General Health

DHT (Dihydrotestosterone): What Is DHT’s Role In Baldness?

While some men wear a bald head with pride, others instead feel concerned when they start to notice signs of male pattern hair loss.

Healthy hair growth is often experienced during youth. As men grow older, there are a few things that change in their bodies.

The level of the male hormone testosterone starts to fall. Other hormones are also affected by age. This includes DHT, also known as Dihydrotestosterone

Women can also experience hair loss. Female pattern hair loss is, however, not as common as male pattern baldness. There are several reasons why men can experience hair loss. DHT hair loss is a popular topic that is addressed in publications. The level of DHT in the male body seems to affect their risk of scalp hair loss. 

We look at what Dihydrotestosterone is. We also consider how hair thinning may happen when levels of DHT are not normal. The post also looks at other reasons for balding, including hereditary hair loss. 

What Is DHT?

DHT is also known as Dihydrotestosterone. It is one of the many hormones that circulate through the male body. Dihydrotestosterone is classed as an androgen hormone. It acts upon androgen receptors and has several functions to play in the human body. 

The gonads in the male body make Dihydrotestosterone. This is both a sex steroid and an androgen.

A normal level of DHT should not cause severe problems in the male body. Some men do experience a high level of Dihydrotestosterone in their bodies, however. In such a case, there are a few issues that can develop.

Studies have linked DHT to problems with the production of hair. There also seem to be links between DHT and prostate enlargement1. This can lead to a condition known as benign prostatic hyperplasia. In some studies, DHT has also been associated with prostate cancer. 

The product of DHT relies on testosterone in men. There is an enzyme that converts testosterone into Dihydrotestosterone. This enzyme is known as 5-alpha-reductase. It is sometimes also referred to as 5-AR. The enzyme can be found in both the prostate gland and the testicles. It converts testosterone to DHT in both of these areas. 

About 10% of the testosterone in a man’s body will usually be converted into DHT. There are cases where a higher amount is converted. This is when men may sometimes experience adverse effects caused by a high level of DHT. 

What Does DHT Do?

The important roles of DHT start to play a part during the development of a fetus. Without DHT, a fetus would not be able to grow male genitals. The hormone helps with the development and growth of the prostate gland while the fetus is still growing. Additionally, DHT is also essential for testicle development in a fetus. 

DHT plays a role in the development of several factors that are generally associated with masculine characteristics. It helps with the deepening of a boy’s voice once he hits puberty. It also assists with the growth of body hair during this time. 

In adults, DHT also has essential roles to play. It ensures men can build up muscle mass. Androgen helps maintain muscle mass too. 

Dihydrotestosterone is generally considered to be a more powerful version of testosterone. It has many similar properties as testosterone. Both of these hormones contribute to masculine characteristics in the male body. DHT just seems to be more potent compared to testosterone

Both testosterone and DHT are attached to similar sites throughout the male body. There are two differences in the attachment process, however. These include:

  • DHT attaches to sites easier and faster than testosterone. This means the body can use more DHT compared to testosterone. 

  • DHT also remains attached to these sites for a more extended period than testosterone. 

DHT And Hair Loss

Among men, hair loss is one of the more common complaints. It can cause some men to experience low self-worth. It affects a man’s confidence. Understanding the role between DHT and hair loss can help men know what to expect and why they may be experiencing thinning hair. 

Studies have suggested that DHT might be the major risk factor related to male pattern hair loss. In one study2, hair follicles from a group of men were tested. Some of the men were bald, while others had normal hair growth. Hair follicles were collected from all the participants. 

This allowed the researchers to take a closer look at the differences in hair follicles from various participants. Hair follicles from bald patients were compared to those extracted from individuals with no signs of balding. 

It was found that more androgens were present in hair follicles from bald men. The number of androgens and androgen receptors were less in those with normal hair growth. The study suggests that an accumulation of DHT androgen hormones is one factor that leads to hair loss. 

Understanding how hair grows can help men know why DHT may be the reason behind hair loss. There are three specific phases related to hair growth. Each of these plays a specific role in allowing hair growth. 

  • Anagen: This is the growing phase of hair. Hair will remain in the anagen phase for up to six years. Hair grows longer when the anagen phase happens over a long period of time. Up to 85% of the hair on a man’s head will always be in this phase. 

  • Catagen: Hair goes from the anagen phase to the catagen phase. This is a short-term phase. It lasts for only about two weeks. The hair follicle is given this time to renew. 

  • Telogen: During the telogen phase, the hair follicle enters a resting phase. The phase may last for as long as our months. In normal situations, only up to 20% of hair may be in the telogen phase. 

There are androgen receptors in hair follicles on the head. When too much DHT attaches to these androgen receptors, it causes the follicle to shrink over time. The miniaturization of the follicle is what essentially contributes to the development of male pattern hair loss. 

The anagen phase becomes shorter every time when male pattern balding develop. Hair also starts to remain in the telogen phase for a longer period of time. This cycle becomes worse over time. Hair also becomes less anchored to the patient’s scalp. This makes it easier for hair to fall out. 

With every cycle of hair growth, the follicle itself starts to grow thinner. Vellus hairs begin to develop instead of standard hair. The hair is light and soft. They easily fall out and break. 

DHT And Testosterone

As we have noted previously, there is a link between DHT and testosterone. Both of these are sex and androgen hormones. They are both also looked at as steroid hormones.

There are many other similarities between DHT and testosterone. For example, both of these hormones are responsible for the development of male characteristics. 

One thing that should be taken into consideration is that DHT is more powerful than testosterone. 

The body uses an enzyme to convert testosterone into Dihydrotestosterone. Since DHT is so powerful, only a minimal amount of the testosterone in the body into this androgen hormone. 

In some men, there is an increase in DHT levels. In such a case, the problem may be with a high level of the enzyme that performs the conversion. This can cause more testosterone to be converted into DHT. In turn, testosterone levels decline, and DHT levels rise. This can lead to a higher risk of complications associated with increased DHT. 

How To Reduce DHT

High DHT levels are considered a major reason for men to develop pattern hair loss problems. With this in mind, men are frequently looking for methods that can help reduce hormone levels

Both natural and pharmaceutical options have been suggested in the past. Men do need to consider their options carefully. A significant reduction in DHT may lead to adverse events. This is why the careful dosage of drugs is needed to ensure DHT levels do not decline too quickly or too much. 

Saw palmetto had been suggested for men experiencing hair loss. This plant extract is mainly promoted as a natural DHT blocker. It primarily works against the enzyme that converts testosterone hormones into DHT. 

Some studies have considered how Saw Palmetto affects DHT production in the male body. Some of these studies have shown positive results. Some studies show positive effects in men with androgenetic alopecia. 

In one study3, Serenoa Repens is referred to specifically as a natural five alpha-reductase inhibitor. The paper does note that the current evidence related to Saw Palmetto as a DHT blocker is limited. There are a few studies that have shown positive results. Further studies are still requested to provide more evidence. 

Pharmaceutical interventions are generally advised for men with a significant increase in DHT levels. A doctor may sometimes prefer to do a few tests on the patient first. This allows the doctor first to identify the real reason for hair loss in the male patient. While DHT is often linked to balding, there are other causes too. 

A doctor needs to consider all the possible reasons why hair loss may occur. They may test for testosterone and DHT levels. This gives them an indication of whether or not there is too much Dihydrotestosterone in the patient’s body. 

When a doctor determines the patient is suffering from hair loss due to DHT, they may prescribe specific drugs. These drugs will then focus on reducing the amount of DHT in the male body. 

Finasteride is currently considered one of the most commonly used pharmaceutical drugs. It is also known as Propecia. The FDA approved the use of this drug for male pattern baldness in 1997. 

Finasteride is classified as a selection 5-AR inhibitor. It only inhibits the function of certain 5-alpha-reductase enzymes. 

To understand how the drug works, men do need to know that there are two types of 5-AR enzymes in the body. Type 1 is found in the sebaceous glands in the body. They help with the production of sebum. This is a natural lubricant that the skin uses. 

Type 2 is the one found in the genitourinary tract. Type 2 5-alpha reductase also attaches to hair follicles. 

When it comes to hair loss, it is type 2 of the 5-AR enzyme that needs to be addressed. The formulation used in the production of Finasteride focuses on these enzymes specifically. 

There are two ways for men to use Finasteride. The first includes the use of oral medication. The drug is taken on a daily basis. The patient will have to use Finasteride over the long term. 

An injection is also available. Finasteride is injected into the patient’s bloodstream directly. This helps to ensure the drug acts faster and more effectively. A regular injection is needed for this method to work effectively.

The patient may experience hair loss again if they stop with the treatment.  However, it is important to be aware that Finasteride can have several severe side effects.

A few companies also make DHT blocking shampoo. These shampoo products might help to reduce DHT from binding to receptors in hair follicles. They could help to improve hair density. 

Side Effects Of DHT Blockers

Some side-effects can happen in men who take DHT blockers. The specific adverse effects depend on the specific drug or DHT blocker the man uses. 

Even the natural Saw Palmetto extract had been shown to cause some side-effects. 

Most people with side effects from Saw Palmetto will not experience serious events. The side-effects are generally mild. They can, however, still interfere with the man’s day-to-day activities. 

These side-effects may include4:

  • Constipation

  • Diarrhea

  • Headache

  • Nausea

  • Vomiting

Some reports have also claimed that there is a risk of impotence when using Saw palmetto. This is a very rare side-effect, however. It is still something that men should be aware of. 

Finasteride, on the other hand, does seem to cause a few unpleasant side-effects. In some cases, men may find that these side-effects disrupt certain areas of their life. 

A few of the possible side-effects associated with Propecia include5:

  • Swelling of the man’s breasts.

  • Breast tissue may be tender.

  • There may be swelling in the feet or hands.

  • Weakness may occur. 

  • Some men feel dizzy. 

  • A runny nose has been reported too. 

  • Some men reported a skin rash. 

    ~
  • Headaches seem to be common. 

There have also been cases where men experienced sexual side-effect. These included abnormal ejaculation. Some men find it hard to have an orgasm while using the drug. A loss of libido has been reported. In rare cases, men may also find that the drug causes erectile dysfunction symptoms

A few rare cases report that sexual side effects remain present even when the man stops taking the drug. This is why men should ensure they discuss the use of Propecia with their doctor first. Careful consideration should go into this decision. Men should consider alternative options if the possibility of sexual side-effects seems too serious for them. 

Other Causes Of Hair Loss

While an increase in DHT is a major cause of hair loss, this is not the only reason why men may experience balding symptoms.

There are other reasons for hair loss to occur too. Men should ensure they understand all of the possible reasons. This ensures they are able to analyze their own situation more accurately. 

Other potential causes of hair loss include:

  • With age, the skin may become drier. This can cause shrinkage of hair follicles. In turn, hair loss may be experienced. 

  • Some medications can lead to hair loss. 

  • An imbalance in testosterone may also harm hair growth. This is primarily due to an increased buffer in hair follicles. It is also important to consider other hormones, such as Thyroid hormone. Healthy hair growth needs an appropriate balance in hormones. 

  • Stress has also been linked to hair loss. If a man goes through a very stressful time, then there is a risk of hair loss. This is only temporary hair loss, however. The man will find that hair starts to grow normally again once the stress passes. 

Conclusion

Hair loss is a common issue in the male population. Alopecia, male pattern baldness, and several other conditions can cause hair loss. An appropriate hair loss treatment depends on the cause behind the symptoms.

A high level of Dihydrotestosterone may lead to problems with scalp hair and body hair growth. Some men may find that using a DHT blocking agent helps with hair growth. Other causes of hair loss also need to be considered, however. 

Sources

  1. Journal of Urology. (2004) Dihydrotestosterone and the Prostate: The Scientific Rationale for 5alpha-reductase Inhibitors in the Treatment of Benign Prostatic Hyperplasia. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/15371854/
  2. Journal of Endocrinology. (1998) Balding Hair Follicle Dermal Papilla Cells Contain Higher Levels of Androgen Receptors Than Those From Non-Balding Scalp. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/9496234/
  3. Journal of Cutaneous and Aesthetic Surgery. (2009) Serenoa Repens Does It have Any Role in the Management of Androgenetic Alopecia? [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840915/
  4. WebMD. Saw Palmetto. [online] Available at: https://www.webmd.com/vitamins/ai/ingredientmono-971/saw-palmetto#:~:text=Side%20effects%20are%20usually%20mild,than%20with%20a%20sugar%20pill.
  5.  RxList. Propecia. [online] Available at: https://www.rxlist.com/propecia-side-effects-drug-center.htm

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