Chris Kresser: This is another one of those nuances that’s also very confusing and somewhat complex, and you can refer back to the materials for this because I’m just going to kind of give an overview here, but I’m not going to go into the full detail that I do in the unit.
Total DHEA cannot be measured in the urine, and that’s really important to remember because obviously we’re doing a urine test and it cannot measure total DHEA. You can measure DHEA-sulfate, which is written as DHEA-S with no parentheses around the S. So with the Comprehensive DUTCH Test, they look at DHEA-sulfate, and then they look at two DHEA metabolites—etiocholanolone and androsterone, and that is viewed as a very good estimate of total DHEA production. However—and I mentioned this in Part Two of DUTCH Test—there are some situations where you can see normal total DHEA with either low DHEA-sulfate on the urine test or high DHEA-sulfate on the urine test. It’s not a very common presentation, but it does come up, as you’ve already seen. What it sounds like you’re seeing, Brent, is DHEA-sulfate normal on the urine test and then total DHEA on the blood test is low, and that can happen … I think a specific example of this where I had a 38-year-old male with ulcerative colitis and his DHEA on the DUTCH test—total DHEA, including etiocholanolone and DHEA-sulfate—was … No, that was a different situation. Let me see if I can find an example of this.
I can’t find a specific example, but essentially … Oh, it was DHEA-sulfate that was measured in the serum. OK, let me get this straight. Sorry for the confusion, everyone. I wish someone would figure out a better way to write total DHEA that wasn’t so confusing. It sounds like Brent’s patient had—and confirm this, Brent—total DHEA was in the mid-normal range on the DUTCH test? Or was DHEA-sulfate alone in the mid-normal range? That makes a difference. Since total DHEA on the DUTCH is a combination of etiocholanolone, androsterone, and DHEA-sulfate, it’s possible that DHEA-sulfate could be low on DUTCH but the total DHEA could still be normal if etiocholanolone and androsterone are high enough. If you mean that DHEA-sulfate on the urine test was normal, but DHEA-sulfate in serum was low, then I would probably go with the serum value in terms of which one to favor in terms of accuracy there.
I probably just thoroughly confused everyone. If you’re on the live call and you have any clarification questions, let me know. The key things to remember here are that you cannot measure total DHEA in the urine; you can only measure DHEA-sulfate. However, DUTCH has added etiocholanolone and androsterone, which are DHEA metabolites, and combined them with DHEA-sulfate to give a better representation of overall DHEA production. Then when you measure serum, you can either measure total DHEA and/or DHEA-sulfate, or you can measure both. And if there is a conflict between DHEA total or DHEA-sulfate between blood and urine, I would probably favor the serum values. Hopefully that clarifies it a bit.