DHT - Dihydrotestosterone

Dihydrotestosterone (DHT) is a hormone that plays a key role in the development of male characteristics in people assigned male at birth (AMAB) [1]. DHT is an androgen hormone that stimulates the growth of facial, body, and pubic hair, as well as the growth of the penis, scrotum, and prostate during puberty in AMAB individuals [3]. It is derived from testosterone, which is present in both men and women [4].

However, DHT can also contribute to male pattern hair loss as it is thought to cause hair follicles to miniaturize [2]. Finasteride, which is commonly used to treat male pattern baldness, works by blocking the formation of DHT [5]. However, this product can come with some side effects.

DHT also plays a crucial role in men's overall health. It is necessary for an energetic and athletic body and is a vital component of a healthy hormone profile [8]. In fact, DHT is an effective mood booster and can have neurological effects that last longer than those of testosterone [6]. However, abnormal levels of DHT and other androgens can lead to various health problems, such as low libido, erectile dysfunction, and prostate issues [9].

Overall, DHT is a hormone that is essential for the development of male characteristics during puberty and for maintaining men's overall health. While it is important for various bodily functions, abnormal levels of DHT can lead to health problems, and treatments such as finasteride can help regulate DHT levels [5].

What is DHT ?

Dihydrotestosterone (DHT) is synthesized from testosterone in the prostate gland, testes, hair follicles, and adrenal glands by 5-alpha reductase. Dihydrotestosterone exerts its action similar to testosterone, which binds to and activates androgen receptors. Dihydrotestosterone is responsible for the formation of male primary sex characteristics and most male secondary sex characteristics during puberty, such as muscular growth, facial and body hair growth, and deepening of the voice.

This test is performed with the sensitive liquid chromatography/mass spectrometry assay that has no interference with supplements like biotin used in hair growth.

With the exception of estradiol, no hormone is more misunderstood than dihydrotestosterone, DHT. In fact, many men actually fear DHT, going out of their way to lower it and frustrate its biological activity. However, DHT is actually a critical hormone, one that men need for sexual and prostate health, cognitive function, skeletal strength – and many other reasons. Like everything in life, there are downsides to DHT, but the upside of healthy DHT levels far outweighs the challenges it can present.

DHT – Where it Comes From

The principal hormone produced in men is, of course, testosterone. When testosterone is produced by the testicles (or injected/absorbed by a man on testosterone replacement) an enzyme, 5-alphareductase (5-AR) sets to work converting a portion of that testosterone to DHT. This conversion actually prevents some portion of testosterone from reaching the androgen receptors in the brain, genitals, skin, and other tissues. Initially, that may sound as if the body is being deprived of a needed hormone – testosterone. However, for the most part, this conversion is actually in a man’s best interest. DHT binds much more efficiently to androgen receptors, estimates vary, but it would seem that DHT is 300 to 500 percent more efficient at reaching and binding to the receptors, and is far more potent than testosterone. If tissues were deprived of DHT, if 5-AR hadn’t done its job, there would be dramatic physiological changes.  While it is true that testosterone remains the primary, active androgen in muscle/muscle development, DHT is still critical for the full performance enhancing effects of testosterone. Specifically, the impact of DHT on the central nervous system which bring about increased neurological efficiency/strength.

DHT – Positive Effects

 To understand DHT’s androgenic properties, consider the following.

• Male Development – Physical and sexual development in the human male is DHT-dependent. DHT is responsible for the growth and development of the penis, the prostate, and the testicles. It not only helps with sex differentiation during fetal development, it also supports the changes that occur during puberty and adulthood.
• Libido – A healthy sex drive is supported by DHT. Men with optimal levels of the hormone report a far stronger drive than men with lower levels.
• Prostate Health – It seems that men with balanced levels of DHT may have fewer prostate health issues.
• Cognitive Function – One study indicated that administering DHT to men between the ages of 34 and 70 resulted in memory improvements. The androgenic properties of the hormone encouraged the retrieval of stored memories as well as the archiving or new ones. Low/lower levels of DHT were linked to a decline in cognitive function in elderly men.
• Blood Sugar Management – Higher levels of DHT help to reduce the risk of diabetes by controlling sugar levels and preventing hyperglycemia. DHT can improve insulin sensitivity, support efforts to lose weight, and may provide adjunctive support in treating diabetes.
•  Cardiovascular Health – Men with coronary artery disease may benefit from higher levels of DHT since lower levels of the hormone have been shown to actually increase the risk of cardiovascular disease. It may be a simple association – higher levels of DHT might lower the mortality associated with heart disease.
• Stroke Risk – Researchers followed a group of men for six years and learned that higher levels of both DHT and testosterone seemed to lower the risk of stroke. 
• Depression – In one study, men who used finasteride, a drug that blocks 5-AR and, thus, generate lower levels of DHT, had higher rates of depression than a control group. DHT may well be necessary to support mental and emotional health.
• Anti-Aging – Higher levels of DHT, testosterone, and estradiol seem to slow the decline associated with aging. Lower levels of all three hormones brought about cellular changes seen in the elderly. Higher levels were associated with “younger” cellular function.
• Bone and Skeletal Health – Along with estradiol, appropriate levels of DHT support and maintain bone density in men.

DHT – The Downside

The DHT story is strongly, but not universally, positive. The drawbacks of DHT must be considered.

• Baldness – Hair loss is probably the number one DHT – negative in the minds of most men who are involved in testosterone therapy.  Studies have shown that higher levels of DHT are linked to an increase in male-pattern baldness. In women, elevated levels of DHT can actually lead to male-like patterns of hair growth.
• Cancer – DHT is critical for the normal development of the prostate, but high levels of the hormone have been associated with prostate cancer risk. However, studies on DHT and prostate cancer are contradictory.
• Acne – Inflammatory acne flares have been linked to DHT.

 DHT – The Bottom Line...a Friend or Foe?

For men, DHT is clearly a friend, and an important one. However, like virtually every hormone in the body, the key to health is balance. If DHT levels drop too far, men open themselves to low libido. 

DHT is not likely to be tested in most men undergoing testosterone replacement therapy. Some clinicians fail to recognize the importance of DHT for men’s health and libido – and so they fail to monitor it. It’s entirely possible, even likely, that some men are not obtaining the maximum benefits of  testosterone replacement because (unbeknownst to them) their DHT levels are not optimal.

How to Increase DHT

There are natural ways to boost DHT levels if one is not on a testosterone replacement protocol. Here are a few things that can be done.

• Exercise more – particularly resistance training and high-intensity training.

• Increase your intake of caffeine, creatine, or green tea supplements.

• Boost the amount of zinc in your diet, either via the food you’re eating or via a supplement.

• Take a DHEA supplement if your DHEA blood level is low.  Get a DHEA blood test

• Lose weight.

• Optimize your testosterone blood level if low.

• Last but not least, use a scrotal testosterone cream. Applying compounded (alcohol free) testosterone cream to the testicular skin has been shown to increase DHT considerably.

How to Decrease or Block DHT?

It should be clear that the vast majority of men have no reason to suppress their DHT levels. However, Propecia is still prescribed regularly for men anxious about losing their hair. As was noted, Propecia will stop or suppress the 5-AR activity that produces DHT. By stopping or slowing the work of 5-AR, male pattern baldness, one of the possible, negative side effects that DHT can produce, may be prevented or arrested. Unfortunately, there is evidence that some men who take this medication may risk lowering their libido and mood.

For reasons still not clearly understood, this medication can produce a syndrome in some men very similar to those symptoms associated with hypogonadism. Loss of libido, weak erections, malaise, and fatigue plague many men even after they have stopped the use of the drug. While it’s true that no one wants to lose their hair, no man wants to wind up with what has come to be known as post-finasteride syndrome.

With proper attention, DHT can be not only a friend, but an ally in the search for optimal health. Don’t fear it – accept it and have it work to your advantage.

References:

[1] "What is DHT (dihydrotestosterone)? DHT (dihydrotestosterone) is a hormone that plays a key role in the sexual development of people assigned male at birth (AMAB). More specifically, DHT is an androgen — a hormone that stimulates the development of male characteristics." URL: https://my.clevelandclinic.org/health/articles/24555-dht-dihydrotestosterone

[2] "DHT is an androgen and helps give males their male characteristics. DHT is thought to cause hair follicles to miniaturize, and this contributes to male pattern hair loss. By the age of 50 years ..." URL: https://www.medicalnewstoday.com/articles/68082

[3] "Dihydrotestosterone (DHT) is an androgen, or male hormone, that promotes the growth of facial hair, body hair, and pubic hair during puberty in those assigned male at birth. It also plays a role in the growth of the penis, scrotum, and prostate.  These effects are similar to those of testosterone." URL: https://www.verywellhealth.com/what-is-dihydrotestosterone-4684657

[4] "DHT is derived from testosterone. Testosterone is a hormone that's present in both men and women. It and DHT are androgens, or hormones that contribute to male sex characteristics when you go..." URL: https://www.healthline.com/health/dht

[5] "Finasteride: Finasteride (typically referred to as Propecia) obstructs the formation of DHT (dihydrotestosterone). "DHT is a male androgen hormonal agent which contributes to hair loss by making hair follicles short and thin," states Green. ""Hair grows in 3 phases, and DHT interrupts the hair growth cycle (anagen stage). As a result of ..." URL: https://thebiohack.org/what-is-dht-and-its-role-in-hair-loss/

[6] "DHT is an effective mood booster, for the brain to function at its best, it relies on optimum levels of all the main sex hormones ( Testosterone, DHT and Estrogen). It has been shown that the neurological effect of DHT can last many times longer that that of Testosterone." URL: https://lowtestosteroneexpert.com/the-effects-of-dht/

[7] "What is DHT? Dihydrotestosterone (DHT) is a male sex hormone with powerful androgenic properties. It plays a crucial role during puberty and is largely responsible for the development of adult male characteristics. Things like: Deeper voice, Muscle development Body hair, etc. DHT is quite literally derived from testosterone." URL: https://androgenhacker.com/dht

[8] "DHT is a natural hormone scientifically known as dihydrotestosterone. In men, it is necessary for an energetic, athletic body and a vital component of a healthy hormone profile. The primary form of DHT production comes from the enzyme 5-alpha-reductase (5-AR) which forms DHT from testosterone within the testicles and prostate gland of men." URL: https://itestosterone.com/dht-hormone-benefits/

[9] "In this article, we explain what testosterone and DHT are and provide an overview of how these hormones are produced and regulated by the body. We also discuss the role of these androgens in men's health and what can go wrong when androgen levels are abnormal. Lastly, we review treatments for low testosterone." URL: https://xyonhealth.com/article/role-of-testosterone-and-dht-mens-health/

[10] "DHT is an essential male hormone, not just for libido, or feeling manly, but for general health as well. DHT is synthesized from: Testosterone through the enzyme 5 alpha reductase (5AR) 17-hydroxypregnenolone and 17-hydroxyprogesterone in what is termed the "backdoor" pathway 5α-androstane-3α, 17-β-diol (dihydroandrosterone/3α-diol) via the intracrine reverse synthesis pathway (3α ..." URL: https://men-elite.com/2020/09/29/the-truth-on-dht-what-the-research-shows/