Other names: DH; 5a-dihydrotestosterone
What is dihydrotestosterone?
Dihydrotestosterone (=DHT) is a hormone that contributes to the development of sexual structures and characteristics in people assigned male at birth. When DHT levels are too high or too low, it can cause different issues depending on your age and stage of sexual development.
DHT and testosterone:
DHT is made through conversion of the more commonly known androgen, testosterone. Almost 10% of the testosterone produced by an adult each day is converted to dihydrotestosterone. This takes place in the testes and prostate (in men), in the ovaries (in women), as well as the skin and other parts of the body such as the liver. This figure is much lower before puberty however, and it is thought that the increased dihydrotestosterone production may be responsible for the start of puberty in boys, causing development of the genitals (penis, testes and scrotum) and growth of pubic and body hair. This hormone also causes the prostate to grow and is thought to combine with testosterone causing the expression of male sexual behavior.
→ Dihydrotestosterone is many times more potent than testosterone, and many of the effects that testosterone has in the body only happen after it is converted to dihydrotestosterone.
Dihydrotestosterone and women:
Much less is known about the importance of dihydrotestosterone in women, but it is known to cause much of the body and pubic hair growth seen in girls after puberty and may help to determine the age at which girls begin puberty.
What are androgens?
Androgens are endogenous steroid hormones. They consist of the hormones dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone (DHT).
DHT is the most potent hormone among the androgens and is considered a pure androgen as it cannot convert into estrogen. It is formed primarily in peripheral tissues of the body, where it exerts its effects. Testosterone converts to DHT by the action of the 5 alpha-reductase enzymes at these target tissues. This isolated synthesis at a specific target tissue makes DHT primarily a paracrine hormone (= they perform a type of cellular communication in which a cell produces a signal to induce changes in nearby cells, altering the behavior of those cells.).
Back to DHT:
As DHT is produced mainly in the liver, only small amounts are present in the systemic circulation. It plays a vital role in the sexual development of males. During embryonic life, it is involved primarily in the sexual differentiation of organs. Through adolescence and adult life, DHT promotes prostate growth, sebaceous gland activity (= sebaceous glands are microscopic glands found in your hair follicles that secrete an oily substance), male pattern baldness, and body, facial and pubic hair growth. This hormone, however, does not seem to play any significant role in normal female physiology. The mutations leading to dramatic losses of DHT in females only have minor effects on their normal physiology.
How is dihydrotestosterone controlled?
The amount of dihydrotestosterone present in the body from day to day depends on the amount of testosterone present. When levels of testosterone increase, more of it is converted to dihydrotestosterone and so levels of dihydrotestosterone also increase as a result.
Control of dihydrotestosterone levels in the body is therefore achieved through control of testosterone production, which is regulated by the hypothalamus and the pituitary gland. In response to decreasing levels of testosterone (and therefore reduced amounts of dihydrotestosterone), the hypothalamus releases gonadotropin-releasing hormone (GnRH), which travels to the pituitary gland, stimulating it to produce and release luteinizing hormone into the bloodstream. Luteinizing hormone in the blood then travels to special cells in the testes in men (or ovaries in women) and stimulates them to produce more testosterone. As testosterone in the blood increases, more of it is also converted to dihydrotestosterone, resulting in higher levels of dihydrotestosterone as well.
As blood levels of testosterone and dihydrotestosterone increase, this feeds back to suppress the production of GnRH from the hypothalamus which, in turn, reduces production of luteinising hormone by the pituitary gland. Levels of testosterone (and thus dihydrotestosterone) begin to fall as a result, so negative feedback decreases and the hypothalamus resumes secretion of GnRH.
What does DHT do to your body?
Unlike testosterone, DHT doesn’t play a significant role in maintaining male physiology in adulthood. Effects mainly include prostate enlargement and male pattern hair loss in adulthood.
DHT and fetal development:
During fetal development, a specific and unique environment of hormones results in male or female differentiation of sexual anatomy. In males, DHT acts with other hormones (including testosterone) to block the formation of the female anatomy and to promote the development of the male anatomy. DHT is essential for the formation of the male external genitalia, including the penis and scrotum, in a fetus. DHT also helps with the formation of the prostate.
DHT and puberty:
During puberty for children AMAB (assigned male at birth), DHT promotes further growth of the penis and scrotum. It’s also the main androgen that’s responsible for:
→ Facial hair
→ Body hair
→ Pubic hair
→ Prostate growth
References:
Kinter KJ, Anekar AA. Biochemistry, Dihydrotestosterone. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557634/
Auchus RJ. The backdoor pathway to dihydrotestosterone. Trends Endocrinol Metab. 2004 Nov;15(9):432-8. doi: 10.1016/j.tem.2004.09.004. PMID: 15519890.
Swerdloff RS, Dudley RE, Page ST, Wang C, Salameh WA. Dihydrotestosterone: Biochemistry, Physiology, and Clinical Implications of Elevated Blood Levels. Endocr Rev. 2017 Jun 1;38(3):220-254. doi: 10.1210/er.2016-1067. PMID: 28472278; PMCID: PMC6459338.
Marchetti PM, Barth JH. Clinical biochemistry of dihydrotestosterone. Ann Clin Biochem. 2013 Mar;50(Pt 2):95-107. doi: 10.1258/acb.2012.012159. Epub 2013 Feb 21. PMID: 23431485.
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What happens if I have too much dihydrotestosterone?
Too much dihydrotestosterone, often resulting from excess testosterone production, has variable effects on men and women. It is unlikely that levels of dihydrotestosterone will be raised before the start of puberty. It is also unlikely that adult men with too much dihydrotestosterone would undergo recognizable changes.
Women with too much dihydrotestosterone may develop increased body, facial and pubic hair growth (= hirsutism), stopping of menstrual periods (= amenorrhoea) and increased acne. Abnormal changes to the genitalia may also occur in women with too much dihydrotestosterone.
Certain health conditions are associated with high levels of DHT, including:
→ Benign prostatic hyperplasia (a condition in which your prostate grows in size)
Your prostate can produce large amounts of DHT. This local DHT production stimulates normal prostate activity but also commonly leads to prostate growth. BPH can cause difficulty with peeing and sexual dysfunction.
→ Prostate cancer
→ Androgenic alopecia (male pattern hair loss).
→ Polycystic ovarian syndrome (PCOS).
→ DHT and benign prostatic hyperplasia
DHT and prostate cancer:
People who have prostate cancer usually have an increase in DHT levels. An increase in DHT activity in your prostate, in addition to certain genetic mutations that cause prostate cells to grow uncontrollably, leads to prostate cancer.
DHT and androgenic alopecia:
Androgenic alopecia is commonly known as male pattern hair loss. The hair loss usually happens on the top and frontal regions of your scalp, causing your hairline to recede over time. Increased DHT activity at your hair follicles is partly responsible for this hair loss, in addition to other factors, including genetic ones. High levels of DHT can shrink your hair follicles and shorten the hair growth cycle, resulting in hair loss.
DHT and PCOS:
Polycystic ovarian syndrome (PCOS) is a hormonal imbalance that affects people AFAB (=Assigned Female At Birth). It happens when their ovaries create excess androgens, including testosterone, which leads to increased DHT levels. This causes a variety of symptoms, including irregular periods, excessive hair growth (hirsutism) and acne.
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What happens if I have too little dihydrotestosterone?
Dihydrotestosterone is thought to have fewer effects in women and, as a result, it is believed they are relatively unaffected by having too little dihydrotestosterone. It is possible, however, that the start of puberty may be delayed in girls with too little dihydrotestosterone and the amount of pubic and body hair present in adult females may also be reduced.
In contrast, low levels of dihydrotestosterone in men can have dramatic effects. If there is too little dihydrotestosterone whilst male fetuses are still in the womb, for example, they may not be 'masculinized' and their genitalia may seem similar to that seen in girls of the same age. Later, boys with too little dihydrotestosterone may undergo some of the changes usually seen in puberty (such as muscle growth and production of sperm) but will not develop normal body hair growth and genital development.
Certain conditions are associated with low levels of DHT, including:
→ 5-alpha reductase deficiency.
→ Low testosterone (male hypogonadism).
→ Lower-than-normal DHT levels mainly affect people AMAB (assigned male at birth). Some scientists think low DHT levels in children AFAB (assigned female at birth) may delay the start of puberty.
DHT and 5-alpha reductase deficiency:
5-alpha reductase is an enzyme that helps convert testosterone to DHT. A genetic mutation (change) that affects the production of the enzyme can cause low or no levels of DHT. This is called 5-alpha reductase deficiency. People inherit this condition in an autosomal recessive pattern.
5-alpha reductase deficiency affects the sexual development of genetically male (XY chromosomes) fetuses. Males born with the deficiency typically have:
In cases of severe 5-alpha reductase deficiency, genetically male babies with XY chromosomes have external genitalia that appear female. Low DHT does not affect the development of the testicles (they can still produce sperm) and internal sexual organs and structures. This is different from androgen insensitivity syndrome. People with this condition have normal testes with normal to high testosterone levels - they just lack androgen receptors. This causes them to not have secondary sexual characteristics and to have infertility.
During puberty, children who are genetically male with 5-alpha reductase deficiency experience a lack of facial hair growth. Because their body still makes testosterone, they still experience voice deepening, muscle mass increase and penis enlargement.
DHT and low testosterone:
As your body converts testosterone to DHT, if you have low levels of testosterone, you’ll have lower-than-normal levels of DHT as well. Another name for low testosterone is male hypogonadism.
There are two main types of male hypogonadism: classical (congenital or acquired) and late-onset. Male hypogonadism can cause different issues depending on your age.
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