5a-DHT is essential for the development of the male sex characteristics before birth, particularly the formation of the external genitalia. In the adult, 5a-DHT is needed to develop and maintain male gender characteristics, such as facial hair, deep voice, and muscle growth. In women, 5a-DHT may induce the onset of puberty and causes the body and pubic hair growth.
In males, about 70% of 5a-DHT is derived from conversion of testosterone by 5a-Reductase in the prostate, testes, hair follicles, and adrenal glands. In females most of the 5a-DHT is derived from androstenedione. 5a-DHT has approximately 3 times greater affinity for androgen receptors than testosterone and has 15-30 times greater affinity than adrenal androgens.
5a-Reductase is best known because it makes androgens like testosterone more potent. It is also responsible for metabolizing progesterone and cortisol. If up-regulated, it may cause high androgen symptoms in men (thinning hair, prostate) and women (as in PCOS, thinning hair, acne, facial hair growth). 5b-Metabolites are less androgenic (weaker).
High levels of 5a-DHT can increase your risk for certain conditions, but having too little 5a-DHT can also cause problems in your sexual development as you go through puberty.
Low 5a-DHT may cause delays in the onset of puberty for all sexes. Otherwise, low 5a-DHT doesn’t appear to have much effect on women, but in men, low 5a-DHT may cause:
- late or incomplete development of sex organs, such as the penis or testes
- changes in body fat distribution, causing conditions such as gynecomastia
- increase in risk of developing aggressive prostate tumors
5a-DHT is a testosterone metabolite.
- If testosterone levels become too high, it usually results in excess of 5a-DHT, an androgen hormone and sex steroid. Both testosterone and 5a-DHT in excessive amounts can lead to a number of health issues.
- If your testosterone levels are in the normal range, but your 5a-DHT is increased it means that the alpha metabolic pathway is favored instead of the beta metabolic pathway.
List of possible symptoms for high 5a-DHT levels:
Increased 5a-DHT levels are found in about 40% of patients with idiopathic hirsutism and 35% of patients with polycystic ovarian syndrome. Women with too much DHT may develop increased body, facial and pubic hair growth, amenorrhoea and increased acne. Abnormal changes to the genitalia may also occur in women with too much DHT.
Male Pattern Baldness (MPB):
5a-DHT is the primary contributing factor in male pattern baldness (MPB) or Androgenic alopecia. Men with MPB typically have higher levels of 5a-DHT, lower levels of total testosterone and higher levels of free testosterone.
Benign Prostatic Hyperplasia (BPH):
5a-DHT plays a role in the development and exacerbation of benign prostatic hyperplasia, as well as prostate cancer, by enlarging the prostate gland. Prostate growth and differentiation are highly dependent on sex steroid hormones, particularly 5a-DHT.
How to potentially address increased 5a-DHT levels:
If you are going down the alpha pathway towards 5a-DHT the symptoms are usually your typical PCOS-like symptoms like facial hair, acne, anger and irritation and hair loss on the head. Males might experience pattern baldness, prostate enlargement (BPH = Benign prostatic hyperplasia).
You might have completely normal levels of testosterone (please check your testosterone marker in this test to verity) and, yet, have a bad case of acne, are irritated or thinning scalp hair. If your 5alpha-DHT is increased this would be an indication that you are favoring the alpha pathway that’s quite aggressive on your skin, hair and other places. The reasons for your body choosing the alpha pathway can certainly be genetic, but it is often due to inflammation, blood sugar / insulin dysregulation, having extra adipose tissue, etc.. If you can address these underlying issues then your body will balance out the alpha and beta pathways and it will improve the symptoms.
In addition to addressing the underlying conditions (inflammation, glucose/insulin dysregulation, etc), there are things that can be done from a lifestyle perspective to mitigate the symptoms by blocking the alpha pathway, such as:
(before starting a supplement regime, please consult your doctor first)
- Saw palmetto
- Stinging and dwarf nettle
- Pygeum extract (bark)
- Reishi mushroom
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