An Overview of Dihydrotestosterone(DHT) & its Associated Health Conditions

In line with men’s health week, let us look at one of the primary male sex hormones, dihydrotestosterone (DHT), a more potent form of testosterone and understand its role and effects towards the well-being of a man. While DHT and testosterone constitute as male sex hormones, it is worth noting that DHT is stronger than testosterone as they bind to androgen receptors much longer, increasing the impact of testosterone production throughout with specific roles in the growth of facial and body hair, prostate development and scalp hair loss.

Dihydrotestosterone (DHT), is a type of male hormone known as androgens that plays a crucial role in the development and maintenance of male sexual characteristics. It is derived from testosterone, (a primary male sex hormone) through the action of 5-alpha reductase.

In essence, during fetal development, DHT contributes to the formation of male genitalia, whereas in puberty, DHT promotes the growth of facial and body hair, results in deep voice as well as stimulates the development of the prostate gland. One quick fun fact about DHT is that our body converts about 10% of testosterone into DHT each day that aids in the development and maintenance of male sexual characteristics.

While DHT is important for male sexual development, excessive levels of DHT alongside with increased sensitivity of hair follicles and prostate tissue to DHT can contribute to certain health conditions such as male pattern baldness and benign prostate hyperplasia (BPH) respectively, which will be discussed below:

Male Pattern Baldness (Androgenic Alopecia):

A genetic condition characterized by the gradual loss of hair, affecting mainly the scalp. It is influenced by a combination of genetic factors and hormones, especially DHT. In individuals with a genetic predisposition of this condition, hair follicles on the scalp are more sensitive to DHT, resulting in a progressive miniaturization of the hair follicles. This subsequently causes thinner and shorter hair strands. Over time, the affected follicles would stop producing visible hair altogether, causing hair loss and those who are affected would start exhibiting a pattern of baldness. 

Benign Prostate Hyperplasia (BPH):

The prostate is a small gland that is located just below men’s bladder and it functions as semen producer. DHT also plays a prominent role in the development and growth of the prostate gland. With that, high levels of DHT has been linked to the development and progression of BPH, a non-cancerous enlargement of the prostate gland that is characterized by urinary symptoms such as increased frequency of urination, weak urine flow and feeling of incomplete emptying of the bladder. This condition is more common among aging men and is thought to be primarily driven by age-related hormonal changes like DHT and estrogen to a certain extent. 

Pharmacological Treatment Options 

While both male pattern baldness and BPH involve the excessive production of DHT, they are very distinct conditions that affect different areas of the body and do not have a direct causal association. However, it's worth noting that these conditions may share the same medications such as finasteride (Propecia) where 1mg is indicated for male pattern baldness, 5mg for BPH once a day as well as dutasteride (Avodart) 0.5mg once a day. Both of these agents work by inhibiting the enzyme 5-alpha-reductase, which is responsible for converting testosterone to dihydrotestosterone (DHT) in the body.

For male pattern baldness, an anti-hypertensive agent, topical Minoxidil is also indicated. When applied topically to the scalp, Minoxidil has the ability to promote blood flow to the hair follicles, which as a result stimulate hair growth and prolong the growth phase of the hair cycle.

Supplements available for high DHT implicated in male pattern baldness:

1. Saw Palmetto: A popular, long lived supplement that has been used to inhibit the conversion of testosterone into DHT. It is often recommended to support prostate health and is sometimes used as a complementary treatment for male pattern baldness.
2. Pumpkin seed oil: Rich in nutrients and has been reported to have potential effect on DHT levels by supporting hair growth and reducing hair loss.
3. Zinc: An essential mineral that plays a role in hormone metabolism and may help regulate DHT levels. Adequate zinc levels are important for overall health and studies have shown its role in supporting hair growth.
4. Biotin: Also known as vitamin B7, is often included in supplements targeted for hair health. While it does not directly affect DHT levels, it supports the overall health and strength of the hair by boosting and maintaining healthy levels of keratin, a type of protein present in your hair, nails and skin.

Supplements available for high DHT implicated in BPH:

1. Beta-sitosterol: A plant sterol that has shown promising results in improving urinary flow, decreasing the amount of urine left in the bladder and reducing symptoms associated with BPH in general. It is commonly found in supplement formulations targeted for prostate health due to its well-established efficacy in urology.
2. Pygeum Africanum: Herb based supplement derived from the bark of the African plum tree. It has been traditionally used to support prostate health and has been studied to have some inhibitory effects on DHT production.
3. Stinging nettle root: Extract is often used as a supplement for BPH. It may be effective at relieving urinary symptoms such as enhanced urinary flow, incomplete emptying of bladder and fight the constant urge to urinate.
4. Pygeum Africanum: Derived from the bark of the African plum tree, Pygeum Africanum has been traditionally used to support prostate health and alleviate BPH symptoms  by shrinking enlarged prostates. It has also been found to reduce night time urination and improve urinary flow.

Albeit considered as a male hormone, DHT is also found present in females, although at lower levels. In females, DHT contributes to the development of pubic and axillary hair, but its role in female physiology is generally less pronounced compared to males.

The Takeaway

Now that we’ve understood DHT and its functionality in men’s health, we can be more aware of the common signs and symptoms of male pattern baldness and BPH. Since DHT is the main culprit behind these two health conditions, medical treatment is not always warranted. Non-pharmacological treatments like wishful watching are often practiced for BPH and for male pattern baldness, vitamins like biotin and zinc are often recommended for early prevention. 

This article is written by Janelle Leong, Bpharm(Hons) (DOC2US),
reviewed by Dr. Izzan Nadira binti Ismi, MB Bch BAO (DOC2US)

References 

1.  https://www.healthline.com/health/dht#testosterone 
2. https://www.healthline.com/health/enlarged-prostate#causes 

Written by

Janelle Leong, Bpharm(Hons) DOC2US