Dihydrotestosterone (DHT) is a hormone that is closely related to testosterone. It is produced when the enzyme 5-alpha reductase converts testosterone into DHT. DHT plays an important role in the development of male sexual characteristics during puberty. However, high levels of DHT later in life can lead to issues like hair loss, prostate enlargement, and acne. Here we will discuss the common signs and symptoms that can indicate high DHT levels.
Hair Loss
One of the most visible signs of high DHT is male pattern baldness. DHT causes hair follicles to shrink on the scalp, leading to thinning hair or a receding hairline. This type of hair loss is medically known as androgenetic alopecia. DHT binds to receptors in hair follicles that are genetically sensitive to it and causes them to gradually shrink and weaken. This process shortens the growth phase of hair and lengthens the resting phase, resulting in miniaturization of the follicles over time.
Initially, men with high DHT may notice more hair than usual falling out when brushing or washing. As DHT levels remain elevated, the thinning becomes more noticeable. Hair loss typically begins above the temples and crown, but can ultimately affect any area of the scalp. Without treatment, it may progress until only a narrow band of hair remains at the back and sides of the head. Beard hair may also thin.
While DHT is associated primarily with male pattern baldness, it can contribute to hair loss in women as well. Women rely more on estrogen to keep hair healthy, so when DHT overtakes estrogen, it can trigger thinning hair on top of the head. High testosterone levels that convert to excess DHT are often to blame.
Prostate Enlargement
An enlarged prostate, also called benign prostatic hyperplasia (BPH), is another sign that DHT levels may be too high. The prostate is a small gland that surrounds the urethra just below the bladder. Its main function is to produce fluid that nourishes and protects sperm.
DHT stimulates prostate cell growth and multiplication. When DHT is elevated, it can cause excessive growth of prostate tissue. This enlarges the gland and compresses the urethra, leading to uncomfortable urinary symptoms. These may include:
- Weak urine stream
- Straining or pushing to empty the bladder
- Dribbling urine
- Frequent and urgent need to urinate
- Getting up multiple times at night to urinate
- Incomplete bladder emptying
BPH rarely causes serious complications, but can greatly impact quality of life if urinary problems become severe. Enlarged prostate and urinary symptoms are most common in men over age 50.
Acne
Hormonal acne, especially along the jawline and chin, may signal excessive DHT. DHT increases sebum production and inflammation, two key contributors to acne. Sebum is an oily substance produced by sebaceous glands in the skin for lubrication. When sebum combines with dead skin cells and bacteria, it clogs pores and forms pimples. DHT multiplies the number of oil-producing cells in sebaceous glands, increasing sebum output. DHT also ramps up inflammatory chemicals that damage follicles and worsen breakouts.
Adult acne in women is often tied to high androgen levels. Conditions like polycystic ovarian syndrome involve increased production of androgens including testosterone. As testosterone converts to DHT, acne outbreaks may occur as a result of the DHT surge.
Increased Facial and Body Hair
As DHT plays a key role in hair growth development during puberty, elevated levels later in life may stimulate excess hair growth. Men may notice increased facial or body hair, especially in areas sensitive to androgens. Common locations include the:
- Upper lip
- Chin
- Sideburns
- Chest
- Shoulders
- Back
In women, increased hair growth due to high DHT may occur on the face, chest, stomach, and back. Thicker or darker facial and body hair that appears in a male growth pattern is known as hirsutism in women.
Infertility
While normal levels of DHT are needed for reproductive function, excessive amounts can impair fertility in both men and women. In men, too much DHT can block receptors for follicle stimulating hormone (FSH). Since FSH stimulates sperm production, reduced FSH leads to lower sperm counts. High DHT also reduces motility and shape of sperm.
Women rely on a careful balance of androgens and estrogen for proper ovulation and conception. When DHT is elevated, it can shift this balance and interfere with ovulation. High DHT relative to estrogen makes the ovaries less responsive to follicle stimulating hormone as well.
Erectile Dysfunction
Although DHT is important for libido and sexual function, overly high levels can actually increase the risk of erectile dysfunction. This seems contradictory, but DHT in excess amounts can damage tissues in the penis and impair blood flow. Healthy blood circulation is essential for erections.
Men with enlarged prostate may also develop erectile dysfunction due to the prostate compressing the urethra. This obstructs blood flow and nerve signals involved in getting an erection. Urinary difficulties caused by BPH can further undermine sexual confidence and enjoyment.
Mood Changes
Hormonal imbalances involving DHT can negatively impact mood and mental health. Increased irritability, aggression, and depression are possible. DHT modulates neurotransmitters that influence emotions and mood, like serotonin and dopamine. When DHT is very high, serotonin levels tend to drop. Low serotonin is linked to increased anger, anxiety, and depression.
Women with polycystic ovarian syndrome often report anger, irritability, anxiety, and depression as symptoms. These mood disturbances are likely related to the excess androgens and hormonal shifts associated with PCOS.
Breast Tissue Changes
In boys and men who are still developing, elevated DHT can cause gynecomastia. This is benign growth of breast gland tissue that results in enlarged or puffy nipples. Although gynecomastia sometimes occurs transiently during puberty, persistently high DHT may be the cause. Enlarged breast tissue from high DHT is usually concentrated right under the nipple compared to general breast enlargement.
In women, high testosterone converting to high DHT can contribute to shrinking breast tissue. This involves a reduction of fat cells and connective tissue leading to deflated, sagging breasts. These changes are often linked to conditions like PCOS where androgens are very dominant.
Skin Changes
Androgens like DHT and testosterone stimulate oil glands, alter fat distribution, and impact collagen. This can lead to changes in skin texture and appearance when DHT is very high. Oily skin and acne outbreaks are common skin manifestations, as discussed earlier.
However, high DHT may also cause:
- Rough, thickened skin
- Enlarged pores
- Wrinkling and skin aging
- Reddening especially of the chest and face
- Oily scalp
These effects result from increased sebum production combined with DHT’s influence on collagen. DHT degrades collagen and impairs its production, reducing skin elasticity over time.
Decreased Muscle Mass
DHT can interfere with maintaining and building muscle in several ways. It blocks testosterone’s anabolic effects for increasing muscle protein synthesis. DHT also reduces secretion of growth hormone, which normally helps stimulate muscle growth. And DHT can hamper proper utilization of testosterone. The end result is potential loss of lean muscle mass and strength, especially as men age.
Other Possible Signs
A few other indications that DHT may be elevated include:
- Fatigue, low energy
- Brain fog, impaired concentration
- Weight gain, difficulty losing weight
- Sleep problems
- Headaches
These nonspecific symptoms can have many causes. But hormonal imbalances involving DHT should be considered as a potential factor.
Diagnosing High DHT
If you are experiencing potential symptoms of excess DHT, laboratory testing is needed to help confirm the diagnosis. A blood or saliva sample can be analyzed to check current levels of DHT, along with related hormones like testosterone and estrogen. This establishes whether abnormal DHT levels are present.
Some key lab tests may include:
- DHT
- Total and free testosterone
- Estradiol
- FSH
- LH
- SHBG (sex hormone binding globulin)
Based on test results and symptoms, your doctor can determine if high DHT is an issue. Other medical conditions may also need to be considered as potential causes or contributing factors.
Treatment Options
If high DHT is confirmed, there are medications and natural remedies that may help lower levels.
DHT Blockers
Medications like finasteride and dutasteride work by blocking 5-alpha reductase. This is the enzyme that converts testosterone to DHT. By inhibiting this enzyme, less testosterone becomes DHT.
Studies show finasteride can reduce DHT levels by about 65-70%.[1] It was originally developed for treating enlarged prostate but was also found to help prevent hair loss.
Dutasteride lowers DHT by over 90% because it blocks both isoforms of 5-alpha reductase.[2] It is also prescribed for prostate enlargement and hair loss.
However, potential side effects like erectile dysfunction and decreased libido have been reported with these medications. They require close monitoring and may not be appropriate for all individuals.
Anti-Androgens
Medications classified as anti-androgens prevent testosterone from binding to receptors throughout the body. This indirectly decreases DHT effects. Spironolactone is one example. Others include bicalutamide and flutamide. They are sometimes used to treat excess hair growth in women but can also lower high DHT. Anti-androgens carry risks like blood pressure changes, liver toxicity, and feminizing effects.
Hormone Modulators
Birth control pills and metformin may help modulate DHT levels in women by lowering testosterone production and insulin resistance. This reduces testosterone converting into excess DHT. However, these medications have other systemic effects that must be carefully weighed.
Saw Palmetto
Saw palmetto is a plant extract often used to treat BPH and hair loss symptoms. It appears to inhibit 5-alpha reductase much like finasteride, blocking the creation of DHT.[3] Saw palmetto is generally well tolerated with minimal side effects in recommended doses. More research is still needed, but it may offer a natural alternative to help reduce high DHT.
Green Tea
Compounds in green tea called catechins have been shown in studies to inhibit some isoforms of 5-alpha reductase. Drinking green tea daily or taking green tea extracts/supplements may assist in keeping DHT levels lower, especially when used long term.[4]
Stinging Nettle
Like saw palmetto, stinging nettle is used to treat BPH and hair loss. It may work by both decreasing DHT production and blocking DHT binding to receptors in the prostate and scalp.[5]
Pumpkin Seed Oil
Pumpkin seed oil contains phytosterols that may inhibit DHT production. Men with BPH who took pumpkin seed oil were found to have significant prostate symptom improvement compared to placebo.[6] More evidence is needed, but pumpkin seed oil supplements show promise for reducing high DHT.
Weight Loss
Excess body fat can increase conversion of testosterone to estrogen and DHT. Fat tissue contains the enzyme aromatase that converts testosterone into estrogen. Losing weight can help lower elevated estrogen and DHT levels associated with obesity. Even a 10% reduction in body fat can shift hormone profiles.
Exercise
Exercise is another lifestyle factor that may decrease DHT. Intense weightlifting workouts in particular have been associated with lower DHT levels in some research.[7] This may relate to increased testosterone clearance after vigorous training. Staying active with regular exercise is beneficial for healthy hormonal balance.
Conclusion
High DHT levels can contribute to several troubling symptoms in both men and women, from hair loss to enlarged prostate. Diagnosing elevated DHT requires blood testing. Once confirmed, medications like 5-alpha reductase inhibitors, anti-androgens, and hormone modulators may help reduce excess DHT production. Natural supplements and lifestyle measures can also assist in maintaining lower, healthier DHT levels. While more research is warranted, the evidence indicates that prudent DHT-lowering approaches can be beneficial for many people’s hormonal health and wellbeing.
References
- Dallob AL, Sadick NS, Unger WP. The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab. 1994 Sep;79(3):703-6.
- Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004 May;89(5):2179-84.
- Ibañez M, Terra X, Ardèvol A, Blade C, Salvadó MJ, Blay M. Bioavailability of a Saw Palmetto Extract: Absorption, Tissue Distribution, and Pharmacokinetics. Int J Mol Sci. 2020 Oct 23;21(21):7850.
- Kwack SJ, Ahn JY, Kim HS, Kim SS, Lee BM. Epigallocatechin-3-gallate inhibits dihydrotestosterone-induced lipid accumulation and reactive oxygen species production in the sebaceous gland cells. J Dermatol Sci. 2014 Dec;76(3):262-71.
- Gansser D, Spiteller G. Plant constituents interfering with human sex hormone-binding globulin. Evaluation of a test method and its application to Urtica dioica root extracts. Z Naturforsch C. 1995 Jan-Feb;50(1-2):98-104.
- Vahlensieck W Jr, Theurer C, Pfitzer E, Patz B, Banik N, Engelmann U. Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled GRANU study. Urol Int. 2015;94(3):286-95.
- Lane AR, Hackney AC, Premo MC, Lu T. Influence of Acute Exercise on Attenuation of Anabolic Hormones in Middle-Aged and Older Men with Pre-existing Metabolic Syndrome. J Aging Phys Act. 2017 Oct 1;25(4):657-664.