What is the level of Dihydrotestosterone (DHT)?

From the Guidelines

DHT levels are typically managed with 5-alpha reductase inhibitors, such as finasteride or dutasteride, which can reduce DHT levels by 70-95% and improve symptoms of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) 1.

DHT Levels and Treatment

Normal DHT levels in adult males range from 30-85 ng/dL, while females have levels between 4-22 ng/dL. Elevated DHT levels may contribute to male pattern baldness, prostate enlargement, and acne.

• DHT is a potent androgen hormone derived from testosterone through the action of the enzyme 5-alpha reductase.
• Treatment for high DHT may include 5-alpha reductase inhibitors like finasteride (1mg daily for hair loss, 5mg daily for prostate issues) or dutasteride (0.5mg daily), which block the conversion of testosterone to DHT.
• These medications typically take 3-6 months to show effects and require ongoing use to maintain benefits.

Side Effects and Considerations

Side effects of 5-alpha reductase inhibitors may include:

• Decreased libido
• Erectile dysfunction
• Rarely, depression Natural approaches like saw palmetto supplements (320mg daily) may help but are less effective than prescription options.

Importance of Healthcare Provider Consultation

Always consult with a healthcare provider before starting any treatment to address DHT levels, as they can help determine the best course of treatment and monitor for potential side effects 1.

DHT Reduction and Symptom Improvement

Finasteride and dutasteride have been shown to reduce DHT levels by approximately 70% and 95%, respectively, and improve symptoms of BPH and LUTS 1.

• The reduction of DHT in prostate tissues has been measured at approximately 80% with finasteride and 94% with dutasteride.
• Numerous robust analyses of randomized, placebo-controlled trials with finasteride have shown an improvement in standardized symptom scores superior to placebo.

From the FDA Drug Label

The maximum effect of daily doses of dutasteride on the reduction of DHT is dose dependent and is observed within 1 to 2 weeks. After 1 and 2 weeks of daily dosing with dutasteride 0.5 mg, median serum DHT concentrations were reduced by 85% and 90%, respectively. In patients with BPH treated with dutasteride 0. 5 mg/day for 4 years, the median decrease in serum DHT was 94% at 1 year, 93% at 2 years, and 95% at both 3 and 4 years.

DHT Level Reduction: Dutasteride reduces DHT levels by inhibiting the conversion of testosterone to DHT.

• The median serum DHT concentrations are reduced by 85% and 90% after 1 and 2 weeks of daily dosing with dutasteride 0.5 mg, respectively.
• In patients with BPH treated with dutasteride 0.5 mg/day for 4 years, the median decrease in serum DHT was 94% at 1 year, 93% at 2 years, and 95% at both 3 and 4 years 2.

From the Research

DHT Level and Its Relation to Androgenetic Alopecia

• Dihydrotestosterone (DHT) is a potent androgen that plays a significant role in the development of androgenetic alopecia, a common condition characterized by thinning of scalp hair 3.
• The conversion of testosterone to DHT is facilitated by the enzyme 5-alpha-reductase, which has two isoforms: type I and type II 4, 5.
• Inhibitors of 5-alpha-reductase, such as finasteride and dutasteride, have been shown to be effective in treating androgenetic alopecia by reducing DHT levels 4, 6, 7, 5.

Effects of 5-Alpha-Reductase Inhibitors on DHT Levels

• Finasteride, a type II 5-alpha-reductase inhibitor, has been shown to decrease DHT levels, but its efficacy may be limited due to its selective inhibition of only one isoform of the enzyme 4, 5.
• Dutasteride, a dual inhibitor of both type I and type II 5-alpha-reductase, has been demonstrated to be more effective than finasteride in reducing DHT levels and promoting hair growth 4, 5.
• The use of 5-alpha-reductase inhibitors, including finasteride and dutasteride, has been associated with sexual and reproductive side effects, such as erectile dysfunction, decreased libido, and infertility 7.

Clinical Implications of Elevated DHT Levels

• Elevated DHT levels have not been shown to increase the risk of prostate disease or cardiovascular disease, and may not have significant systemic effects beyond those commonly observed with androgen therapy 3.
• The clinical significance of modest elevations in serum DHT levels remains unclear, and further studies are needed to fully understand the implications of elevated DHT levels on men's health 3.