What is DHT and how is it related to hair loss?

Published on June 18, 2021
Updated on June 18, 2021
A bunch of blue, oval finasteride pills scattered against a white background.
Finasteride is a common DHT blocker used to treat androgenic alopecia and benign prostatic hyperplasia.

Dihydrotestosterone, also known as DHT, is the main hormone involved in pattern hair loss. This condition, also known as androgenic alopecia, is the most common type of hair loss. It’s caused by a mixture of hormonal and genetic factors. Blocking DHT can help reduce hair loss symptoms and stop the progression of androgenic alopecia.

 

What is dihydrotestosterone?

Most people have heard of testosterone, the main sex hormone produced in men’s bodies. This hormone is well known for its ability to influence men’s sexual development. According to StatPearls Publishing, testosterone is specifically responsible for pubertal changes like increased muscle mass and growth.

Dihydrotestosterone (DHT) is another hormone that’s also found circulating in men’s bodies. It’s primarily produced from testosterone via the 5-alpha reductase (5-αR) enzyme family.

What does DHT do in the body?

DHT is important for the development of healthy men. According to StatPearls Publishing, DHT is mainly important for developing infants, children, and teenagers. It’s involved in the development of male characteristics, including male sex organs and prostate growth.

Although testosterone is the most common androgen circulating in men’s bodies, DHT is considered to be the most potent. This is because unlike other androgens, it can’t be converted to estrogen (the primary female sex hormone).

DHT is a modified, more active form of testosterone. In your body, testosterone is transformed into DHT, which exerts stronger effects than testosterone itself.

- Joshua Zeichner

Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital of New York City, as published in an interview in , Men’s Health.

What does DHT do to hair?

Dihydrotestosterone is an androgen that affects hair follicles and hair production. It’s specifically this hormone that’s involved in the progression of the hair loss disorder androgenic alopecia.

DHT can affect hair follicles in different ways. When this androgen affects the hair follicles on the top of the scalp, it promotes miniaturization. This means that hair follicles gradually shrink and produce thinner, smaller, and weaker hairs over time. But in other areas of the body, like the face, DHT actually promotes hair growth.

 

DHT and hair loss

Androgenic alopecia, also known as male pattern hair loss, is caused by both genetic and hormonal factors. While elevated DHT levels are generally considered to be the main hormonal culprit behind pattern hair loss, a study in PLOS Genetics reported that there are nearly 300 independent genetic markers associated with this condition.

Targeting these genetic markers isn’t yet a therapeutic option, but targeting DHT is. DHT goes inside cells and binds to hormone receptors found there. It’s only once bound that it triggers the cascade of events that affect hair growth.

This means that it’s possible to target DHT in various ways. As long as it never binds to the cells surrounding the hair follicles, it won’t be able to affect your hair growth.

Two hair follicles, one which is smaller and affected by DHT binding to its receptors

It’s only when DHT binds to the receptors on hair follicles that it affects hair growth. 

What causes DHT to increase?

DHT production is essentially controlled by testosterone. There has to be testosterone before there can be DHT. That being said, a study in the journal Clinical Interventions in Aging says that DHT levels are regulated by the conversion process (which is performed by a protein called an enzyme).

If there’s a lot of testosterone in the body, a larger than average amount of DHT could be converted. But it’s actually the enzyme converting testosterone to DHT and other hormone-binding proteins that are likely responsible for increased DHT levels. DHT that’s bound to other proteins won’t affect your hair, but free DHT can find its way to your hair follicles and affect hair growth. 

According to a study published in the Journal of Ethnopharmacology, DHT can cause a variety of health problems when present in large quantities. High levels of DHT have not only been associated with androgenic alopecia, but with issues like:

·   Acne
·   Enlarged prostates
·   Excessive body hair growth
·   Prostate cancer

That being said, androgenic alopecia is not just about an increase in the levels of DHT. It’s also a genetic predisposition that causes certain people’s hair follicles to be more sensitive to this hormone.

How to lower DHT levels

Lowering DHT levels can be achieved in a variety of ways. There are medications, like finasteride and dutasteride, and shampoos, like ketoconazole. There are also nutraceuticals, like saw palmetto and caffeine, which can be taken orally or applied topically. All of these are DHT blockers.

 

What is a DHT blocker?

Whether they’re natural or manufactured, DHT blockers do exactly what their name implies: They lower levels of DHT and prevent the progression of pattern hair loss. But DHT blockers aren’t all the same. According to a study in the journal Dermatologic Therapy, some DHT blockers target a single receptor of the 5-αR enzyme, while others target multiple receptors. 

DHT blocking medications

DHT blockers can work in different ways. Currently, there are two main types of DHT blockers that people with androgenic alopecia can use. In one case, DHT is targeted by stopping testosterone from being converted to DHT. In the other, DHT blockers bind to the androgen receptors, which also essentially blocks DHT.

At the end of the day, this means that some DHT blockers are more potent than others. And of course, certain types are more likely to cause side effects than others.

Finasteride: A FDA-approved DHT blocker for androgenic alopecia

Even if you’ve never heard of the term ‘DHT blocker’, you’ve probably heard of finasteride. According to a study in the Journal of Clinical and Aesthetic Dermatology, it was actually the first oral treatment approved by the U.S. Food and Drug Administration for pattern hair loss. It works by targeting a single 5-αR enzyme receptor and has been around since 1997.

Finasteride is currently one of two FDA-approved medications for androgenic alopecia. When taken in higher doses, StatPearls Publishing says that it’s also used to treat benign prostatic hyperplasia (BPH), a condition that causes an enlarged prostate.

Since finasteride is used to treat various conditions, a lot is known about how it works and its effectiveness. Although finasteride is certainly an effective DHT blocker, it also comes with an array of well-established side effects.

According to the U.S. National Library of Medicine, finasteride’s side effects include (but are not limited to):

·   Decreased libido
·   Depression
·   Erectile dysfunction
·   Issues ejaculating (including problems with the amount of ejaculate produced)
·   Testicular pain
·   Changes to breast tissue, including increased size, lumps, or nipple discharge
·   Swelling, particularly around the lips and face
·   Itchy skin
·   Skin rashes or hives

Medications for androgenic alopecia need to be taken continuously in order to maintain hair growth. This makes these side effects, especially if experienced over the long-term, pretty serious. Although finasteride has been FDA-approved as a hair loss treatment, these side effects are a serious deterrent for a lot of people.
Finasteride lotions and topical solutions
While not yet FDA-approved, a new, topical version of finasteride is currently being developed. At the moment, the ideal concentrations for this new hair loss treatment are still being optimized. It’s also not known if certain formulations (for example, gels vs. lotions) are more effective than others.  

Although research studies on topical finasteride solutions are still in their early stages, a review in the Journal of Drugs in Dermatology says that results so far seem extremely promising. In addition to being used alone, topical finasteride has also been successfully combined with topical minoxidil, which is already FDA-approved, and both topical minoxidil and dutasteride.  

So far, the side effects of the topical finasteride also seem less severe in comparison to oral finasteride. They include:

·   Scalp irritation
·   Increased liver enzymes
·   Bed wetting
·   Testicular pain
·   Headaches
·   Lightheadedness
·   Sore throat

Dutasteride: A DHT-blocking medication approved in Asia

Dutasteride is another DHT-blocking medication. However, unlike finasteride, it’s not FDA-approved in the USA yet. This medication is in the process of being approved for benign prostatic hyperplasia in various countries, but is currently only approved for androgenic alopecia in South Korea and Japan.

Unlike finasteride, dutasteride targets multiple 5-αR enzyme receptors. A study in Clinical Interventions in Aging reported that this medication is more effective than finasteride. However, it still comes with the same types and likelihood of side effects.

Ketoconazole: An anti-fungal anti-DHT shampoo

Ketoconazole is an antifungal capable of counteracting skin problems. When made into a shampoo, it’s typically used to counteract dandruff and treat dermatitis. But a report in Skin Therapy Letter says that it’s also able to help reduce hair follicle inflammation.

According to studies in the journals Dermatology and the  Dermatologic Therapy journal, ketoconazole can also help fight androgenic alopecia. A study in Current Medicinal Chemistry says that it works as a slightly different type of DHT blocker. This type of DHT blocker blocks the hormone receptor by binding to it.

Although studies are still limited, it seems ketoconazole shampoo works about as well as 2 percent minoxidil solution. And like minoxidil, it’s also able to improve hair density, hair follicle size, and hair follicle production.

Given its ability to reduce dandruff, it’s no surprise that ketoconazole has been reported to help decrease sebum production. This is important since excess sebum has been associated with androgenic alopecia-induced hair loss symptoms. 

 

Natural DHT blockers

Dutasteride and finasteride are both manufactured medications. But there are a wide variety of naturally-occurring DHT blockers, too. 

Studies published in the Journal of Ethnopharmacology, Journal of Cutaneous and Aesthetic Surgery, Andrologia, and Nutrients have reported that a variety of herbs and plants are DHT blockers, as well. Some of these plants are foods we consume each day, while othersare ingredients you’re more likely to find in a nutrient supplement.

DHT blocking foods and supplements

A bunch of different plants people eat and drink are natural DHT blockers. Some of them are common, while others are usually only consumed in specific countries or regions.

You’ve almost certainly drank green tea or consumed some sort of caffeine in your life. These beverages, in addition to nettle, another plant commonly used to make tea, are DHT blockers. 

In some cases, a particular compound is responsible for these properties. For example, in green tea’s case, it’s EGCG (epigallocatechin gallate) that’s the potent DHT blocker. 

If you’re a big fan of shiitake, oyster, or Lingzhi mushrooms, these are all DHT blockers, too. Winter melon is, as well. But if you haven’t tried any of these, don’t worry. Besides for oyster mushrooms, these ingredients aren’t all that common. 

Some spices are also natural DHT blockers. You’ve almost certainly put black pepper on your food at some point in your life. And if you’re a fan of Asian curries, you may have also tried galangal, a peppery root that tastes a lot like ginger. 

At the end of the day, you don’t actually need to eat these foods to get the benefits of natural DHT blockers. You can also take a nutrient supplement. And the upside is that supplements are likely to be infused with nutraceuticals, which are safe to consume but much less likely to be incorporated into your average meal.

DHT blocking nutraceuticals

DHT blocking nutraceuticals have powerful DHT blocking properties. These include herbs and other plants like:

·   Saw palmetto (Serenoa repens/serrulata)
·   Equisetum species (particularly horsetail – Equisetum debile) 
·   East Indian globe thistle (Sphaeranthus indicus Linn.)
·   Japanese climbing fern (Lygodium japonicum)
·   Giant dodder (Cuscuta reflexa Roxb.)

Out of all of these, the best studied natural DHT blocker is saw palmetto. You can find it infused into a variety of products, including nutrient supplements, lotions, and anti-DHT shampoos

According to a review published in the journal Skin Appendage Disorders, saw palmetto can help stop the progression of pattern hair loss, support hair regrowth, and increase hair density. The best results seem to use a combination of both oral and topical products.

Just keep in mind that saw palmetto is often combined with other nutraceuticals, so not all of the reported benefits can be attributed to just this individual DHT blocker. Since natural DHT blockers are usually weaker than manufactured DHT blockers, it’s likely these nutraceuticals need to be combined in order to maximize their effects.

 

Blocking DHT can stop hair loss

DHT is the primary androgen involved in androgenic alopecia. Blocking this hormone can help reduce hair loss symptoms and stop the progression of this condition.

Several medications have the capability to block DHT, but they don’t all work in the same way. The most well-known ones — FDA-approved finasteride, the antifungal ketoconazole, and dutasteride — are all manufactured DHT blockers that work through different pathways. 

A wide variety of natural DHT blockers also exist. From herbs and spices to fruits and fungi, these plants are powerful nutraceuticals that can also help improve your hair. Out of all of these, the most well-established one is saw palmetto, which has been reported to help support hair regrowth.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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