Importance of DHT

Index:

1. Functions of DHT

1.1. Formation of the body and puberty

1.2. Adulthood

a. Maintenance of prostate health

b. Libido and hormonal balance

2. Problems that Finasteride can cause to the hormonal balance of men

3. The importance of a high level of testosterone for general health

4. Secondary hypogonadism

5. Does Saw palmetto also inhibit DHT?

6. 5 Alpha Reductase enzyme





Finasteride inhibits the conversion of testosterone into DHT (dihydrotestosterone). This causes a decrease of 70% in the level of DHT in those taking finasteride.





1. Functions of DHT (dihydrotestosterone) in a man's body:

1.1. Development of the body and puberty:

- Formation of the male sex organs in the fetus. Boys who are born without the ability to convert testosterone into DHT are born with ambiguous genitalia, malformed penises. Pseudohermaphrodites.

- Development of male characteristics at puberty. DHT is responsible for the emergence of body hair (including beard), penis growth, development of the libido and sexual function and prostate. In p seudohemaphrodites these functions do not develop fully at puberty, despite having a normal level of testosterone. They only develop male musculature, with little body hair and their sexual organ is between a micro penis and an overdeveloped clitoris . However, they never develop baldness.



1.2. Adult stage :

a) Maintaining the health of the prostate .

The prostate is where it is found the greatest concentration of DHT in the male body. In a simple analogy, DHT has to the prostate the same importance that oil and gasoline would have to an engine. It lubricates the prostate, maintains the size, stimulates and keeps the prostate functioning. And how important is the prostate? Well, without a prostate the penis does not work ... Men who undergo total prostatectomy (complete removal of the prostate), have impotence, decreased penis size, change in penile corpus cavernosum tissue (the tissue becomes cartilage, impairing the ability of erection), Peyronie's disease (scar in penile tissue, causes deformation and pain), among other problems. In a ripple effect, we can say that DHT is essential to maintain the structure and health of the penis. In the most severeous cases of men affected by finasteride (it has been called Post Finasteride Syndrome) they have exactly these problems ... change in penile tissue and Peyronie's disease (and impotence), which means that the inhibition of 5 alpha reductase in these men was so strong that their prostates were seriously affected (again, these patients are the most serious cases of SPF, not most cases). What's worse is that finasteride causes shrinkage of the prostate and this occurs by apoptosis (cell death), which means that depending on how this happens in the body (time of use, drug sensitivity, propensity, age, among other factors) the prostate can suffer serious consequences because of the use of Finasteride.



b) Libido and hormonal balance :

DHT is a hormone 5 times more erogenous and more potent than testosterone. The truth is that medicine is still crawling on the task of explaining the male libido and exactly how sexual hormones work together. What is known is there is a very subtle balance between testosterone, free testosterone, DHT, estrogen and prolactin (this one released in the brain). Furthermore, each of these hormones have by-products, each is transformed by enzymes into other hormones. It is like a large, interconnected network and one influences the other ... DHT also is subsequently transformed by the same 5 alpha reductase in 3 adiol G - 3 Alpha Androstenadiol Glucuronide (women with high levels of 3 Adiol G have excess hair and reproduction difficulties ... it is a masculinizing hormone. Unfortunately it is common to find an extremely low level of 3 Adiol G in men with persistent effects of finasteride.







2. Problems that Finasteride can cause to the hormonal balance of men

To understand how Finasteride can affect the hormonal balance of a man, one must understand a bit how it works. Depending on the age, this balance occurs differently. In a very simplified explanation, this is glimpse of how it works: Men in andropause ("menopausal" in men) have a high level of DHT and estrogen and mean level of testosterone, as well as a higher level of prolactin. Y oung men have a "low" level of DHT and estrogen, high testosterone and low levels of prolactin. After ejaculation, at any age, prolactin level in the brain rapidly rises, causing lack of sexual interest at that time. The younger you are, the faster the prolactin level will fall back, and soon you will feel sexual interest again. Older men have a higher prolactin level and therefore are less interested in sex. This gradual increase in prolactin level, occurs naturally as the years go by. This is why older men have higher levels of prolactin then young men. The body, to maintain balance and sex drive, increases the level of DHT everytime the estrogen level increases. They are interconnected. The excess testosterone is converted into DHT and estradiol at similar levels. So, to make it clear: In men, DHT has the effect of enhancing libido and estrogen inhibits libido (because the last is linked to prolactin in the brain).

To maintain the balance of a man's body, DHT and estrogen are interconnected. When the level of one is low, the level of the other must be also low. When the level of one increases, the level of the other also increases. Never, in his natural state, a man has a high level of estrogen and a low DHT level , because estrogen is a highly feminizing hormone and DHT a highly masculinizing hormone. Only when a man takes Finasteride, he creates this imbalance in his body.



Below is a rough sketch to facilitate understanding. Note that the level of DHT in young men, seems low compared to a mature man, but the balance between DHT and a low level of Estradiol gives him a higher libido. Remember, estrogen neutralizes libido in men:



Young Men (normal situation)

Testosterone - high level

DHT low - normal

Estrogen (estradiol) low level - normal

Prolactin low - normal

Result: High Libido



Mature men (normal)

Testosterone - median in range

DHT - elevated

Estrogen (estradiol) - Higher than a young man

Prolactin - median in range

Result: average libido





Old men (normal situation)

Testosterone: medium-low

DHT - medium

Estrogen (estradiol) - medium

Prolactin

-high

Result: Low Libido





Young men taking Finasteride - the first month

Testosterone - Elevated, anything between 15-20%

DHT - Very low (reduced by 70 %)

Estrogen (estradiol)?

Prolactin?

Result:?









Young men taking Finasteride - after a few months

DHT very low (reduced by 70%)

Estrogen (estradiol) - elevated (excess testosterone is converted into estrogen only, instead of E2 and DHT. Possibility of feminization of the body)

Prolactin: elevated (increasing the level of estrogen causes increased prolactin)

Impact on libido: Lower libido due to high levels of Prolactin, Estradiol and low level of DHT.





The last two schemes are the only unbalanced ones. In the long run it is unsustainable for the man's body. This is because, as I said before, DHT and Estrogen are connected. DHT is the male body's natural protection against the increase of estrogen (estradiol). With finasteride, men artificially induce low levels of DHT, then the excess testosterone is converted into Estrogen only, instead of DHT and Estrogen. The body will try to find the balance every day, while you keep that state artificially. The problem is the body can find a balance in a way that is not good for the patient ... And that may cause some of the persistent effects in some men.





Risk 1: Risk of developing secondary hypogonadism

The body can interpret this increase in estrogen as an overproduction of testosterone (yes, you read that right). The pituitary "reads" estrogen and testosterone as a single hormone, the pituitary is the same in men and women, just suffered the action of different hormones during development. So if your body understands it is producing excess testosterone, the pituitary will signal to gradually decrease the testicles natural production of testosterone, which also causes a decrease in testicular size (irreversible in most cases). This is called secondary hypogonadism. So there are men who took finasteride and now show a low level of testosterone. T he same thing can happen with someone who takes anabolic steroids. Result: low testosterone levels, infertility, impotence, lack of energy, depression, etc., etc.. Many doctors will roll the chair if you say that Finasteride can cause secondary hypogonadism in some men, but there are proven cases and published studies. The problem is that Merck hid the risk (or did not know it, it may never have appeared in the short-term studies). A few years ago, doctors around the world began calling for a thorough examination of sex hormones before the patient started treatment with finasteride. Thus, it is possible to prove that the fall in testosterone production was caused by the medicine.

When secondary hypogonadism happens, the body can no longer return to the previous level of testosterone production alone in most cases. What you can do is try to reconnect the hypothalamic-testicles through drugs like Clomid and Nolvadex, which stimulate the production of FSH in the pituitary (more information in the "secondary hypogonadism", below).





Risk 2: Raise the level of estrogen (E2) and affect the relationship E2 x DHT:

On this situation, the level of testosterone is not affected, but estrogen stabilizes at a high level. Consequences: Possibility of feminization of the body, gynecomastia or pseudo-gynecomastia, increased fat accumulation in the hips, reduced libido etc., etc.. If your body can balance the level of DHT with the Estrogen when you stop Finasteride , these effects will be mitigated. A possible treatment for this problem is the use of drugs such as Arimidex. It inhibits the conversion of testosterone into estrogen. But it is a very meticulous process, to balance precisely this way. If you overdo the dose and duration of treatment, estrogen level may plunge (and this may worsen erection). So it may only be suitable for someone who is showing a very high level of estrogen and low DHT, and already has a reasonable time he stopped taking finasteride.





Risk 3 :

No known cause. Many men have normal levels of Testosterone, Estrogen and DHT after stopping Finasteride and still have lingering effects of the drug. Probably this group's problems are related to the consequences of 5 alpha reductase inhibition , as it has other functions in the body.









3. The importance of a high testosterone level for overall health

Testosterone is the locomotive of the male body. It runs several processes in the body, since the hormones interact in cycles (feedback loop). Having a higher testosterone level, a man will feel more energy, better health, better fertility, increased sex drive, a faster metabolism, improved memory, more muscle tone, stronger bones, better mood, increased sense of satisfaction and peace. It is therefore extremely serious that finasteride decreases testosterone production in some men. Normal levels of testosterone range between 300 and 1000 ng/dl. However, this is a general range, doctors use this range for men from 13 to 80 years old. Obviously, the testosterone level in an adolescent is closest to the upper limit and in older men it will be closer to the lower limit. A normal level of testosterone for a young man is in the upper third of the scale. Then, on the range presented here, a normal level for a man from 20 to 30 years would be 650 to 1000 ng/dl. For an elderly person, the expected level would be approximately between 300 and 500 ng/dl. Men who have testosterone levels below the lower limit are considered to present hypogonadism. There are other ranges and the analysis must be done according to the range and the age of the patient.

Unfortunately Finasteride is bringing testosterone production down to these levels in men 20 to 30 years old. But they still have a whole life ahead and already present hormone levels as 60 year old men. And in some young men, this decrease in production was more severe, and they have testosterone levels below 300 ng/dl (more about hypogonadism below).

From the age of 30, a man loses 1% of his testosterone production per year until the end of life. It's a very slow progress, and men only realize this situation when this process is close to 60 years old or later and he has already lost 30% of his testosterone level. It is a very different situation if you loose 30% in one year ... as it has happened to some users of Finasteride.



