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People used to think that DHT was the best marker for 5AR activity, but it appears to be relatively inaccurate.
The following study found that the etiocholanolone to androsterone ratio was a much better marker.
"The AUCs (areas under the curve) of the T/DHT and urinary Et/An ratios were 57.7% (95% CI 43.0 - 72.4%, P > 0.05) and 79.7% (95% CI 69.0 - 90.4%, P < 0.001), respectively, in diagnosing 5ARD2 patients and 54.1% (95% CI 42.4 - 65.8%, P > 0.05) and 75.1% (95% CI 65.1 - 85.1%, P < 0.001), respectively, in diagnosing carriers."
T/DHT ratio was 54-58% accurate and the Et/An ratio 75-80% accurate. So it's still not perfect, but it's a lot better.
This was also confirmed that when topical DHEA was used, it didn't increase testosterone or DHT, but markedly increased androsterone and androstanediol, which are much better markers of the total androgenic pool in the body. The DUTCH test looks at both markers.
But ultimately, you want to look at a lot more than just the Et/An ratio. The DUTCH test look at over 35 metabolites of your hormones, so it's definitely more comprehensive than a blood test.
I also did a vid on this a while ago if you want to check it out.
View: https://youtu.be/QxMkbKAkTTw
The following study found that the etiocholanolone to androsterone ratio was a much better marker.
Accuracy of Urinary Etiocholanolone/Androsterone Ratio as Alternative to Serum Testosterone/Dihydrotestosterone Ratio for Diagnosis of 5 Alpha-reductase Type 2 Deficiency Patients and Carriers in Indonesia - PubMed
The testosterone/DHT ratio was inaccurate in diagnosing 5ARD2 patients. When molecular analysis for the <i>SRD5A2</i> gene is lacking, the urinary Et/An ratio may be a useful test to diagnose 5ARD2 patients and carriers.
pubmed.ncbi.nlm.nih.gov
T/DHT ratio was 54-58% accurate and the Et/An ratio 75-80% accurate. So it's still not perfect, but it's a lot better.
This was also confirmed that when topical DHEA was used, it didn't increase testosterone or DHT, but markedly increased androsterone and androstanediol, which are much better markers of the total androgenic pool in the body. The DUTCH test looks at both markers.
But ultimately, you want to look at a lot more than just the Et/An ratio. The DUTCH test look at over 35 metabolites of your hormones, so it's definitely more comprehensive than a blood test.
I also did a vid on this a while ago if you want to check it out.
View: https://youtu.be/QxMkbKAkTTw
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