For a long time, Dihydrotestosterone (DHT) has been given a bad rap because of its role in acne, hair loss, and prostate issues. This article examines previous theories about DHT, and the latest studies to see what science now reveals about this endogenous androgen sex steroid and hormone.
Science is ever-evolving -constantly changing and advancing. Over time, with more studies and new advancements in medical technology, knowledge also changes and we recognize that some of the older theories are wrong – so these get redacted and corrected. But, these new updates can take the general population longer to acknowledge or recognize.
What’s even worse, there are some doctors who do not stay abreast of the latest science and studies, and thus they continue to use the same old procedures, treatments, and theories that they were taught in medical school – which could be decades old, aka the old, outdated, debunked science of yesteryear.
This occurred with SHBG as was covered recently. This protein does far more than simply rendering hormones inert. Read more here.
Vitamin D is another good example. Science first identified it and believed it was only necessary for bone health. However, now we know it basically works in every system in the human body. (Not to mention the fact that “vitamin” is a poor classification for this compound).
If you missed the first part of this series on DHT, it explains the basics of this hormone, as well as discusses the many roles it plays and its benefits. Read it here.
This article will dive into the specific areas of which DHT has been nefariously implicated and shows what the most current science now shows.
In the next, third and final article in this series, we will dive into what can be done to increase or decrease DHT.
What You MUST Understand About DHT
“DHT should be thought of as a paracrine hormone formed and acting primarily in target tissues.”
Most people are not likely familiar with the term “paracrine,” so here is the definition:
“Denoting a type of hormone function in which hormone synthesized in and released from endocrine cells binds to its
receptor in nearby cells and affects their function.”
What this means is that circulating amounts of DHT, that of what is analyzed in blood tests, may have no correlation, or small correlations, to the DHT that is found in the hair follicles, prostate, or the skin.
This doesn’t mean that DHT blood tests are not useful. It does appear to correlate to sexual function to some degree, as covered in the first article. But, according to the evidence, this may be the extent of it.
And honestly, simple logic may explain this, without even having to get scientific…
Testosterone and DHT tend to be the highest during post-puberty and throughout one’s 20s. Yet hair loss and prostate issues tend to only occur in older men. Just wrap your mind around this for a moment. Notice how it cannot be explained as simply as, “DHT causes prostate growth or hair loss.”
DHT and Prostate Issues
DHT has been implicated in both BPH (benign prostate hyperplasia) and prostate cancer.
The following study from a paper titled, “5Alpha-Reductase: History and Clinical Importance,” shows the scientific discoveries that lead this route. 
- 1786 Prostate dependence on testes
- 1849 Blood-borne nature of testosterone; first hormone
- 1939 Isolation, synthesis of testosterone
- 1941 Responsiveness of prostate diseases to androgen deprivation therapy
- 1969 Biologic role of DHT
- 1974 Effects of congenital deficiency of 5AR
- 1975 Co-discovery of 5AR syndrome
- 1992 Approval of finasteride
- 2002 Approval of dutasteride
Now it’s been fourteen years since that paper was published, and the science continues to keep rolling…
A two-year placebo-controlled study looked at healthy men who used a DHT gel daily and concluded:
“Dihydrotestosterone treatment for 24 months has no beneficial or adverse effect on prostate growth.” 
Another study found similar results. There were no changes in prostate size, as well as no changes in the PSA levels (prostate-specific antigen).
An analysis that looked at multiple studies stated:
“Studies show that DHT, a potent androgen that cannot be aromatized, has minimal and perhaps inhibitory effects on prostate size and symptoms associated with benign prostatic hypertrophy”
So not only is DHT not “bad” for the prostate, it may even be helpful. Which means for decades doctors have been treating and medicating men all wrong …and in the process subjected the men to the many long-term side effects of drugs such as Finasteride. (Unfortunately, it is common enough that this has been named, “Post-Finasteride Syndrome”).
Another recent review says this:
“Although androgens support the growth, proliferation, and progression of aggressive prostate cancer, there is no consensus that elevated levels of circulating androgens contribute to the risk of developing prostate cancer. On the contrary, there is strong evidence that circulating levels of DHT are not associated with increased risk of prostate cancer… In addition, we have been unable to identify a single epidemiological study that has implicated serum DHT as a factor positively associated with an increased risk of prostate cancer.”
Now, this is not to say that those drugs do not work at all in relieving the symptoms of BPH or prostate cancer. They are absolutely providing some relief to people because the local DHT does cause growth. But this is a band-aid approach and it is not fixing the root issue. This is because neither testosterone nor DHT CAUSES cancer in the prostate.
In fact, a review of those using these pharmaceutical drugs found that while cancer did not increase, there are possibly worse high-grade cancers, that grow and spread more quickly. And they did not lead to a longer life.
So what does cause cancer?
It’s complicated, however, major factors include toxicity, nutrient deficiencies, diet, and lifestyle. These are the true root causes, not the hormones.
DHT, Male Pattern Baldness and Hair Loss
This section will be shorter because hair loss parallels to how DHT works in the prostate, in that there is a local action that may occur when the serum levels are either low or high.
And here is an area where genetics do play a large role.
One study with 35 subjects found that DHT, testosterone and DHT/T ratio were all higher in blood levels of those with male pattern baldness compared to those that weren’t. 
Yet, in this study with 315 men, higher DHT was actually correlated with lower amounts of baldness.  (Though free testosterone was correlated with more baldness.)
And a study of 49 subjects, including men and women with androgenetic alopecia, found no differences between DHT levels in those with hair loss and those without. They did, however, conclude, “Based on the results of our study and others, the most important factors would appear to be the genetically-determined sensitivity of the follicles to DHT and their different reactions to androgen concentration.” 
So the ultimate conclusion here is that it is the local DHT in the hair follicles themselves, not the DHT in the blood or serum levels. One article I saw describes this as the difference between tissue DHT and serum DHT.
However, this matter gets further complicated. In addition to the hair on your head, DHT is also at play in the body and facial hair. It plays a strong role in puberty. Yet here we see that tissue DHT is needed for beard growth…while at the same time it is being possibly implicated at causing hair loss in male pattern baldness. 
Drugs such as Finasteride and Dutasteride, are often prescribed for hair loss. It is my non-medical opinion that it would be best to avoid these drugs because of their associated risk in creating more serious long-term side effects.
So if it is not DHT or other androgens, what does cause hair loss? Genetics certainly play a role. But, so does systemic inflammation which is behind a majority of all of our health problems.
Without going into full detail, one article listed the following and appears to be more on the cutting edge of science in terms of searching for the causes:
- Men having similar hormonal profiles as women with PCOS, that is high prolactin and high LH: FSH ratio. (This pattern is also associated with insulin resistance/metabolic syndrome as well as heart disease.)
- Increased estrogen levels and thus lower testosterone: estrogen ratios
Certainly, aim to bring these hormonal imbalances back in order and keep systemic inflammation under wraps.
And even if you continue to go bald, I say OWN IT! Bald can be a good look. I have long hair, but if I ever start balding, I am going to proudly rock it by going totally bald.
In fact, a series of studies show that bald men are perceived by others as more dominant, taller, stronger, more masculine, more confident and with better leadership, even while being judged slightly older and less attractive. 
DHT and Acne
One study found that DHT is involved in sebum production as well as the production of proinflammatory cytokines that may cause acne. 
Yet in other studies with humans, DHT does not seem to be implicated, though other androgens are. “Although androgenic hormones may be raised in the acne patients as compared to controls, only Testosterone and DHEA-S levels serve as markers of acne severity.” 
Although circulating serum levels are in play, here again, we see that local action in the skin may be most important.
“Local factors other than androgen plasma levels, also play a part in the development of acne. The skin contains enzymes that convert precursor hormones to the more potent androgens such as testosterone and dihydrotestosterone. Androgen synthesis can, therefore, be regulated locally. The effects of androgens on the skin are the result of circulating androgens and enzyme activity in local tissues and androgen receptors.” 
While hormones play a role, the main causative factor in my experience is dietary. Even at 34 years of age, if I eat any refined sugar, I am pretty much guaranteed or expect to have a little bit of acne within the next following day or two. If I eat sugar along with diary (like milk chocolate) I get a bad case of acne. Perhaps because I have a high level of circulating androgens. But I’d rather keep that going, and simply keep my diet cleaner.
There is a clear difference between local or tissue DHT and serum DHT. And these may not have any correlation. Yet, with our reductionist science, we found DHT in areas of concern like in the prostate and scalp and then launched a series of drugs to lower DHT, which results in some pretty bad side effects.
When will we learn?
Instead, in these areas, we see the worse culprits as being elevated levels of estrogen and other hormonal imbalances. Which is most likely due to the increasingly widespread of endocrine-disrupting chemicals. Add these to the toxicity and ultra-processing of our diet and we see inflammation is on the rise and at the root of just about every disease. Not a lot of differences in these areas.
We’ll wrap up with one final article in this series looking at specific interventions, including many herbs, that can be used to raise or lower DHT (should you want too after learning more about how it works better).
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