About 65% of circulating testosterone is bound to sex hormone-binding globulin. SHBG is increased in plasma by estrogen, by thyroid hormone, and in patients with cirrhosis of the liver. It is decreased by androgen and growth hormone and is lower in obese individuals. Most of the remaining testosterone is bound to albumin. Approximately 2% remains free and available to enter cells and bind to intracellular receptors.
In many target tissues, testosterone is converted to dihydrotestosterone by 5α-reductase. In these tissues, dihydrotestosterone is the major active androgen. The conversion of testosterone to estradiol by P450 aromatase also occurs in some tissues, including adipose tissue, liver, and the hypothalamus, where it may be of importance in regulating gonadal function.
The major pathway for the degradation of testosterone in humans occurs in the liver, with the reduction of the double bond and ketone in the A ring, as is seen in other steroids with a Δ4ketone configuration in the A ring. This leads to the production of inactive substances such as androsterone and etiocholanolone that are then conjugated and excreted in the urine.
Androstenedione, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEAS) are also produced in significant amounts in humans, although largely in the adrenal gland rather than in the testes. They contribute slightly to the normal maturation process supporting other androgen-dependent pubertal changes in the human, primarily development of pubic and axillary hair and bone maturation. As noted in Chapter 39, some studies suggest that DHEA and DHEAS may have other central nervous system and metabolic effects and may prolong life in rabbits. In men they may improve the sense of wellbeing and inhibit atherosclerosis. In a placebo-controlled clinical trial in patients with systemic lupus erythematosus, DHEA demonstrated some beneficial effects (see Adrenal Androgens, Chapter 39). Adrenal androgens are to a large extent metabolized in the same fashion as testosterone. Both steroids—but particularly androstenedione—can be converted by peripheral tissues to estrone in very small amounts (1–5%). The P450 aromatase enzyme responsible for this conversion is also found in the brain and is thought to play an important role in development.
In the normal male, testosterone or its active metabolite 5α-dihydrotestosterone is responsible for the many changes that occur in puberty. In addition to the general growth-promoting properties of androgens on body tissues, these hormones are responsible for penile and scrotal growth. Changes in the skin include the appearance of pubic, axillary, and beard hair. The sebaceous glands become more active, and the skin tends to become thicker and oilier. The larynx grows and the vocal cords become thicker, leading to a lower-pitched voice. Skeletal growth is stimulated and epiphyseal closure accelerated. Other effects include growth of the prostate and seminal vesicles, darkening of the skin, and increased skin circulation. Androgens play an important role in stimulating and maintaining sexual function in men. Androgens increase lean body mass and stimulate body hair growth and sebum secretion. Metabolic effects include the reduction of hormone binding and other carrier proteins and increased liver synthesis of clotting factors, triglyceride lipase, α1antitrypsin, haptoglobin, and sialic acid. They also stimulate renal erythropoietin secretion and decrease HDL levels.
Synthetic Steroids with Androgenic & Anabolic Action