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. 2023 Sep 26;131(9):097009. doi: 10.1289/EHP11811

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EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.

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Figure 3 is an estrogen biosynthesis pathway with fourteen steps. Step 1: Cholesterol leads to Pregnenolone. Step 2: Pregnenolone leads to Progesterone and 17-hydroxypregnenolone. Step 3: Progesterone leads to 17-hydroxyprogesterone. Step 4: 17-hydroxypregnenolone leads to Dehydroepiandrosterone. Step 5: 17-hydroxyprogesterone and Dihydroandrostendione lead to Androstenedione. Step 6: Dehydroepiandrosterone leads to Androstenedione . Step 7: There is a bidirectional relationship between Dehydroepiandrosterone and Androstenediol. Step 8: There is a bidirectional relationship between Androstenedione and Testosterone. Step 9: Androstenedione leads to Estrone. Step 10: Androstenediol leads to Testosterone. Step 11: There is a bidirectional relationship between Testosterone and Estradiol. Step 12: There is a bidirectional relationship between Estrone and Estradiol. Step 13: Estradiol leads to 4-hydroxyestradiol. Step 14: 4-hydroxyestradiol leads to 4-methoxyestradiol. — Estrogen biosynthesis pathway (circulating hormones and at tissue level). Note: DHEA, dehydroepiandrosterone; OH, hydroxy.