Test ID: DHTS
Dihydrotestosterone, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring patients receiving 5 alpha-reductase inhibitor therapy or chemotherapy
Evaluating patients with possible 5 alpha-reductase deficiency
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
See Steroid Pathways in Special Instructions.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
5-Alpha-Dihydrotestosterone
Allodihydrotestosterone
Androstanolone
DHT
Serum Dihydrotestosterone
Stanolone
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Specimen Volume: 1 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | Mild OK; Gross OK |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Refrigerated (preferred) | 7 days |
| Frozen | 90 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
The principal prostatic androgen is dihydrotestosterone (DHT). Levels of DHT remain normal with aging, despite a decrease in the plasma testosterone, and are not elevated in benign prostatic hyperplasia (BPH).(1)
DHT is generated by reduction of testosterone by 5 alpha-reductase. Two isoenzymes of 5 alpha-reductase have been discovered. Type 1 is present in most tissues in the body where 5 alpha-reductase is expressed, and is the dominant form in sebaceous glands. Type 2 is the dominant isoenzyme in genital tissues, including the prostate.
Androgenetic alopecia (AGA; male-pattern baldness) is a hereditary and androgen-dependent progressive thinning of the scalp hair that follows a defined pattern.(2) While the genetic involvement is pronounced but poorly understood, major advances have been achieved in understanding the principal elements of androgen metabolism that are involved. DHT may be related to baldness. High concentrations of 5 alpha-reductase have been found in frontal scalp and genital skin and androgen-dependent processes are predominantly due to the binding of DHT to the androgen receptor (AR). Since the clinical success of treatment of AGA with modulators of androgen metabolism or hair growth promoters is limited, sustained microscopic follicular inflammation with connective tissue remodeling, eventually resulting in permanent hair loss, is considered a possible cofactor in the complex etiology of AGA.
Currently available AGA treatment modalities with proven efficacy are oral finasteride, a competitive inhibitor of 5 alpha-reductase type 2, and topical minoxidil, an adenosine triphosphate-sensitive potassium channel opener that has been reported to stimulate the production of vascular endothelial growth factor in cultured dermal papilla cells.
Currently, many patients with prostate disease receive treatment with a 5 alpha-reductase inhibitor such as finasteride (Proscar) to diminish conversion of DHT from testosterone.
See Steroid Pathways in Special Instructions.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Males
Cord blood: < or =100 pg/mL
< or =6 months: < or =1,200 pg/mL
Tanner Stages
| Mean | Age | Reference Range (pg/mL) |
| Stage I (>6 months and prepubertal) | 7.1 years | < or =50 |
| Stage II | 12.1 years | < or =200 |
| Stage III | 13.6 years | 80-330 |
| Stage IV | 15.1 years | 220-520 |
| Stage V | 18 years | 240-650 |
>19 years: 112-955 pg/mL
Females
Cord blood: < or =50 pg/mL
< or =6 months: < or =1,200 pg/mL
Tanner Stages
| Mean | Age | Reference Range (pg/mL) |
| Stage I (>6 months and prepubertal) | 7.1 years | < or =50 |
| Stage II | 10.5 years | < or =300 |
| Stage III | 11.6 years | < or =300 |
| Stage IV | 12.3 years | < or =300 |
| Stage V | 14.5 years | < or =300 |
20-55 years: < or =300 pg/mL
>55 years: < or =128 pg/mL
1. Pang S, Levine LS, Chow D, et al: Dihydrotestosterone and its relationship to testosterone in infancy and childhood. J Clin Endocrinol Metab 1979;48:821-826
2. Stanczyk FZ: Diagnosis of hyperandrogenism: biochemical criteria. Best Pract Res Clin Endocrinol Metab 2006;20(2):177-191
Interpretation Provides information to assist in interpretation of the test results
Patients taking 5 alpha-reductase inhibitor have decreased dihydrotestosterone (DHT) serum levels.
Patients with genetic 5 alpha-reductase deficiency (a rare disease) also have reduced DHT serum levels.
DHT should serve as the primary marker of peripheral androgen production. However, because it is metabolized rapidly and has a very high affinity for sex hormone-binding globulin (SHBG), DHT does not reflect peripheral androgen action. Instead, its distal metabolite, 3 alpha, 17 beta-androstanediol glucuronide, serves as a better marker of peripheral androgen action
See Steroid Pathways in Special Instructions.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Patients with benign prostatic hyperplasia (BPH) or prostatic cancer may not have elevated dihydrotestosterone (DHT) levels even though growth of the prostate gland may be stimulated by DHT.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Bartsch G, Rittmaster RS, Klocker H: Dihydrotestosterone and the concept of 5 alpha-reductase inhibition in human benign prostatic hyperplasia. World J Urol 2002;19(6):413-425
2. Trueb RM: Molecular mechanisms of androgenetic alopecia. Exp Gerontol 2002;37(8-9):981-990
3. Singh SM, Gauthier S, Labrie F: Androgen receptor antagonists (antiandrogens): structure-activity relationships. Curr Med Chem 2000;7(2):211-247
4. Rhodes L, Harper J, Uno H, et al: The effects of finasteride (Proscar) on hair growth, hair cycle stage, and serum testosterone and dihydrotestosterone in adult male and female stumptail macaques (Macaca arctoides). J Clin Endocrinol Metab 1994;79:991-996
5. Gustafsson O, Norming U, Gustafsson S, et al: Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a randomized population. Br J Urol 1996;77:433-440
Method Description Describes how the test is performed and provides a method-specific reference
Deuterated stable isotope (d[4]-DHT) is added to a 0.5 mL serum sample as internal standard. The DHT and internal standard are extracted from the sample by solid phase extraction. This is followed by conventional liquid chromatography on a multiplexed LC System and analysis on a tandem mass spectrometer equipped with an electrospray ion. (Lagerstedt SA, O'Kane DJ, Singh RJ: Measurement of plasma free metanephrine and normetanephrine by liquid chromatography-tandem mass spectrometry for diagnosis of pheochromocytoma. Clin Chem 2004;50[3]:603-611)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday, Wednesday, Friday; 10 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82651
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 81479 | Dihydrotestosterone, S | 1848-1 |
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