Impact of hormonal contraceptives on urinary steroid profile in relation to serum hormone changes and CYP17A1 polymorphism

To detect doping with endogenous steroids, six urinary steroids are longitudinally monitored in the athlete biological passport (ABP). These steroids include testosterone, etiocholanolone, androsterone, 5 alpha-androstane-3 alpha,17 beta-diol, 5 beta-androstane-3 alpha,17 beta-diol, and the testosterone isomer epitestosterone. It is known that the intake of hormonal contraceptives may interfere with the ABP biomarkers. A previous study showed that athletes using hormonal contraceptives (HCs) display lower urinary epitestosterone concentrations than non-using athletes. In this study, we analyzed the urinary steroid profile prior to and three months after administration of an oral HC including levonorgestrel and ethinylestradiol (n = 55). The urinary concentrations of all the ABP metabolites decreased after three months, with epitestosterone showing the largest decline (median 6.78 to 3.04 ng/mL, p<0.0001) followed by 5 alpha-androstane-3 alpha,17 beta-diol (median 23.5 to 12.83 ng/mL, p<0.0001), and testosterone (median 5.32 to 3.66, p<0.0001). Epitestosterone is included in two of the five ratios in the ABP (T/E and 5 alpha Adiol/E), and consequently these ratios increased 1.7-fold (range 0.27 to 8.50) and 1.26-fold (range 0.14 to 5.91), respectively. Some of these changes may mimic the changes seen after administration of endogenous steroids leading to atypical findings. Notably, even though participants used the same contraceptive treatment schedule, the HC-mediated epitestosterone change varied to a large extent (median 0.43-fold, range 0.06 to 6.5) and were associated with a functional T>C promoter polymorphism in CYP17A1. Moreover, the epitestosterone changes correlated with HC-induced testosterone and gonadotropins changes in serum, indicating that urinary epitestosterone reflects the androgen load in HC-using women.