When do you become concerned about high DHT?

[Golfboy307]

Things have been pretty steady and positive for me on my current TRT regimen: 40mg every 2.5 days, IM (120 per week). No AI, no HCG. Just got my latest 6 month labs from my Body Logic doctor, who is very up to date on all matters HRT. The numbers were great, but for second time in a row, my DHT is a bit high. Here is a quick summary:

Total T: 825 (range 250-1100)
Free T: 149 (range 49-224)
SHBG: 27
E2: 28 (Ultrasensitive LC/MS)
DHT: 114 (range 12-79) HIGH
PSA: 0.2

The DHT number from six months ago was 75, but my dosage was a bit lower. Looking back on several years of results it has been as high as 94 and low as 43. I feel great libido wise at this higher level, and have no side effects (prostate, hair loss etc). I know guys on transdermals can run a lot higher.

My question for the group is: at what level do you get concerned?

My doctor mentioned DHT lowering options, but does not favor them if at all possible. I am going to retest in 6 months, but don't want this to become an issue. My doctor does not obsess on the numbers, but wanted me to be aware. Appreciate any thoughts or research articles.

 

[ghce]

I ran very high DHT levels for about 18 months well over range ( 223 ng/dl) on a transdermal protocol and like you had great libido and no other measurable negative side effects other than complete shutdown and low sperm count and the latter was the only reason for changing the protocol to a Clomid based regime for fertility.

Had I no other concerns other than fertility I would return to my former cream regime as I have never felt better in my life, though sexual performance was still not up to par wrt to pre low T days.

 

[Golfboy307]

Thanks GHCE! Good to see you over here... FYI, forgot to add in my post, age 53.

 

[ghce]

Thanks GB, I should frequent here more often.
Yes I suppose age is a very relevant thing, I was about 57 on my DHT trip, 59 now and looking for another kid to fill out the family so a bit adverse to reverting to full TRT at the moment.

 

[Ardoc2]

I used to test for DHT but it always came back extremely high (no numbers handy) in fact once it was at/above the upper limit of the test. In discussions with my doctor, the fact that I am bald already and have no prostate concerns, led us to decide to stop testing it. The methods of controlling DHT (Finasteride etc) have there own concerns and if you are one of the unlucky ones, could end up with ongoing sexual side effects. The doctor said that hair loss and prostate concerns aside there was no clear evidence of how/if it was "bad" and certainly not worth risking the Finasteride sides. So unless and until new concerns emerge what is the point?
FYI am on injections already so its not from Transdermal's

 

[Seth]

I've been taking Propecia for over 20 years. My doctor never mentioned testing my DHT, nor mentioned that it could interfere with testosterone levels. I am currently on T injections, and Anastrozole and take a daily .5 mg Cialis. Just started HCG to restore testicle size, and am considering FSH or Clomid if needed to get my boys back up to size. Is DHT something I should get tested? If so, would the propecia skew the results?

 

[madman]

Things have been pretty steady and positive for me on my current TRT regimen: 40mg every 2.5 days, IM (120 per week). No AI, no HCG. Just got my latest 6 month labs from my Body Logic doctor, who is very up to date on all matters HRT. The numbers were great, but for second time in a row, my DHT is a bit high. Here is a quick summary:

Total T: 825 (range 250-1100)
Free T: 149 (range 49-224)
SHBG: 27
E2: 28 (Ultrasensitive LC/MS)
DHT: 114 (range 12-79) HIGH
PSA: 0.2

The DHT number from six months ago was 75, but my dosage was a bit lower. Looking back on several years of results it has been as high as 94 and low as 43. I feel great libido wise at this higher level, and have no side effects (prostate, hair loss etc). I know guys on transdermals can run a lot higher.

My question for the group is: at what level do you get concerned?

My doctor mentioned DHT lowering options, but does not favor them if at all possible. I am going to retest in 6 months, but don't want this to become an issue. My doctor does not obsess on the numbers, but wanted me to be aware. Appreciate any thoughts or research articles.

Leave it be!

Dihydrotestosterone: Biochemistry, Physiology, and Clinical Implications of Elevated Blood Levels

Circulating levels of DHT in response to testosterone replacement therapy (TRT) do not correlate with those found in androgen sensitive tissue due to homeo

academic.oup.com

Key Conclusions and Recommendations for Future Clinical Research

Circulating levels of DHT in response to TRT do not correlate with those found in androgen-sensitive tissue (e.g., prostate, adipose, muscle) due to local regulatory mechanisms that tightly control intracellular androgen homeostasis. Observations from numerous clinical studies are consistent with current knowledge that androgen-sensitive tissues can self-regulate tissue DHT levels by downregulating its synthesis and upregulating metabolism during DHT excess or, conversely, upregulating synthesis and downregulating metabolism under conditions of T or DHT deprivation. We are reminded of Horton’s admonition some 25 years ago when he concluded that blood levels of DHT provide only a hint of tissue levels and that DHT should be regarded as a paracrine hormone formed and acting primarily within target tissues (39).

The modest increases observed in serum DHT and in the DHT/T ratio observed after TRT are unlikely to be a cause of clinical concern, particularly when viewed in the context of changes observed in these parameters for currently marketed T replacement products and those under development for which DHT data are available. There is no sound current clinical evidence to indicate that elevated DHT concentrations (either short-lived peaks or sustained supraphysiological levels) are associated with risk beyond that known for androgens (most notably, T), including adverse effects on the prostate.

 

[Golfboy307]

Madman, you are the best dude. Thanks for posting that article. Correct, no interest in taking Finasteride or Saw Palmetto etc. That sets my mind at ease a bit. Appreciate it. I will enjoy the good libido and retest in six months.

 

[ghce]

Yes its nice to see the DHT - prostate linkage totally debunked, shame many GP's arn't aware of it though.