DHT, erectile dysfunction, finasteride and male pattern baldness, what’s the truth about all of this?

Not all testosterone is created equally. As the testosterone book explains, there are several kinds of testosterone and one of the most controversial is DHT or Dihydrotestosterone.

DHT have been accused of prostate enlargement and cancer and Male pattern baldness. As everything related to testosterone, there is confusing information everywhere. Some years ago it was the bad guy in this movie, but others say it’s the most potent, androgenic and anabolic hormone, so we should be trying to increase it.

Today, we take a look at DHT, separating truth from myth.

What is DHT

Dihydrotestosterone is formed when testosterone and the enzyme 5-alpha reductase get in contact. Once this transformation has occurred, DHT can no longer be converted into another hormone. Why is this important to us? Because, mainly DHT can not be reverted and transformed into estradiol, an androgenic hormone running around in our body.

Remember the testosterone book? Testosterone can be converted into estrogen by the enzyme aromatase. One of the keys to naturally increase your testosterone is getting the aromatase in check. We can accomplish that through diet.

Is DHT good or bad? It seems confusing

Well, it’s not an easy answer. DHT is not “bad”, in fact, it can be one of your best friends if you plan to keep being a man in the next years. It has a role (a very important one), so, as always, the key is balance. If we try to lower DHT, we will have very nasty side effects as we will see here, but DHT seems to be involved in something that we, men, hate with a passion: male pattern baldness.

In fact, Dihydrotestosterone is more powerful than testosterone and the strongest androgen. It binds to receptors with more affinity and stays longer, doing its thing.

DHT can be very related to sexual function and erections. Finasteride and Durasteride are two common solutions to male pattern baldness. They inhibit 5-alpha reductase, so testosterone cannot be converted into Dihydrotestosterone. There is ample evidence that these treatments lower DHT, sometimes a lot, and sometimes it’s a stubborn effect that does not go away when you stop the treatment.

According to this study [1]: “Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5α-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life”.

Those treatments lower DHT, but when you take samples, it seems that testosterone and free testosterone does not change a lot with 5 Alpha reductase inhibitors. Although we talked in the testosterone book about how free testosterone is what matters to us, pay attention to this.

Nickel and others [2] evaluated the efficacy and safety of 2 years treatment of moderate BPH with finasteride. In the safety analysis, the incidence of adverse events related to sexual dysfunction were significantly higher in the finasteride group than in the placebo group (ejaculation disorder, 7.7% vs. 1.7%; erectile dysfunction (ED), 15.8% vs. 6.3%, respectively; p<0.01 or p=0.01 for both parameters). Tenover et al. [43] also showed that the overall sexual adverse events were greater with finasteride (12.3%) compared with placebo (6%). Finasteride increased the incidence of ED by 7.4% compared to 3.3% in the placebo arm. Similarly, finasteride resulted in loss of libido (4.9%) compared to 2.9% in the placebo group.

So DHT seems to have a powerful role in sexual health, potency and androgenic tasks, like creating muscle and general well being. As always, when we are talking about our bodies, nothing is simple and easy, everything is intertwined in a delicate balance.

So, for practical purposes, DHT can be your friend.

Contrary evidence

Some others say that testosterone goes down with age, but DHT does not. And old men tend to have more erectile dysfunction and muscle atrophy even when DHT levels are maintained.

Some even conclude that the effects of Dihydrotestosterone reduction are not that significant, according to some data, and that DHT has a lesser role in erectile dysfunction than testosterone [3].

I don’t care, DHT, Testosterone, Free testosterone, all of them are wheels in the same car. You quit one wheel, you fuck up the car.

It’s a balanced system where you have to keep every piece greased and optimized. As in every complex system, if just one piece fails, the whole system pays for that.

Can DHT cause cancer or baldness?

Dihydrotestosterone is related to benign prostatic hyperplasia (prostate enlargement), so it does not seem very good news, but I have other information for you. Although use of 5-alpha reductase inhibitors decreased the incidence of prostate cancer in its users overall, 5-alpha reductase users had an increased incidence of high-grade prostate cancer when compared with placebo (see study [1] again).

As many things in life, when you get older you have to choose between evils, and frankly, I prefer the lesser evil.

Ok, but, what about Male Pattern Baldness? It’s true that DHT is related to MPB, it has a role when that curse starts and if you use 5-alpha reductase inhibitors, many people see improvements. But that does not mean that Dihydrotestosterone necessarily causes MBP.

We don’t know everything yet about baldness, it’s genetic, it’s complex, and DHT has a role, but plenty of people have high DHT and good hair. I don’t know everything, but I will give my two cents and say that it seems a matter of genetic predisposition. If you don’t have it, all the DHT in the world won’t start the damned MPB process.

How to increase Dihydrotestosterone

Ok, DHT seems like a useful tool, how can I increase it? There is a tried and true method, that happens to be cheap also:

Take creatine monohydrate. Yes, that supplement that bodybuilders take.

7 days of supplementation increased DHT in healthy rugby players by a staggering 56% (they had a loading phase of 25g of creatine daily). After that, DHT levels remained about 40% higher than the control group when they took daily doses of creatine, for maintenance purposes (5 grams daily) [4].

As with many things about health, Creatine is not fully understood, but it’s one of the most studied supplements and seems to be safe even when not cycled and even when used during years.

So there you have it.

Studies referenced

[1]The Dark Side of 5α-Reductase Inhibitors’ Therapy: Sexual Dysfunction, High Gleason Grade Prostate Cancer and Depression

Abdulmaged M. Traish,corresponding author1,2 Ashwini Mulgaonkar,2 and Nicholas Giordano2

[2] Efficacy and safety of finasteride therapy for benign prostatic hyperplasia: results of a 2-year randomized controlled trial (the PROSPECT study). PROscar Safety Plus Efficacy Canadian Two year Study.

Nickel JC, Fradet Y, Boake RC, Pommerville PJ, Perreault JP, Afridi SK, Elhilali MM

CMAJ. 1996 Nov 1; 155(9):1251–9.

[3] The Effect of 5 a-Reductase Review. Inhibitors on Erectile Function. ONDER CANGUVEN AND ARTHUR L. BURNETT

[4] Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. van der Merwe J1, Brooks NE, Myburgh KH.