A common question I see online and something I get personally asked a lot about as well is about the role of DHT itself in regards to male pattern hair loss. Put simply this post explores how DHT and hair loss are related.
The guys in question may be concerned about certain hormone levels such as DHT, testosterone, and estrogen, both before and after starting various interventions such as finasteride or anti-androgens.
They may also be confused about the role these hormones play in terms of hair loss itself and relate it all to genetic variability, environmental factors, etc.
It’s a great question and my goal is to give an overview and general explanation of how DHT levels relate to hair loss – to do this we look at 4 studies relevant to the question at hand to begin to form an opinion.
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DHT and Hair Loss
As you may already know – DHT is (currently) considered to be one of the root causes of androgenic alopecia.
So how is it possible that some people have very high amounts of serum DHT naturally or even due to steroid abuse but don’t bald at all while others with relatively much lower DHT levels are aggressively balding?
The answer is genetics – but there is some nuance here in terms of the levels as well.
If you are genetically susceptible to DHT, inhibiting it with finasteride or dutasteride will likely be extremely effective in halting and potentially even regrowing hair.
So for those genetically susceptible, you can say that the levels do matter to an extent because if we lower the levels we will see the positive impacts that has on the hair.
However, genetics play a huge role here as well because you could have naturally lower DHT levels but have a higher susceptibility to DHT genetically requiring the use of finasteride to maintain your hair.
It’s a common statement I see all the time: “I have higher testosterone which is why I’m balding” or something along those lines when in reality it’s probably more on the end of your genetic susceptibility to androgens rather than purely being due to the levels themselves.
Treatment
Like I mentioned – lots of guys ask me about their levels and if finasteride is working for them because their levels are this or that, etc. To me, the actual levels aren’t too relevant unless you want to keep them in a specific range for a reason.
Of course – always consult with a legal, reputable, and qualified medical provider.
I would personally say this in general: if you are taking something like finasteride this seems to produce sufficient results for most men taking the drug. It reduces serum DHT by around ~70% so you will still have some DHT in your blood markers.
If you want to decimate DHT you could research dutasteride which crushes serum DHT by around 90% by inhibiting two types of the 5AR enzyme. This might be worth looking at for guys who aren’t responding as well as they’d like to finasteride in terms of regrowth or maintenance.
Personally speaking, I think having some amount of DHT not being inhibited is probably healthier, and considering the efficacy of the standard oral 1 mg finasteride dose this should be suitable for the majority of guys either way.
Studies
“Dihydrotestosterone has the strongest androgenic action and seems to play an extremely important role in the pathogenesis of androgenetic alopecia. In the pathogenesis of androgenetic alopecia, the most important factor seems to be the individual, genetically-based sensitivity of hair follicles to DHT concentration and their varied response to androgen action.”
“AGA occurs universally in all adult men and severity progresses with age. Twin studies have confirmed that the age of onset, severity, rate of progression, and pattern of hair loss are all influenced by inherited factors. Heredity is thought to contribute more than 80% to the AGA phenotype, while environmental factors account for less than 20%. AGA is inherited as a complex polygenic trait. Genome-wide association studies have identified over 190 genes that are thought to be involved in AGA, however, the first gene associated with AGA, the androgen receptor gene, is thought to account for over 60% of the heredity of AGA.”
“AGA can be defined as a DHT-dependent process with continuous miniaturization of sensitive hair follicles. The type 2 5a-reductase plays a central role in the intrafollicular conversion of testosterone to DHT. So far the predisposing genes for AGA are unknown and we do not understand the molecular steps involved in androgen-dependent beard growth vs. androgen-dependent hair loss. However, with the cloning of the entire human genome, we may have new resources to explore the etiopathogenesis of AGA in more detail.”
“Hair growth is under complex genetic and hormonal control, regulated predominantly by androgens. Androgenic control of hair growth, and of male pattern hair loss, is mediated through a final common pathway involving the enzyme 5α-reductase. Men with male pattern hair loss have increased 5αreductase activity in their hair follicles, and the male bald scalp has an increased capacity to convert testosterone to the more potent dihydrotestosterone. There is increasing evidence that Type 2 5α-reductase activity plays an important role in this condition.”
Conclusion
Thank you for reading – hopefully, this offered a basic overview of why the exact hormone levels may not play as big of a role in androgenic alopecia.
Yes – the levels play a role to those susceptible but there is nuance that needs to be looked at here. If you’re already treating hair loss with something like finasteride a low amount of DHT is still expected and the vast majority of men will still maintain hair on the standard dose of 1 mg.
I think those 4 studies I cited have some interesting points as well which I highlighted – it’s interesting to see exactly how much and which genes play a role based on the second study noted.