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dihydronorethisterone dhnet active metabolite norethisterone norethindrone androgenic estrogenic liver progestogenic antiprogestogenic selective progesterone receptor modulator sprm receptor pr androgen ar estrogen er 3d hormone hormonal therapy replacement function action endocrine level prohormone analogue metabolism biosynthesis cycle mechanism pathway path catabolism biosynthetic intermediate biogenesis substrate precursor synthesis derivative bioprecursor metabolic enzyme endogenous contractor