The first crystallographic structure of human type 3 3␣-hydroxysteroid dehydrogenase (3␣-HSD3, AKR1C2), an enzyme playing a critical role in steroid hormone metabolism, has been determined in complex with testosterone and NADP at 1.25-Å resolution. The enzyme's 17-HSD activity was studied in comparison with its 3␣-HSD activity. The enzyme catalyzes the inactivation of dihydrotestosterone into 5␣-androstane-3␣,17-diol (3␣-diol) as well as the transformation of androstenedione into testosterone. Using our homogeneous and highly active enzyme preparation, we have obtained 150-fold higher 3␣-HSD specificity as compared with the former reports in the literature. Although the rat and the human 3␣-HSDs share 81% sequence homology, our structure reveals significantly different geometries of the active sites. Substitution of the Ser 222 by a histidine in the human enzyme may compel the steroid to adopt a different binding to that previously described for the rat (Bennett, M. J., Albert, R. H., Jez, J. M., Ma, H., Penning, T. M., and Lewis, M. (1997) Structure 5, 799 -812). Furthermore, we showed that the affinity for the cofactor is higher in the human 3␣-HSD3 than the rat enzyme due to the presence of additional hydrogen bonds on the adenine moiety and that the cofactor is present under its reduced form in the active site in our preparation.Human 3␣-hydroxysteroid dehydrogenases (3␣-HSDs; 1 EC 1.1.1.213) work in concert with the 5␣/5-steroid reductases to convert steroid hormones into the 3␣/5␣ and 3␣/5-tetrahydrosteroids. These isozymes catalyze the inactivation of androgens, estrogens, progestins, and glucocorticoids. However, the inactivation of the most potent androgen 5␣-dihydrotestosterone (5␣-DHT) to 5␣-androstane-3␣,17-diol (3␣-diol) is its best known function (1). These isoenzymes thus play a major role in the regulation of the intracellular concentration of 3␣-DHT in peripheral tissues, especially in the androgen-sensitive prostate that is susceptible to benign prostatic hyperplasia and prostate cancer. Testosterone, after entering prostatic cells, is transformed to 5␣-DHT by 3-oxo-5␣-steroid-4-dehydrogenase (2, 3). 5␣-DHT is a more potent androgen than testosterone in stimulating prostate cancer growth (4, 5) and preferentially binds to the androgen receptor (dissociation constant (K d ) for the androgen receptor of 10 Ϫ11 M) (6). Elevation of 5␣-DHT content in prostate has been associated with benign prostatic hyperplasia in humans (6, 7) and with human prostate carcinoma (8, 9). The action of 5␣-DHT may be terminated by 3␣-HSD, which catalyzes the inactivation of 5␣-DHT to 3␣-androstanediol (a weak androgen; K d for the androgen receptor of 10 Ϫ6 M) (1). It has also been proposed that, by catalyzing the reverse reaction, 3␣-HSD may function as a molecular switch and, in this manner, may regulate the amount of 5␣-DHT available for androgen receptor binding and activation. Three isoforms of 3␣-HSD have been described in human tissues (10 -12) as playing critical roles in sex hormone metabolism and action...