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Hair Loss: Testosterone and DHT

Testosterone and DHT, a metabolic product of testosterone, are required in males for normal development in the womb and for development in adolescence of libido or sex drive. They are important in the development of secondary sexual characteristics such as pubic and facial hair, and the maturation of male muscle mass and skeletal integrity.


Testosterone is the male sex hormone associated with sexual drive, fertility, muscle growth, and male psychosocial attitudes. DHT, is more essential for the fetal development of the male reproductive system and the male genitalia. If in males, the enzyme which converts testosterone into DHT is lacking during fetal development, then the female-appearing genitalia system will be formed although these men will be genetically males. These males appear physically as rather thin-hipped and small-breasted but highly attractive females. Normally, personality difficulties emerge since these men possess many male attitudes. At this point, genetic testing often reveals their basic male identity and hormonal therapy is often used to switch their body into a more male growth pattern.


However, later in life, a higher than normal blood DHT level appears to cause premature aging of the male reproductive system, male pattern baldness, and the prostate condition known as benign prostate hyperplasia which is a non-cancerous enlargement of the prostate gland.An enlargement of the prostate gland makes urination increasingly difficult in men as they age. The production of DHT in older men is not well controlled by biochemical feedback mechanisms and compounds such as saw palmetto oil are widely used in Europe to reduce the body's level of DHT.

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DHT Inhibition and Immune Cell Damage

The most current idea on androgenic scalp hair loss is that it is a two step process:

(1) DHT acts on sensitive hair follicles to inhibit their growth and shrink their size.

This is followed by (2) a decay in the health and vitality of the follicle and the surrounding skin.

This causes immune system cells to damage the hair follicle and ultimately stop its hair growth. Blocking both of these steps is the best method to stop hair loss and regrow hair.

DHT is produced from the male sex hormone, testosterone, by an enzyme called 5-alpha reductase. Not all hair follicles are inhibited by DHT, for example, body hair in men may increase while scalp hair is lost. Beard growth is stimualated by DHT.


Conflicting Studies on DHT and Hair Loss

Studies on DHT and hair loss are conflicting but the general conclusion is that DHT is a key player in hair loss but other factors influence the final outcome.

It does appear that hair follicles in balding individuals are more sensitive to inhibition by DHT. The first link of hair loss to testosterone metabolism was the very ancient observation that men who were castrated at a young age did not develop pattern baldness. Modern research has confirmed this but such men can develop baldness if they receive supplemental testosterone.


Individuals born with a deficiency of 5-alpha reductase suffer neither scalp hair loss nor prostate hyperplasia. The deficiency reduces levels of DHT and spares sensitive hair follicles. (Imperato-McGinley J et al Science 1974; 186:1213-5) Studies reported that adult males with congenital 5 alpha-reductase deficiency had decreased levels of dehydrotestosterone (DHT). These individuals had a small prostate gland throughout life and did not develop BPH. They also did not develop male pattern baldness or acne. On the other hand, the genes controlling 5-alpha reductase activity and DHT production are not the only factor involved in balding.

In a study of 828 healthy families comprising 3000 individuals, both young, bald individuals as well as older, non-bald individuals were compared for the genes controlling DHT production.


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Important facts we've learned:

  • It was found that the genes controlling DHT production in men are not the cause of male pattern baldness.
  • This study shows that there is no overproduction of DHT, or if there is it is not caused by the genes that control DHT production (5-alpha reductase activity).



Another interesting finding of this study was that baldness did not follow a simple genetic inheritance pattern which suggests that multiple genes and or environmental factors control hair loss (Genetic analysis of male pattern baldness and the 5-alpha-reductase genes, Ellis JA; Stebbing M; Harrap SB, J Invest Dermatol, 110(6):849-53 1998).