5a-Androstanediol: A Marker of Androgen Status in Women

Androgen hormones play a critical role in women’s health, influencing multiple organ systems beyond their function as estrogen precursors. When abnormally elevated, androgen activity in women commonly manifests as cutaneous symptoms such as male-pattern hair growth (hirsutism), scalp hair loss (androgenetic alopecia), and acne. These symptoms are thought to stem from the intracellular actions of the most potent testosterone metabolite, dihydrotestosterone (DHT), exerting localized effects inside the cells of peripheral tissues without significantly altering systemic hormone levels. DHT intracellularly converts to its metabolite — 5α-androstanediol — which is released into the bloodstream and excreted in urine. 5α-androstanediol is thought to be the best available marker of intracellular DHT activity in peripheral tissues. While androgen status is commonly assessed using measurement of serum testosterone, circulating testosterone alone does not fully capture localized androgen activity at the tissue level.

In this white paper, we discuss the rationale for taking a broad view of androgens in women’s health, evaluating not only testosterone but also its metabolites, to provide a more accurate, comprehensive understanding of androgen activity underlying a woman’s symptoms. We review the growing body of research evidence supporting the value of 5α-androstanediol as a marker of androgen excess in women, particularly in cases when circulating testosterone appears normal.