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11-Hydroxy-Etiocholanolone, a less commonly discussed but significant androgen, represents a unique aspect of adrenal steroid metabolism. 

Metabolites such as 11-hydroxy-etiocholanolone play a crucial role in our understanding of hormonal regulation and adrenal function. 

This metabolite, a product of adrenal steroidogenesis, offers researchers a window into the intricate processes of steroid metabolism and the body's stress response mechanisms. With its significant implications for health, from hormone balance to immune system interactions, 11-hydroxy-etiocholanolone has become a focal point in medical research. 

This article delves into the nature of 11-hydroxy-etiocholanolone, exploring its formation, functions, and the pivotal role it plays in both physiological and pathological states, shedding light on its potential as a marker in diagnosing and understanding various health conditions.

Understanding 11-Hydroxy-Etiocholanolone

Definition: What is 11-Hydroxy-Etiocholanolone? [2., 4., 6., 8.]

11-hydroxy-etiocholanolone is an end product of androgen metabolism that is pivotal in adrenal steroidogenesis research, serving as a key marker for studying steroid metabolism and enzyme pathways involved in steroid degradation. 

This compound is instrumental in understanding the regulation of hormone levels, homeostasis, and its potential roles in immune modulation.  It also has broader implications in the study of stress response and physiological adaptation to environmental and physiological changes.

11-hydroxy-etiocholanolone is a member of the 11-oxyandrogen family.  These compounds  represent a class of adrenal-derived C19 steroids that include both potent androgens and inactive precursors. 

Traditionally overshadowed by testosterone and 5α-dihydrotestosterone, recent discoveries highlight the significance of 11-oxygenated androgens in human physiology, expanding our understanding of the androgen pool, especially in women. 

These androgens are synthesized primarily in the adrenal cortex through the action of cytochrome P450 11β-hydroxylase (CYP11B1) and contribute to various conditions including congenital adrenal hyperplasia, polycystic ovary syndrome, and Cushing's syndrome. 

Peripheral tissues play a key role in converting the circulating precursor 11β-hydroxyandrostenedione (11OHA4) into active androgens like 11-ketotestosterone.  11β-hydroxyandrostenedione can also be converted to 11-hydroxy-etiocholanolone. 

11-hydroxy-etiocholanolone can also be produced from cortisol.  [3.] 

This process is influenced by factors such as body mass index (BMI) and insulin resistance, highlighting the metabolic significance of 11-oxygenated androgens. 

Physiological Roles of 11-Hydroxy-Etiocholanolone  [7., 8., 9.] 

11-hydroxy-etiocholanolone is an androgen metabolite, so it is considered a marker for androgen levels.  Elevated levels signify elevated levels of androgen production or exogenous use.  

Unlike traditional androgens, 11-oxyandrogens do not show an age-related decline in concentration, indicating their continuous relevance across the human lifespan.  [9.]

This insight has sparked a broader reevaluation of their roles, particularly in conditions characterized by androgen excess such as congenital adrenal hyperplasia, premature adrenarche, polycystic ovary syndrome, and even in the androgen-dependent dynamics of castration-resistant prostate cancer. 

Measuring adrenal-origin androgens like 11-keto-testosterone, 11-keto-dihydrotestosterone, and their metabolites  is increasingly recognized as clinically important, especially for diagnosing and monitoring conditions with androgen excess. 

In congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, levels of 11-keto-testosterone are significantly elevated.

Such measurements are also crucial for understanding conditions like polycystic ovarian syndrome (PCOS), where elevated adrenal activity is common but not always reflected in total testosterone levels. 

These androgens contribute significantly to the circulating androgen pool, remain stable across the menstrual cycle, and do not decline with age as sharply as other androgens, necessitating age-specific reference ranges. 

Clinically, the role of adrenal androgens is pivotal in understanding androgen-deprivation therapies for conditions like prostate cancer, where blocking adrenal androgens may enhance therapy efficacy. 

Production of 11-Hydroxy-Etiocholanolone and other 11-Hydroxy-Androgens  [5.] 

The production of 11-oxyandrogens is primarily mediated by the adrenal enzyme cytochrome P450 11β-hydroxylase (CYP11B1), which is abundantly expressed in the zona fasciculata and zona reticularis of the adrenal gland. 

This enzyme catalyzes the last step in cortisol synthesis under the influence of adrenocorticotropic hormone (ACTH) and also converts androstenedione (A4) and testosterone (T) into 11β-hydroxyandrostenedione (11OHA4) and 11β-hydroxytestosterone (11OHT), respectively.  11β-hydroxyandrostenedione (11OHA4) can be converted into 11-hydroxy-androsterone or 11-hydroxy-etiocholanolone.  [3.]

While 11β-hydroxyandrostenedione can also be synthesized from cortisol, this is a less significant pathway. 

Both 11OHA4 and 11OHT are further metabolized by 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2) into their respective ketosteroids, 11-ketoandrostenedione (11KA4) and 11-ketotestosterone (11KT), processes occurring in both the adrenal gland and peripheral tissues. 

11-ketoandrostenedione is then converted to 11-keto-androsterone by a 17-beta hydroxylase.  [1.] 

Additionally, 11KT can be formed by the reduction of 11KA4, facilitated by aldo-keto reductase 1C3 (AKR1C3) or 17β-hydroxysteroid dehydrogenase type 5 (17βHSD5). Moreover, 11-ketodihydrotestosterone (11KDHT) can be produced from 11β-hydroxydihydrotestosterone (11OHDHT) through 11βHSD2, or from 11-keto-5α-androstanedione (11KDHA4) via AKR1C3.

Laboratory Testing for 11-Hydroxy-Etiocholanolone

Laboratory Test Information, Sample Collection and Preparation

Laboratory assessment of 11-Hydroxy-Etiocholanolone is typically accomplished via urine.  A 24-hour urine collection may be recommended or required.  

It is essential to consult with the ordering healthcare provider prior to sample collection, as alterations in medication use may be recommended.  

Interpretation of 11-Hydroxy-Etiocholanolone Results

Reference Range for 11-Hydroxy-Etiocholanolone Testing

It is recommended to consult with the laboratory company used to interpret test results.

Clinical Significance of Elevated 11-Hydroxy-Etiocholanolone Levels

Causes of increased 11-hydroxy-etiocholanolone levels can include:

Congenital adrenal hyperplasia (CAH): specifically, forms like 21-hydroxylase deficiency which leads to increased production of adrenal androgens.  [5., 9.] 

Adrenal tumors: tumors or hyperplasia in the adrenal glands can lead to excessive production of 11-oxygenated androgens.  [9.] 

Polycystic ovary syndrome (PCOS): although primarily associated with ovarian androgen excess, PCOS may also involve adrenal contributions to elevated androgen levels.  [9.] 

Endocrine disorders: Other disorders that dysregulate the hormonal balance, leading to increased adrenal androgen production.  [9.] 

Clinical Significance of Low Levels of 11-Hydroxy-Etiocholanolone

Low levels of 11-hydroxy-etiocholanolone may not be considered clinically relevant.  However, in the presence of symptoms of androgen deficiency, low levels of 11-hydroxy-etiocholanolone may signal an androgen deficiency.    ‌

Testing Biomarkers Related to 11-Hydroxy-Etiocholanolone

Understanding related biomarkers alongside 11-Hydroxy-Etiocholanolone can offer a more comprehensive assessment of adrenal health and hormonal balance.


Cortisol, often referred to as the "stress hormone," is a key steroid hormone produced by the adrenal glands. It plays essential roles in regulating metabolism, immune function, and stress responses. 

Measurement of cortisol levels in serum or saliva is commonly used to assess adrenal function and diagnose conditions such as adrenal insufficiency, Cushing's syndrome, and adrenal tumors. 

Cortisol testing may complement 11-hydroxy-etiocholanolone measurements in evaluating adrenal steroidogenesis and identifying abnormalities in cortisol metabolism.

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is a precursor hormone synthesized by the adrenal glands and gonads. It serves as a substrate for the production of androgens and estrogens, playing a role in sexual development, mood regulation, and immune function. 

Measurement of DHEA levels in serum or saliva can provide insights into adrenal function and hormonal balance. Alterations in DHEA levels may indicate adrenal dysfunction, aging-related changes, or metabolic disorders. 

Assessing DHEA levels alongside 11-hydroxy-etiocholanolone can enhance the evaluation of adrenal steroidogenesis and hormonal status.


Androstenedione is an androgenic steroid hormone synthesized in the adrenal glands and gonads. It serves as a precursor for testosterone and estrone, contributing to the androgenic and estrogenic pathways. 

Measurement of androstenedione levels in serum or urine can aid in assessing adrenal and gonadal function and diagnosing conditions such as adrenal tumors, polycystic ovary syndrome (PCOS), and congenital adrenal hyperplasia (CAH). 

Monitoring androstenedione levels alongside 11-hydroxy-etiocholanolone may provide additional insights into adrenal steroidogenesis and androgen metabolism.


Aldosterone is a mineralocorticoid hormone synthesized by the adrenal cortex, primarily in response to changes in blood pressure, sodium, and potassium levels. It plays a crucial role in regulating electrolyte balance, blood volume, and blood pressure. 

Measurement of aldosterone levels in serum or urine is used to evaluate adrenal function and diagnose conditions such as primary aldosteronism (Conn's syndrome), adrenal hyperplasia, and adrenal tumors. 

Assessing aldosterone levels alongside 11-hydroxy-etiocholanolone can help assess adrenal steroidogenesis and mineralocorticoid activity, particularly in the context of adrenal disorders and hypertension.

Order 11-Hydroxy-Etiocholanolone Testing

Click here to order testing for 11-Hydroxy-Etiocholanolone.

11-Hydroxy-Etiocholanolone, often shortened to 11-OH-Etiocholanolone, is a naturally occurring substance in your body. It's a type of steroid, but not the kind that athletes might misuse. Instead, it's a part of your body's complex system for managing stress and maintaining balance. This substance is a metabolite, which means it's a product of the body's metabolic processes. Specifically, it's a metabolite of cortisol, a hormone that your body produces in response to stress. When you're under stress, your body produces more cortisol, and as a result, more 11-Hydroxy-Etiocholanolone. 11-Hydroxy-Etiocholanolone is a bit like a footprint that cortisol leaves behind. By measuring the levels of this substance in your body, doctors can get an idea of how much cortisol your body has been producing. This can provide valuable insights into how your body is managing stress and maintaining balance.
If Your Levels Are High
High levels of 11-Hydroxy-Etiocholanolone in your body could indicate that you've been experiencing a lot of stress, as this substance is a byproduct of cortisol, the hormone your body produces when you're under stress. It could also suggest that your body is producing more cortisol than usual, which could be due to a variety of factors. For instance, certain medications, such as corticosteroids or hormonal contraceptives, can increase cortisol production. Additionally, conditions like Cushing's syndrome, which is characterized by an overproduction of cortisol, could also result in elevated levels of 11-Hydroxy-Etiocholanolone. Therefore, high levels of this substance could be a sign that your body is trying to manage a high-stress situation, whether it's due to external factors like medication or an underlying health condition.
Symptoms of High Levels
Symptoms of high levels of 11-Hydroxy-Etiocholanolone could potentially mirror those of high cortisol levels, including fatigue, difficulty sleeping, weight gain, and mood swings. However, it's important to note that these symptoms are quite general and could be caused by a variety of factors.
If Your Levels are Low
Low levels of 11-Hydroxy-Etiocholanolone in your body could suggest that your body isn't producing as much cortisol as it usually does. Cortisol is a hormone that your body makes when you're stressed, so low levels could mean that you're not under a lot of stress, or that your body isn't responding to stress in the usual way. Certain medications, like steroids or drugs that affect your immune system, can also lower your cortisol levels. In some cases, low levels might be a sign of a health condition like Addison's disease, which affects your body's ability to produce cortisol.
Symptoms of Low Levels
Symptoms of low levels of 11-Hydroxy-Etiocholanolone could include fatigue, muscle weakness, loss of appetite, weight loss, low blood pressure, and abdominal pain.
See References

[1.] Barnard L, Nikolaou N, Louw C, et al. The A-ring reduction of 11-ketotestosterone is efficiently catalysed by AKR1D1 and SRD5A2 but not SRD5A1. The Journal of Steroid Biochemistry and Molecular Biology. 2020;202:105724. doi: 

[2.] Bashaw MJ, Sicks F, Palme R, Schwarzenberger F, Tordiffe AS, Ganswindt A. Non-invasive assessment of adrenocortical activity as a measure of stress in giraffe (Giraffa camelopardalis). BMC Vet Res. 2016 Oct 18;12(1):235. doi: 10.1186/s12917-016-0864-8. PMID: 27756312; PMCID: PMC5070010.

[3.] Etiocholanolone - an overview | ScienceDirect Topics. Accessed April 15, 2024. 

[4.] Jung BH, Bai SW, Chung BC. Endogenous urinary steroids in premenopausal women with uterine leiomyomas. Int J Gynaecol Obstet. 2004 Jan;84(1):55-60. doi: 10.1016/s0020-7292(03)00336-9. PMID: 14698830. 

[5.] Kamrath C, Wettstaedt L, Boettcher C, Hartmann MF, Wudy SA. Androgen excess is due to elevated 11-oxygenated androgens in treated children with congenital adrenal hyperplasia. Journal of steroid biochemistry and molecular biology/˜The œJournal of steroid biochemistry and molecular biology. 2018;178:221-228. doi: 

[6.] Shackleton CH, Neres MS, Hughes BA, Stewart PM, Kater CE. 17-Hydroxylase/C17,20-lyase (CYP17) is not the enzyme responsible for side-chain cleavage of cortisol and its metabolites. Steroids. 2008 Jul;73(6):652-6. doi: 10.1016/j.steroids.2008.02.001. Epub 2008 Feb 13. PMID: 18355883.

[7.] Stárka L, Dušková M, Vítků J. 11-Keto-testosterone and other androgens of adrenal origin. Physiol Res. 2020 Sep 30;69(Suppl 2):S187-S192. doi: 10.33549/physiolres.934516. PMID: 33094617; PMCID: PMC8603739.

[8.] Storbeck KH, O’Reilly M. The clinical and biochemical significance of 11-oxygenated androgens in human health and disease. European journal of endocrinology. 2023;188(4):R98-R109. doi: 

[9.] Turcu AF, Rege J, Auchus RJ, Rainey WE. 11-Oxygenated androgens in health and disease. Nat Rev Endocrinol. 2020 May;16(5):284-296. doi: 10.1038/s41574-020-0336-x. Epub 2020 Mar 16. PMID: 32203405; PMCID: PMC7881526.

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