The clinical and biochemical significance of 11-oxygenated androgens in human health and disease.

For many decades, the prevailing paradigm in endocrinology was that testosterone and 5α-dihydrotestosterone (DHT) are the only potent androgens in the context of human physiology. The more recent identification of adrenal derived 11-oxygenated androgens and particularly, 11-ketotestosterone (11KT), have challenged these established norms, prompting a revaluation of the androgen pool, particularly in women. Since being recognised as bone fide androgens in humans, numerous studies have focussed their attention on understanding the role of 11-oxygenated androgens in human health and disease and have implicated them as role players in conditions such as castration resistant prostate cancer, congenital adrenal hyperplasia, polycystic ovary syndrome, Cushing's syndrome and premature adrenarche. This review therefore provides an overview of our current knowledge on the biosynthesis and activity of 11-oxygenated androgens with a focus on their role in disease states. We also highlight important analytical considerations for measuring this unique class of steroid hormone.