Steroid Pathways & DUTCH Testing
Cholesterol
Pregnenolone
3b-HSD 17-hydroxylase
Progesterone 17OH-Pregnenolone
5a 17-hydroxylase 3b-HSD
5b 17,20 Lyase
17b-HSD
a-Pregnanediol b-Pregnanediol 17OH-Progesterone DHEA Androstenediol
Sulfotransferase
CYP-21
Sulfatase
3b-HSD
DHEA-S 3b-HSD
CYP-11b1 17,20 Lyase
11b-HSD 17b-HSD
Cortisone Cortisol Androstenedione Testosterone
5b 5a 5b
5b
5b
THE a-THF b-THF Etiocholanolone 5a
5b
Aromatase Aromatase
(CYP-19) 5a 5b-Androstanediol 5a-DHT (CYP-19)
3a-HSD
17b-HSD
Epi-Testosterone Androsterone 5a-Androstanediol
17b-HSD
Estrone (E1) Estradiol (E2)
CYP-1a1 CYP-3a4
CYP-3a4
CYP-1b1
17b-HSD
2-OHE1 4-OHE1 16-OHE1 Estriol (E3)
aka 16-OHE2
COMT
2-MeOE1
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herbal supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. The use of any information provided
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Steroid Pathways & DUTCH Testing
17, 20 LYASE May be decreased by: Hypothyroidism, anorexia,
CONTRIBUTING FACTORS May be increased by: PCB exposure33, DHEA
cholestasis, or poor liver function.
Next to each arrow on the steroid pathway chart
supplements7, obesity34. COMT
is the name of the protein responsible for moving
each hormone further downstream. May be decreased by: Licorice root34, 35, May be increased by: SAM-e, magnesium, choline, B6,
spironolactone37, azole antifungals38, hyperglycemia27, B12, folate, betaine/TMG (cofactors).
These proteins are important because they can
be targeted with lifestyle changes and supple- apegenin31, 38. May be decreased by: Estradiol80, phthalate esters81,
mentation to improve symptoms associated
DHEA & DHEA-S rhodiola rosea, quercetin, catechin and epicatechin83.
hormone imbalances.
DHEA converts to DHEA-S with hydroxysteroid AROMATASE (CYP-19)
Use the corresponding number next to a protein
sulfotransferase while DHEA-S converts to DHEA
to find the list of contributing factors that may be May be increased by: Obesity and inflammation46,
with steroid sulfatase; these interconvert in different
affecting the results of a DUTCH Test. high insulin47, forskolin48, quercetin, genistein
locations within the body.
(bioflavonoids)49, white peony and licorice root50,
LEARN MORE DHEA-S may be increased by: Spironolactone84,
atrazine51, rutin39.
Scan the QR code for access to our dexamethasone85, bile acid86, St. John’s Wort84,
references and additional information. May be decreased by: Enterolactone, apigenin,
forskolin87.
genistein, chrysin and other flavonoids52,white
DHEA-S may be decreased by: Low cysteine88,
button mushrooms53, grape seed extract, red wine
inflammation88, LPS89, ketoconazole88, progestin88,
3b-HSD procyanidin dimers55, PCOS56, antifungal medications57,
licorice90.
May be increased by: Fenugreek1, high ACTH/ metformin58, glyphosate59, aromatase inhibitors
5a-REDUCTASE & 5b-REDUCTASE (letrozole, anastrozole).
hyperadrenalism2, PCOS3.
5a-Reductase is best known because it makes andro-
May be decreased by: Isoflavonoids/phytoestrogens4, CYP-3a4
gens like testosterone more potent. It is also respon-
phthalates, organochlorines, BPA , ketoconazole ,
5 5
sible for metabolizing progesterone and cortisol. If Many common medications induce CYP3A4, including
finasteride, dutasteride. up-regulated, it may cause high androgen symptoms in but not limited to, phenobarbitol, phenytoin,
men (thinning hair, prostate) and women (as in PCOS, rifampicin, and glucocorticoids.
11b-HSD
thinning hair, acne, facial hair growth). 5b-Metabolites
Many common medications interfere with or
May push to cortisone: EGCG20, PCOS8, curcumin21, are less androgenic (weaker). 5b-Reductase may be
competitively inhibit CYP3A4, including but not limited
7-keto-DHEA19, progesterone19, coffee22, holy basil23, affected by some of the listed things for 5a as well
to, cimetidine, tamoxifen, quinolones, and fluoxetine.
(often to a lesser degree). This same enzyme also
bitter melon24, hyperthyroidism19, 26, high estrogens19,
metabolizes cortisol, see 8 for more detail. May be increased by: St. John’s Wort74, pesticides75,
glucocorticoids19.
caffeine62, smoking62, PAHs74, moderate alcohol
5a may be increased by: Insulin resistance and
May push to cortisol: Insulin resistance, obesity 6,
consumption68, obesity68.
obesity6, DHEA supplementation7, PCOS8.
, inflammation18, hypothyroidism25, licorice root19,
17
May be decreased by: Grapefruit60, resveratrol60,
phthalates, organotins, alkylphenols19, mother’s diet 5a may be decreased by: Saw palmetto and beta-
rosemary65, wild yam77, peppermint oil78, azole
during pregnancy19. sitosterol9, reishi10, nettle root11, pygeum africanum12,
antifungals79.
PUFA and EGCG13.
17b-HSD
CYP-1b1
5b may be increased by: Insulin resistance, high
May be increased by: Rutin39, alcohol41, abdominal
triglycerides14, PCOS15. May be increased by: Inflammation70, smoking71,
obesity42, bioflavonoids43.
PAHs69.
5b may be decreased by: Licorice16.
May be decreased by: Licorice , apigenin
4, 34, 35
,
4, 38
May be decreased by: Flavonoids73, resveratrol71.
pyhtoestrogens4, 43, atrazine45. CORTISOL METABOLISM/CLEARANCE
CYP-1a1
Cortisol is metabolized by 5a/5b-reductase (and
17-HYDROXYLASE
3a-HSD) to a/b-THF & THE for excretion. This same May be increased by: Cruciferous vegetables60, DIM/
May be increased by: Hyperglycemia27, enzyme metabolizes testosterone, androstenedione,
IC361, caffeine62, soy63, fish oil64, rosemary extract65,
hyperinsulinemia28. and progesterone, see 7 for more detail.
thyroxine66, flaxseed67.
May be decreased by: Ketoconazole29, May be increased by: Obesity, high insulin and
May be decreased by: High sugar diet67, moderate
spironolactone30, apigenin, polyphenols31, 32. hyperthyroid.
alcohol consumption68, resveratrol and pterostilbene69.
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All contents copyright © 2023 Precision Analytical Inc. All rights reserved. P: 503.687.2050 | F: 503.687.2052
3138 NE Rivergate St, Suite 301C, McMinnville, OR 97128
