Elevated DHT levels...prostate...@Dr Justin Saya MD

JimBob

Active Member
Thread starter #1
@Dr. Justin Saya MD, what are your concerns with elevated DHT and the prostate? You've implied in other threads that there could be problems. I'd like your take on why there is cause for concern. Thanks.

The quote here was from your past discussion with Dr. Nichols. You mention DHT/prostate twice here:
"Not monitoring DHT, especially with the route of administration being high doses to the scrotum...you mentioned hair, what about the prostate? You also mentioned if a male had high DHT symptoms (of which you only mention hair...again think about prostate) that you would prescribe the appropriate medication."
 
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#8
BPH, not prostate cancer. Male pattern baldness. Guys applying an entire testosterone replacement dose directly to the scrotum can have well-above physiologic DHT levels.
If I am not having problems with BPH and already lost my hair do I need to be concerned then? I am one of those guys you speak of and last labs my DHT was 260 when the range is (some number-85).
 
#11
Im wondering if sexual function wouldnt be compromised by keeping dht levels in the low/ normal area while total and free T are in the upper?
Example- dht at 25-35 and total T at 700-800 along with higher free T.
I thought i read somewhere that low normal dht is preferred as long as total T is upper 1/3. The problem arises when dht is almost zero.

Im wondering if those men who develope sexual side effects from finasteride already are “ on the brink” due to total T being low normal. Perhaps higher free T will mitigate any sexual sides from low dose finasteride?
 

JimBob

Active Member
Thread starter #12
BPH, not prostate cancer. Male pattern baldness. Guys applying an entire testosterone replacement dose directly to the scrotum can have well-above physiologic DHT levels.


Pharmacokinetics of testosterone cream applied to scrotal skin
"Disproportionate increases in serum DHT are reported after administration of all transdermal testosterone products with the higher DHT/T ratio attributable to the strong expression of 5‐alpha reductase in skin structures which foster the conversion of testosterone to DHT during transdermal passage. Furthermore androgens induce greater expression of the 5α reductase enzyme whereby administration of an androgen directly onto the skin creates a feed‐forward (positive feedback) mechanism (Russell & Wilson, 1994; McNamara et al., 2013). Analogous disproportionate increases in serum DHT (creating a higher DHT/T ratio) are also reported after oral testosterone undecanoate (Schnabel et al., 2007; Yin et al., 2012). The clinical significance of such increased DHT/T ratio, common to all non‐parenteral routes of testosterone administration, is doubtful as studies maintained circulating DHT levels of 10 times the physiological concentrations for up to 2 years without increasing prostate size or growth or any adverse sequelae (Idan et al., 2010) nor do exogenous androgens increase intraprostatic DHT (Marks et al., 2006; Page et al., 2011; Mostaghel et al., 2012; Thirumalai et al., 2016).
 
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#13
Nice find @JimBob. Conventional wisdom has it that exogenous T will grow your prostate. And doubly so for scrotal application. Which always struck me as odd, since we have higher T when we are young, yet BPH happens when we get older and our T levels go down. If high T caused BPH, teenagers should be getting it not old men.
 
#14
Why do some men go bald in their 40’s rather than 19 when T is highest? Genetics. With the prostate, it starts another growth rate around 40 and begins to slowly grow again. The prostate converts T to dht much more than other sites in the body so not much dht is needed. That said, higher dht levels can speed up the process a bit.
Despite what that literature states, many men over 50 experience urination issues after a few T injections.
 
#15
Why do some men go bald in their 40’s rather than 19 when T is highest? Genetics. With the prostate, it starts another growth rate around 40 and begins to slowly grow again. The prostate converts T to dht much more than other sites in the body so not much dht is needed. That said, higher dht levels can speed up the process a bit.
Despite what that literature states, many men over 50 experience urination issues after a few T injections.
Can you elaborate/link...never read this before.
 
#16
Pharmacokinetics of testosterone cream applied to scrotal skin
"Disproportionate increases in serum DHT are reported after administration of all transdermal testosterone products with the higher DHT/T ratio attributable to the strong expression of 5‐alpha reductase in skin structures which foster the conversion of testosterone to DHT during transdermal passage. Furthermore androgens induce greater expression of the 5α reductase enzyme whereby administration of an androgen directly onto the skin creates a feed‐forward (positive feedback) mechanism (Russell & Wilson, 1994; McNamara et al., 2013). Analogous disproportionate increases in serum DHT (creating a higher DHT/T ratio) are also reported after oral testosterone undecanoate (Schnabel et al., 2007; Yin et al., 2012). The clinical significance of such increased DHT/T ratio, common to all non‐parenteral routes of testosterone administration, is doubtful as studies maintained circulating DHT levels of 10 times the physiological concentrations for up to 2 years without increasing prostate size or growth or any adverse sequelae (Idan et al., 2010) nor do exogenous androgens increase intraprostatic DHT (Marks et al., 2006; Page et al., 2011; Mostaghel et al., 2012; Thirumalai et al., 2016).

Few issues with that study linked below (which was conducted in 1988) - only 5 participants, only applied 10-15mg of testosterone directly to scrotum, DHT wasn’t 10 times physiologic concentrations.

Transdermal Testosterone Therapy in the Treatment of Male Hypogonadism *
 
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