Hormonal treatment

As part of a comprehensive study of hormonal treatment, the level of male and female steroid sex hormones (androgens and estrogens), which are the most significant in the diagnosis of androgen metabolites, are determined, and calculated indicators.

Androgens, their metabolites, ratios:

• dehydroepiandrosterone (DHEA);
• androstenedione;
• testosterone;
• androsterone;
• epiandrosterone;
• etiocholanolone;
• androsterone / etiocholanolone ratio;
• testosterone / epitestosterone ratio.

Estrogens and progestogens:

• estradiol;
• estrone;
• estriol;
• pregnandiol.

Androgens are steroid sex hormones that are produced in the male body by the testes and in the female by the ovaries. In addition, in both sexes, the cells of the reticular layer of the adrenal cortex can act as hormone producers. The function of androgens includes the formation of secondary sexual characteristics in men. With an excess of the hormone in the female body or a violation of the translation of androgens into estrogens in women, the voice coarsens, the figure becomes masculine, an intensive growth of the body hair is observed (i.e., the process of virilization occurs).

DHEA (dehydroepiandrosterone) is a multifunctional steroid hormone synthesized primarily by the adrenal glands. It is obtained as a result of the hydroxylation reaction of 17-hydroxypregnenolone (an intermediate product formed from pregnenolone with the participation of the enzyme 17-alpha-hydroxylase, which then converts it to DHEA). A small amount of the hormone is produced by the sex glands (about 5-6%). DHEA is a raw material for the production of sex hormones - androgens (testosterone and androstenedione) and estrogens (estrone and estradiol). Its androgenic properties are 15 times weaker than testosterone. An increase in the excretion of DHEA from the body indicates an excessive synthesis of androgens by the adrenal glands. Most of the DHEA produced is converted to DHEA sulfate.

Androstenedione is the main androgen secreted by the ovaries. A small amount is also secreted by the adrenal cortex (in both sexes) and the male testes. The hormone has a significantly weaker androgenic effect than testosterone.

Testosterone is the main androgenic steroid hormone. More than half of the testosterone entering the bloodstream is bound by globulin (SHBG), which is responsible for binding sex steroids. The formation of this bond minimizes the androgenic activity of testosterone by preventing it from entering androgen-sensitive cells. About 43% of testosterone (40% due to albumin, 3% free) remains biologically available. When it enters the tissues, testosterone is converted to its active form - 5-alpha-dihydrotosterone.

Epitestosterone is an isomer of testosterone (that is, a substance with absolutely similar molecular weight and atomic composition, but different in the arrangement of atoms and, accordingly, properties). The androgenic activity of the isomer is low. Its amount is an indicator of the metabolism of testosterone produced in the body (endogenous). The indicator is used to calculate the testosterone / epitestosterone ratio.

Androsterone - can be a metabolite of both androstenedione and testosterone. Its formation occurs during the 5a-resuctase reaction. In terms of the strength of androgenic action, it is 5-7 times inferior to testosterone. Androsterone takes part in the formation of secondary sexual characteristics in the male pattern. According to the level of adrosterone, a conclusion is made about the amount of androgens synthesized by the body. Also, the indicator is used to calculate the ratio of androsterone / etiocholanolone.

Epiandrosterone (isoandrosterone) is a metabolite of DHEA and an isomer of androsterone, exhibiting 5-7 lower androgenic activity than androsterone. According to the level of epiadndroterone, a conclusion is made about the activity of the enzyme 5 alpha reductase.

Etiocholanolone is a metabolite of androstenedione, formed with the participation of the enzyme 5β-reductase. There is no androgenic activity. The indicator is used to analyze the work of the adrenal glands and calculate the androsterone / etiocholanolone ratio.

The calculation of the ratio of androsterone / etiocholanolone is carried out to determine the ratio of the activity of two enzymes - 5α-reductase and 5β-reductase, the first of which is involved in the conversion of testosterone or androstenedione into the active, and the second - inactive form. The resulting indicator allows us to make a conclusion about the effectiveness of testosterone, DHEA and androstenedione in virilizing transformation.

Calculation of the ratio of testosterone and epitestosterone is intended to determine the performance of systems that produce enzymes for the transformation of testosterone into inactive metabolites. On the basis of the obtained indicator, a conclusion is made about the efficiency of the conversion of testosterone, especially when it enters the body from the outside.

Estrogens are a subclass of female steroid hormones. For their production in women, the follicular apparatus is responsible, in men - the testes (they produce up to 20% of the total amount of the hormone). In both sexes, estrogens are synthesized by the adrenal cortex, skin, adipose tissue, hair follicles, bones, and the brain.

The function of the hormone in the female body is to ensure the normal development and work of the reproductive system, in the male - the normalization of the functioning of the testicles and prostate gland.

In the human body, there are three forms of estrogens - estrone (E1), estradiol (E2), estriol (E3). The most active of these is estradiol, followed by estriol. The most inactive minor form of estrogen is estrone. Estrone, estradiol and estriol are formed as a result of a complex interaction between androgens (male steroid hormones) and enzymes.

Progestogens are a subclass of female steroid hormones. In the female body, they are produced by the corpus luteum of the ovaries, the placenta and in a small amount of the adrenal cortex. The function of these hormones is to ensure the onset and maintenance of pregnancy. With their participation, the formation of a normal secretory endometrium occurs, during which the internal mucous membrane of the uterus passes from the proliferative phase to the secretory phase. In addition, progestogens suppress the synthesis of estrogens, androgens, gonadotropic hormones (a subclass of tropic hormones produced by the anterior pituitary gland and the placenta).

In the male body, the production of progestogens occurs in small quantities. They are an intermediate in the production of cortisol and testosterone. As an independent biologically active substance, progestogens are involved in the functioning of the central nervous system. The adrenal cortex and testes are responsible for the synthesis of these hormones.

Estradiol, the most active form of estrogen, is produced by granulosis and is their main hormone. Its formation comes from the precursor of testosterone. In addition, granulosis synthesizes estrone, but its amount is less than that of estradiol. The liver and placenta convert estrone to estriol. Granulosis also produce progesterone (this hormone is necessary for ovulation), but in very small quantities. The main "producer" of progesterone is the cells of the corpus luteum, which are controlled by luteinizing hormone (produced by the pituitary gland). The cyclicity of the secretory activity of these cells is influenced by the sexual cycle of women.

With the assistance of estrogens, the following processes take place:

• development of the embryo and the formation of its sexual characteristics;
• puberty;
• development of female sexual characteristics;
• establishing the sexual cycle of women;
• development of muscles and glandular epithelium of the uterus;
• the formation of the mammary glands;
• regulation of sexual behavior (behavior associated with the implementation of sexual needs);
• development of the female reproductive cell (ovogenesis);
• fertilization and egg implantation;
• normal delivery.

The genomic effect of estrogens is manifested in suppressing the process of destruction (resorption) of bone tissue, providing a general anabolic effect (i.e. hormones contribute to the formation of new substances or structures), although it is less pronounced than in androgens. The action of the non-genomic mechanism of estrogen is directed to:

• on the retention of salts, nitrogen and water in the body;
• activation of NO-synthetase - an enzyme that accelerates the reaction of nitrogen oxidation in coronary vessels, which is a kind of prevention of the development of coronary artery disease (coronary heart disease) in women;
• modulation of insulin secretion and maintenance of calcium balance within cells.

The multifunctionality of estrogens is explained by the prevalence of their receptors on the membranes of various types of body cells (blood, nerve, bone, secretory, muscle, connective tissue cells). Therefore, a sharp drop in their level in the female body during menopause is the reason for a change in the work of various systems.

The action of progesterone is aimed at weakening the readiness of the uterine muscles to contract, i.e. the hormone acts as a "guarantor" of the preservation of pregnancy. In small amounts, it is involved in the ovulation process. Progesterone also inhibits the production of aldosterone by the adrenal cortex, stimulates the process of excretion of sodium in the urine.

An increase in the concentration of progesterone can cause an increase in body temperature by 0.5-0.7 ° C (i.e., it has a thermogenic effect with an increase in the level). When it enters the liver, progesterone partially loses its activity due to the rapid formation of conjugated (bound) compounds, as a result of which biologically inactive products are formed. Pregnanediol - the main one, accumulates in adipose tissue and is a source of progesterone if the body stops synthesizing it. The ability of pregnandiol to accumulate for a long time in adipose tissue explains the stability of its level in urine when intramuscularly large doses of gesterone (female sex hormone) are injected, although progesterone from the blood quickly disappears. To date, the following scheme has been adopted for the conversion of progesterone in the liver: progesterone → pregnandione → pregnenolone → pregnandiol.

The consequence of a violation of the production of estrogen can be among women:

• dysfunction of the ovaries;
• violation of the menstrual cycle;
• slowing down or accelerating sexual development.

among men:

• functional disorders of the epididymis and testicles;
• disorders in the development of germ cells;
• decrease in reproductive capacity;
• enlargement of one or both breasts.

among both sexes:

• osteoporosis;
• fatty degeneration of the liver;
• obesity;
• infertility.