Decoding DHT: Your Body’s Powerful Hormone

By Dr. Priya Sammani ( MBBS, DFM )

You know, it’s not uncommon for someone to sit across from me in the clinic, maybe a gentleman in his 50s, looking a bit worried. He might say, “Doc, my hair’s thinning more than I’d like,” or perhaps, “I’ve been having some… uh… bathroom troubles.” Sometimes, these concerns, and others, lead us to talk about hormones, and one that often comes up, especially for men, is something called Dihydrotestosterone (DHT).

So, what exactly is this DHT we’re talking about? Well, Dihydrotestosterone, or DHT for short, is a pretty potent hormone. Think of it as a super-charged version of testosterone. It’s an androgen, which is just a medical term for a hormone that sparks the development of male characteristics. Our bodies, believe it or not, make DHT from testosterone. About 10% of the testosterone floating around in an adult gets converted into DHT each day. This conversion happens in places like the genital skin and prostate in men, and in the skin for women. It also pops up in other spots, like your liver. Yep, women have it too, though in much smaller amounts because, well, they naturally have less testosterone to start with.

The Big Roles of DHT: From Baby to Adult

Now, DHT is a real workhorse, especially early in life for boys.

DHT and Fetal Development

Before birth, while a baby boy is still developing in the womb, DHT is crucial. It helps form the penis and scrotum, and gets the prostate started. It’s a key player in making sure male anatomy develops as it should, and even helps block the formation of female anatomy in male fetuses.

DHT and Puberty

Fast forward to the teenage years, and DHT steps up again.

  • In boys, it’s behind the growth of facial hair, body hair, and pubic hair. It also helps the penis and scrotum continue to develop and the prostate to grow.
  • For girls, while testosterone levels are much lower, the small amount of DHT produced is thought to contribute to pubic and body hair growth during puberty as well.

DHT in Adulthood

Once we’re adults, DHT’s role shifts a bit. It’s not so much about building new things, but its presence can still have some noticeable effects. This is where we sometimes see it linked to things like prostate enlargement and male pattern hair loss.

When DHT Levels Might Be Too High

Sometimes, the balance of DHT can be a bit off, and levels can creep up. When that happens, it can be linked to a few conditions I see in my practice:

  • Benign Prostatic Hyperplasia (BPH): This is a very common one – an enlarged prostate. As men get older, particularly over 50, the prostate can produce a fair bit of DHT locally. While this helps normal prostate function, it can also encourage the prostate to grow too much, leading to annoying urinary symptoms and sometimes sexual dysfunction.
  • Prostate Cancer: We also know that increased DHT activity in your prostate, in addition to certain genetic mutations that cause prostate cells to grow uncontrollably, can play a part in the development of prostate cancer. It’s complex, but DHT is often part of the picture.
  • Androgenic Alopecia (Male Pattern Hair Loss): Ah, the dreaded hair thinning. If you’re noticing a receding hairline or thinning on top, high levels of DHT at your hair follicles might be partly to blame. It can cause hair follicles to shrink and shorten their hair growth cycle. Genetics play a big role here too, of course.
  • Polycystic Ovarian Syndrome (PCOS): This one’s for the ladies. PCOS is a hormonal imbalance where their ovaries create excess androgens, including testosterone. This can lead to higher DHT levels, causing a variety of symptoms like irregular periods, excessive hair growth (what we call hirsutism), and acne. It’s a tricky one, and DHT is often involved.

And What If DHT Levels Are on the Low Side?

Just as too much DHT can cause issues, too little can also have effects, mainly in males. Scientists also think low DHT in female children might delay the start of puberty, but we’re still learning.

  • 5-alpha Reductase Deficiency: This is a rare genetic condition. 5-alpha reductase is an enzyme – a kind of biological helper – that converts testosterone into DHT. If there’s a problem with this enzyme due to a genetic mutation (it’s an autosomal recessive pattern, meaning you inherit it from both parents), the body can’t make enough DHT.
  • For baby boys born with this, it can mean their external genitalia, like the penis and scrotum, are underdeveloped. Their testicles are usually there and functional (they can still produce sperm!), but they might not have descended properly (undescended testicles). The prostate might be small or even absent. In severe cases, genetically male babies might have external genitalia that appear female. It’s different from androgen insensitivity syndrome, where the body makes androgens but can’t use them properly.
  • Interestingly, when these boys hit puberty, because they still make testosterone, they’ll often experience voice deepening, muscle growth, and penis enlargement. But they might not develop much facial hair.
  • Low Testosterone (Male Hypogonadism): This one’s more straightforward. Since DHT comes from testosterone, if your testosterone levels are low (what we call male hypogonadism), then your DHT levels will likely be low too. Low testosterone can happen for various reasons and at different ages, causing different symptoms.

So, How Do We Figure Out What’s Going On with DHT?

If any of this sounds familiar, or if you’re worried about symptoms that might be related to DHT – whether too high or too low – it’s always a good idea to chat with us.

When you come in, we’ll talk through your symptoms, your family history, all that good stuff. Depending on what we find, we might suggest:

  • Blood tests: These can help us check your hormone levels, including testosterone, and sometimes directly measure DHT or other related markers.
  • A physical exam: This is always important to assess things directly.
  • Further investigations: Sometimes, we might need to refer you to a specialist, like an endocrinologist (a hormone doctor) or a urologist (for prostate issues), for more specific tests or management.

The main thing is, we’re here to help you understand what’s happening and find the best path forward. We’ll discuss all the options available for you.

Your DHT Story: Key Things to Remember

Alright, that was a lot of information, I know! So, let’s just boil it down to a few key takeaways about Dihydrotestosterone (DHT):

  • DHT is a powerful male hormone: It’s made from testosterone and is vital for developing male characteristics, especially before birth and during puberty.
  • Its role changes with age: From forming male anatomy in the womb to influencing hair growth and prostate health in adulthood.
  • Too much DHT can be linked to: Benign prostatic hyperplasia (BPH), prostate cancer, male pattern hair loss, and PCOS in women.
  • Too little DHT can cause issues: Particularly in males, such as in 5-alpha reductase deficiency or due to low testosterone. It may also affect puberty timing in girls.
  • Talk to your doctor: If you have concerns about symptoms that might be related to your DHT levels, please don’t hesitate to reach out. We can figure it out together.

Hormones can seem mysterious, but understanding them a little better can be really empowering. You’re not alone in navigating these health questions.

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