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What would I do about low 5-α reductase activity?

Dr. Amy Nett: Great question. It depends a little bit. What do the rest of the hormones look like? Because in some people, if they have high androgen levels, low 5-α reductase activity isn’t actually an issue. More often the issue would be low testosterone or low androgens across the board, so I don’t know if you have a case where you have high androgens, but they are having symptoms of like low testosterone or low androgens, but I don’t know that I’ve come across a case where I’m only worried about low 5-α reductase activity. More often I see that in what looks to be almost like a protective mechanism, because 5-α reductase—when you go down that 5-α reductase pathway, you’re kind of making some of the more potent androgens. So sometimes I see in men who have just like high androgen levels, such as high testosterone, and all of the testosterone metabolites, the androgens are elevated. It seems like there tends to be lower 5-α reductase activity, and I think of that as the body almost protecting itself and not making those more potent forms. I don’t know that there is necessarily anything to do more specifically. I think it depends on what the clinical picture is. If the hormones are just low, and that’s your question, then what is causing the low hormones? Inflammation? And that’s when you go back to your sort of functional approach. What’s going on? Why is there hormonal imbalance?

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