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Endocrinology

DHT, Percent Free Dialysis

Optimal Result: 0.54 - 2.58 %.

Dihydrotestosterone (DHT), Percent Free Dialysis is a laboratory measurement used to assess the bioavailable portion of dihydrotestosterone (DHT) in the bloodstream. DHT is a potent androgen hormone derived from testosterone through the action of the enzyme 5a-reductase. This conversion primarily takes place in target tissues, such as the skin, prostate, and hair follicles, and DHT plays a crucial role in male sexual development and secondary sexual characteristics.

What is DHT?

Dihydrotestosterone is one of the most powerful androgens, even more potent than testosterone itself. Its effects include:

- Development of male genitalia during fetal development

- Growth of body hair and facial hair

- Sebaceous gland activity

- Contribution to male-pattern baldness

- Influence on prostate growth

DHT acts by binding to androgen receptors in target tissues, influencing cellular activity and gene expression.

Why Measure DHT, Percent Free Dialysis?

The DHT, Percent Free Dialysis test specifically measures the fraction of circulating DHT that is not bound to proteins like sex hormone-binding globulin (SHBG). Most DHT in the blood is tightly bound to SHBG, rendering it biologically inactive. However, the free fraction (DHT not bound to SHBG) represents the bioavailable DHT - the portion of the hormone that can actively interact with cells and tissues.

This measurement is critical because only the free fraction of DHT is available to exert its physiological effects. Assessing the free fraction of DHT provides a more accurate reflection of how much of the hormone is available to the body, which can be useful in diagnosing certain hormonal disorders and assessing androgen utilization.

Clinical Applications:

The DHT, Percent Free Dialysis test is particularly important for diagnosing and evaluating conditions related to androgen metabolism, including:

5a-Reductase Deficiency:

This genetic condition involves a deficiency of the enzyme that converts testosterone to DHT. Individuals with this condition may present with ambiguous genitalia or underdeveloped male genitalia despite normal or elevated testosterone levels. Measuring DHT levels, especially the free fraction, helps to confirm the diagnosis.

Androgen Utilization Disorders:

Conditions where the body either underutilizes or overutilizes androgens can be better understood through this test. For instance, in cases of androgen insensitivity syndrome, where the body does not respond to DHT effectively, free DHT levels may still be normal or elevated.

Monitoring Androgen Replacement Therapy:

In patients undergoing testosterone replacement therapy, evaluating DHT levels helps ensure that excessive DHT, which can contribute to side effects like prostate enlargement or hair loss, is not being produced.

How is the Test Performed?

The DHT, Percent Free Dialysis test is typically conducted using a method known as equilibrium dialysis. This process involves separating the free hormone from the protein-bound hormone in a sample of blood. The percentage of free DHT is then calculated, providing insight into the bioavailable fraction of the hormone.

Conclusion

The DHT, Percent Free Dialysis test is a valuable tool for understanding androgen physiology and diagnosing conditions such as 5α-reductase deficiency. By assessing the bioavailable fraction of DHT, this test offers crucial insights into the body's hormonal balance and can guide the management of various disorders related to androgen metabolism.

References:

Azzouni, F., Godoy, A., Li, Y., & Mohler, J. (2012). The 5 alpha-reductase isozyme family: A review of basic biology and their role in human diseases. Advances in Urology, 2012, Article ID 530121. https://doi.org/10.1155/2012/530121

Hoffman, R. M. (2020). Clinical practice. Screening for prostate cancer. New England Journal of Medicine, 382(11), 1076-1078. https://doi.org/10.1056/NEJMcp1905812

Rossi, A., Cantisani, C., Melis, L., Iorio, A., & Scali, E. (2021). Finasteride and dutasteride in androgenetic alopecia: A review. Dermatologic Therapy, 34(1), e14591. https://doi.org/10.1111/dth.14591

Libianto, R., Norman, R. J., & Cassar, S. (2021). Androgens and polycystic ovary syndrome: Pathophysiology and implications for clinical management. Human Reproduction Update, 27(5), 707-732. https://doi.org/10.1093/humupd/dmab008

Stout, S. M., & Stumpf, J. L. (2010). Finasteride treatment of hair loss in women. The Annals of Pharmacotherapy, 44(6), 1090-1097. https://doi.org/10.1345/aph.1M684

Gupta, A. K., & Charrette, A. (2014). The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia. Journal of Cutaneous Medicine and Surgery, 18(6), 356-363. https://doi.org/10.2310/7750.2014.14118

What does it mean if your DHT, Percent Free Dialysis result is too high?

Elevated levels of free dihydrotestosterone (DHT) can indicate several physiological and pathological conditions related to excessive androgen activity. Since DHT is a potent androgen, elevated levels of bioavailable DHT can lead to an overactivation of androgen receptors in various tissues, resulting in several clinical symptoms and conditions.

Potential Causes of Elevated DHT Levels:

  1. Androgenic Alopecia (Male-Pattern Baldness):

    • Elevated DHT is one of the primary contributors to male-pattern baldness. In susceptible individuals, excess DHT binds to androgen receptors in hair follicles, leading to hair miniaturization and thinning over time.

  2. Benign Prostatic Hyperplasia (BPH):

    • DHT is a key hormone driving the growth of prostate tissue. Elevated DHT levels can cause the prostate to enlarge, leading to BPH, which may present with urinary difficulties, such as frequent urination, weak urine stream, or incomplete bladder emptying.

  3. Prostate Cancer:

    • While DHT is not the direct cause of prostate cancer, elevated levels can promote the growth of androgen-sensitive prostate cancer cells. Therefore, high DHT levels are often linked to a higher risk of prostate cancer progression in individuals with the condition.

  4. Hirsutism in Women:

    • Elevated DHT levels in women can lead to excessive hair growth on the face, chest, and back (a condition known as hirsutism). This is often associated with conditions like polycystic ovary syndrome (PCOS) and androgen-secreting tumors.

  5. Acne and Seborrhea:

    • High DHT levels can overstimulate the sebaceous glands, leading to increased sebum production and contributing to acne formation, particularly in men and women prone to hormonal acne.

Symptoms of Elevated DHT Levels:

  • In Men:

    • Male-pattern baldness (receding hairline, thinning hair)
    • Benign prostatic hyperplasia (enlarged prostate and urinary symptoms)
    • Oily skin and acne
    • Increased body and facial hair growth (in some cases)

  • In Women:

    • Hirsutism (excessive hair growth on face, chest, and back)
    • Acne, particularly in areas with more sebaceous glands (face, chest, back)
    • Thinning scalp hair (female-pattern hair loss)

Treatment Options for Elevated DHT Levels

The treatment for elevated DHT levels depends on the underlying condition and the symptoms experienced. Several treatment strategies are available to reduce DHT production or block its effects:

  1. 5α-Reductase Inhibitors:

    • Finasteride and Dutasteride are medications that inhibit the enzyme 5α-reductase, which is responsible for converting testosterone to DHT. These drugs are commonly used to treat:
      • Male-pattern baldness: Reducing DHT levels in the scalp can slow hair loss and, in some cases, promote hair regrowth.
      • Benign prostatic hyperplasia (BPH): By lowering DHT levels, these medications can shrink the prostate, relieve urinary symptoms, and reduce the risk of needing surgery.

  2. Anti-Androgens:

    • Spironolactone: This medication blocks androgen receptors and reduces the effects of DHT on tissues. It is often used to treat conditions like hirsutism and acne in women, as well as some forms of androgen-driven hair loss.

  3. Topical Treatments for Hair Loss:

    • Minoxidil (Rogaine): While not directly reducing DHT levels, minoxidil can improve blood flow to the scalp and promote hair growth. It is often used alongside DHT-reducing treatments like finasteride.

  4. Hormonal Therapies:

    • In women with elevated DHT levels due to conditions like PCOS, oral contraceptives or medications like metformin may help regulate androgen production and reduce symptoms like hirsutism and acne.

  5. Lifestyle Changes:

    • Dietary Adjustments: A balanced diet rich in vegetables, whole grains, and healthy fats can help support hormonal balance.
    • Regular Exercise: Physical activity may help manage androgen levels by improving insulin sensitivity and reducing the effects of conditions like PCOS.
    • Weight Management: In individuals with obesity, excess body fat can contribute to hormone imbalances, so maintaining a healthy weight can help regulate androgen production.

Conclusion

Elevated levels of DHT can result in several androgen-related conditions, including male-pattern baldness, benign prostatic hyperplasia, hirsutism, and acne. Understanding DHT levels, particularly the free, bioavailable fraction, is important for diagnosing these conditions and implementing effective treatments. Options include 5α-reductase inhibitors, anti-androgens, and lifestyle modifications, all of which can help manage the symptoms and underlying causes of elevated DHT.

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