being used up by cells other than the liver which converts DHT into urinary metabolites), is because we have observed that:
    a) serum DHT can be normal, while DHT metabolism is either high or low.
    b) serum DHT can be high or low, while DHT metabolism can be normal

    A more reliable metric which monitors DHT metabolism is to monitor the 5-AR enzyme activity which is responsible not just for the conversion of T into DHT, but also the conversion of some glucorcorticoids into their downstream metabolites.

    Ie: when the rate of DHT metabolization is high, then 5-AR enzyme activity is always high.
    Ie: when the rate of DHT metabolization is low, then 5-AR enzyme activity is always low.

    ###

    The way to use serum labs to monitor 5-AR activity, and thus DHT metabolism, is to look for the classic case of high-T with high-E2 with low-SHBG.

    But if this situation is not self-evident, then we must switch to 24 hr urinary anlaysis.

    24hr Rheins urine analysis provides measurements of THF (tetrahydrocortisol) and 5a-THF (allo-tetrahydrocortisol), and the ratio of 5a-THF to THF ( ie: 5a-THF / THF ) follows the 5alpha reductase activity, ie:

    high ( 5a-THF / THF > 1.3 ) shows high 5 alpha reductase activity (above 90 percentile)

    mid ( 5a-THF / THF = 0.8 ) shows average 5 alpha reductase activity

    low ( 5a-THF / THF < 0.6) shows low 5 alpha reductase activity (below 10 percentile)


    Taken together, these are good indicators of 5 alpha reductase acitivity, and thus DHT metabolism. Dr Crisler seems to agree.

    http://www.allthingsmale.com/forum/showpost.php?p=21184&postcount=23

    ...and the physiological ranges have been determined by Dr Jonathan Wright (Meridian Valley Labs) here:
    http://www.meridianvalleylab.com/news-fall2004.html

    ...with the minim and average values taken directly from Meridian Valley Lab's paper report , ie: there is no URL link available at this stage, per CowboyBob's posts here:
    part 1: http://allthingsmale.com/forum/showpost.php?p=60037&postcount=10
    part 2: http://allthingsmale.com/forum/showpost.php?p=60096&postcount=12

    ...and there are many research papers which use the same urinary metabolite markers to demonstrate 5 alpha reductase activity, and DHT metabolic activity, eg:

    "Diagnosis of 5alpha-reductase 2 deficiency: a local experience"
    http://www.hkmj.org/article_pdfs/hkm0904p130.pdf

    ####

    Additional papers:

    "The Diagnosis of 5{alpha}-Reductase Deficiency in Infancy"
    http://jcem.endojournals.org/cgi/content/abstract/63/6/1313

    "A Case of 5 alpha-reductase Deficiency in Infancy"
    http://www.koreamed.org/SearchBasic.php?RID=262999&DT=1

    "Early diagnosis and management of 5 alpha-reductase deficiency"
    http://adc.bmj.com/cgi/content/abstract/67/6/720

    "Increased 5{alpha}-Reductase Activity and Adrenocortical Drive in Women with Polycystic Ovary Syndrome"
    http://jcem.endojournals.org/cgi/content/full/94/9/3558

    ############

    As for the measurement of 3a-Androstanediol Glucuronide, I respect Mayo labs' science, and this test may be the next best DHT metabolism test.

    But thus far it's still unproven in a wider setting than just a small clinical trial - and so if we're going to recommend it, we should always include the advisory that it's still being evaluated, so we should not make decisions relating to DHT when considering 3a-Androstanediol Glucuronide lab metrics, without backup from additional sources of DHT metabolism inputs (eg: urinary labs, or the classic high-T, low-E2, low-SHBG case, and/or obvious DHT symptoms).

    #############

    And last but not least - if you've confirmed via these methods that your DHT metabolism does indeed closely follow your serum total DHT levels, then you're one of the lucky ones, and you can switch back to monitoring only your serum total DHT.

    .
     
    Last edited: Sep 29, 2010
  5. rick055

    rick055 Active Member

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    great articles, chilln.
     
  6. JanSz

    JanSz Well-Known Member

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    Re: Surprising cholesterol results and a few others

    I do not know how to read them, but you will have opportunity to help me (please).
    -------------------



    Hi chilln

    If I could, I would correct title of this thread, from

    Monitoring DHT metabolism and 5 alpha reductase activity

    to

    Monitoring and MANAGING DHT metabolism and 5 alpha reductase activity
    ----------------------

    You posted, quote:

    high ( 5a-THF / THF ) shows high 5 alpha reductase activity

    low ( 5a-THF / THF ) shows low 5 alpha reductase activity

    Taken together, these are good indicators of 5 alpha reductase acitivity, and thus DHT metabolism. Dr Crisler seems to agree.
    ----------------------

    Rhein reports individual analytes, not their ratio.
    I will post three actual examples taken from Rhein reports, please describe 5a-reductase activity and give me some concrete advice on managing those actual conditions.

    I will keep this examples anonymous, so you are not constrained in helping me to understand this 5a-reductase issue.

    What to do if too high, what to do if low?

    For real men that are in a slump:
    what is high ratio,
    what is just right ratio,
    what is too low ratio?

    We are dealing here with real men.
    We are not dealing with people with ambiguous genitalia, ambiguous sex, extreme cases.
    Those cases may be interesting from medical perspective, buy all I can do is just wish them luck.

    My self, by managing, I am thinking of using
    more or less transdermal-T
    higher or lower density of transdermal-T
    switching from transdermal to injectable-T

    I will also post DHT and Androstanediol values
    tell me if they are helpfull in this evaluation and if yes, then how.

    ------------------------------------------------
    Example#1
    THF=836(942-2800)ug/24hrs
    5a-THF=758(796-2456)ug/24hrs

    ( 5a-THF / THF )=758/836=0.91

    DHT=12(0-13)ug/24hrs
    Androstanediol=7(0-50)ug/24hr
    ------------------------------------------------
    Example#2
    THF=816(942-2800)ug/24hrs
    5a-THF=1317(796-2456)ug/24hrs

    ( 5a-THF / THF )=816/1317=0.62

    DHT=5.8(0-13)ug/24hrs
    Androstanediol=91(0-50)ug/24hr
    ------------------------------------------------
    Example#3
    THF=2444(942-2800)ug/24hrs
    5a-THF=3647(796-2456)ug/24hrs

    ( 5a-THF / THF )=2444/3647=0.67

    DHT=39(0-13)ug/24hrs
    Androstanediol=321(0-50)ug/24hr
    ------------------------------------------------

    ..........
     
    Last edited: Oct 25, 2009
  7. chilln

    chilln Banned

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    Re: Surprising cholesterol results and a few others

    While I admire your attempt to use hypothetical cases, I don't have time for hypothetical cases. There are too many posts, and not enough time.

    The best place to discuss 5a-THF and THF ratios is as propeciahelp.com.

    There are many more males with DHT deficiencies there than here, and some of them are Dr Crisler's patients, with Rheins results too.

    And there are no super moderators on that site who will enforce MAN LAW 17.

    .
     
  8. JanSz

    JanSz Well-Known Member

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    Re: Surprising cholesterol results and a few others

    Those cases I posted are not hypothetical.
    I just did not attached names to protect innocent members on this board that need help.

    Your effort will not go in support of hypothetical cases.
    You will help real people.
    ------------------------------------

    I will also look at

    propeciahelp.com

    thanks for the lead.

    .........

    I signed to propecia.com

    I searched the site for THF
    I have found only one link, one page, discussing THF

    http://www.propeciahelp.com/forum/viewtopic.php?t=761

    How to test for 5AR/DHT activity via urine/blood test

    Have I missed anything?

    ..................
    =============
    Quote:
    So on future bloodtests request ADIOL-G, in addition to DHT.
     
    Last edited: Oct 26, 2009
  9. JanSz

    JanSz Well-Known Member

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    Before we wander out into theoretical field, I have confession to make.

    I have a hammer.
    I would like to figure out how to use it.

    So far it was simple.

    1. I measure DHT level, believe in test results
    2. if it is too high, I change from low density transdermal-T to higher density of thansdermal-T.
    Higher denisity utilizes smaller skin area, DHT goes down.
    If not low enough, I go for T-injections.

    I do not use finasteride or duosteride because that is a bad news for smal group of men.
    I am not among those un-lucky few, but lets not push it, besides there are other people who needs to know what to do.

    So, so far my biggest problem was to figure out desirable DHT level.

    Everybody needs DHT, but
    not enough is bad
    too much is bad
    we need just the right amount.

    ATM this is what I do about DHT
    DHT(60-90)ng/dL (I am active when it gets over or under this range)
    ---------------

    But now there is a doubt, two of them:

    Mayo says measuring
    3a-Androstanediol Glucuronide
    is more reliable.
    I am glad that measurement is reliable
    but I still need 2 pieces of info
    what level is desirable
    what to do if it is outside desirable range

    There is also a ratio (5a-THF/THF)

    same questions
    what level is desirable
    what to do if it is outside desirable range
    ===============================================

    I am not a theoretician.
    Just trying to stay practical.
    I am looking for information only if :

    I know what to do with it when I find it (best possibility)
    I know when it is good and when it is bad (at minimum).

    So far I am not able to answer any of this questions when looking at
    ratio (5a-THF/THF)

    individual values of 5a-THF and THF are not important (I think) but Rhein report lists their ranges.

    ...........
     
  10. chilln

    chilln Banned

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    For someone whose medical professional adviser has diagnosed only a DHT metabolism issue (rare):

    1) Measure 5a-THF and THF metrics, and calc ratio.

    2) Monitor DHT symptoms.

    3) Based on symptoms, not metrics, if need more DHT then:

    .....a) Boost DHT by first boosting T.

    .....b) remeasure 5a-THF and THF ratio.

    .....c) monitor DHT symptoms

    .........the 5a-THF and THF metrics are there to improve your ability to monitor subtle changes in DHT symptoms, and to confirm to third parties that the person making the observations is not a hypochondriac.

    4) If T is fine, and still need more DHT, and using T gel / cream, then:

    .....a) boost DHT via transdermal T applied over wider area.

    .....b) remeasure 5a-THF and THF ratio.

    .....c) monitor DHT symptoms

    .........the 5a-THF and THF metrics are there to improve your ability to monitor subtle changes in DHT symptoms, and to confirm to third parties that the person making the observations is not a hypochondriac.

    5) If your T still fine, and still need more DHT, then:

    .....a) boost DHT via transdermal DHT

    .....b) remeasure 5a-THF and THF ratio.

    .....c) monitor DHT symptoms

    .........the 5a-THF and THF metrics are there to improve your ability to monitor subtle changes in DHT symptoms, and to confirm to third parties that the person making the observations is not a hypochondriac.

    ###

    If DHT symptoms and 5a-THF and THF ratio have not increased significantly, then see one of the top echelon medical professional advisers, eg: Dr Crisler, because your medical professional adviser has misdiagnosed your endocrine dysfunction.

    .
     
    Last edited: Oct 27, 2009
  11. JanSz

    JanSz Well-Known Member

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    How do I monitor DHT symptoms?

    Do you measure DHT in the blood, if yes, what criteria do you use to figure
    when it is in desirable range.

    What do you mean by "significantly"?

    In my 3 examples on previous post the values of (5a-THF) and (THF) were in the range of (700-4000)
    their ratios 0.91, 0.67, 0.62

    Some numerical examples that would narrow down meaning of what is significant, would help.

    ...
     
  12. chilln

    chilln Banned

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    This is just an attempt at hormone numerology, ie: attempting to assess hormones by targeting numbers in isolation from the complete hormone symphony.

    As usual, hormones need to be assessed as a complete picture, ie: comprehensive labs, symptoms, and dosage-response trials.

    .
     
    Last edited: Nov 21, 2009
  13. moonman

    moonman Member

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    can THB and 5aTHB also be used to find 5AR activity???


    edit: yes it can
     
    Last edited: Jul 30, 2011

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