5-Alpha-Tetrahydrocortisol + Tetrahydrocorticosterone/Tetrahydrocortisone Ratio, Urine
This urine test measures relative levels of cortisol and cortisone metabolites and can help evaluate steroid metabolism, especially 11-beta-HSD2 activity.
["The result can help identify abnormal handling of cortisol by the kidneys, particularly when hypertension or other steroid-related symptoms are present."]
Key facts at a glance
- LOINC
- 82856-6
- Short code
- THF+5a-THC/THE Ur-sRto
- Synonyms
- THF+5a-THC/THE Ur-sRto
- Category
- liver
- Sample
- urine
- Container
- Sterile urine container
- Units
- N/A
- Ref low
- 36
- Ref high
- 50
- Critical range
- 18 N/A – 60 N/A
- Fasting
- false
- Population
- adult
- Sex
- all
- Age range
- 18–65 years
- CPT
- 85014
- Specimen volume
- 10 mL
- Stability
- Room temperature: 2h, Refrigerated: 24h, Frozen: 7d
- Hemolysis max
- 0
- Lipemia max
- 0
- Icterus max
- 0
- TAT
- 4–24 hours
- Order
- routine
What is this test?
This test measures the relative amounts of several steroid metabolites in urine: 5-alpha-tetrahydrocortisol and tetrahydrocorticosterone compared with tetrahydrocortisone. These substances help show how the body and kidneys process cortisol and cortisone.
Why might I need this test?
A clinician may order it to evaluate steroid metabolism, including the activity of the 11-beta-HSD2 enzyme. It may be considered in people with hypertension, low renin levels, adrenal symptoms, or suspected excess mineralocorticoid activity.
How is the test performed?
A urine sample is collected and analyzed in the laboratory to determine the amounts of the steroid metabolites and calculate their ratio. The type of urine collection will depend on your clinician's instructions.
How do I prepare for the test?
Follow the collection instructions exactly. If a timed or 24-hour collection is requested, collect all urine during the specified period and record the total volume; otherwise, provide a urine sample when instructed. Do not stop medicines without medical advice.
Reference range
Adult males: 38-50%; Females: 36-44%N/A
No special preparation usually required. Stay well hydrated. Inform your healthcare provider of all medications and supplements you are taking.
Clinical interpretation
How abnormal results are interpreted and what conditions they suggest.
◆Associated findings1
Short name
Urinary 5-alpha-THF + THC/THE ratio
Frequently asked questions
What does the 5-alpha-THF + THC/THE ratio mean?
Is this the same as a serum cortisol test?
Can medications affect the result?
Sources
- 1
- 2Lab Tests OnlineSource
- 3
Click any link to access the full source. PubMed Central (PMC) links provide free full-text access.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed August 17, 2026. · Read our editorial policy