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Metabolites that significantly correlated with PROMIS-Fatigue T -scores were overrepresented by the steroid hormone biosynthesis pathway (KEGG ID: M00107), including androgen and estrogen metabolism (SMPDB ID: SMP0000068) and androstenedione metabolism (SMPDB ID: SMP0030406) (Figure 4C), which included androsterone sulfate ( r = 0.26, p = 0.0009), epiandrosterone sulfate ( r = 0.25, p = 0.0016), etiocholanolone glucuronide ( r = 0.19, p = 0.018), and dehydroepiandrosterone sulfate (DHEA-S) ( r = 0.18, p = 0.023)