DHT Cream: Have a feeling that this may generate conversation

[MikeXL]

Male sexual function can be maintained without aromatization: randomized placebo-controlled trial of dihydrotestosterone (DHT) in healthy, older men for 24 months.

Sartorius GA[SUP]1[/SUP], Ly LP, Handelsman DJ.

• [SUP]1[/SUP]Andrology Department, Concord Hospital, Sydney, NSW, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia.

Abstract

INTRODUCTION:

Male sexual function is highly androgen dependent but whether aromatization of testosterone (T) to estradiol is required remains contentious.
AIM:

This study aims to investigate the effects of selective estrogen deficiency induced by a nonaromatizable androgen, dihydrotestosterone (DHT), on sexual function of healthy middle-aged and older men.
METHODS:

Randomized clinical trial of daily transdermal DHT (70 mg) or placebo gel treatment in 114 healthy middle-aged and older (>50 years, mean 60.5 years) men without known prostate disease maintaining selective estrogen deficiency for 24 months.
OUTCOME MEASURES AND ANALYSIS:

The end points were responses to a psychosexual and mood questionnaire completed before, at 3 months, then at 6 monthly intervals during and 3 months after study. Data were analyzed by mixed model analysis of variance for repeated measures using age and body mass index (BMI) as covariates and including interactions of treatment with age and time-on-study.
RESULTS:

DHT treatment increased serum DHT with complete suppression of serum T, luteinizing hormone, follicle stimulating hormone, and estradiol throughout the 24-month study resulting in reduced spinal bone density. There were no spontaneous complaints, or discontinuations for, adverse effects on sexual function during the study. DHT administration had no effects on any of 33 measures of sexual function and mood, apart from a mild, but significant decrease in overall sexual desire, which was reversible after cessation of treatment. Increasing age and less often increasing BMI were associated with significant decreases in most aspects of sexual function.
CONCLUSIONS:

We conclude that aromatization plays only a minimal role in maintenance of sexual function in healthy eugonadal middle-aged or older men, but age and obesity are significantly associated with decreases in most aspects of self-reported sexual function and satisfaction. The dependence of male sexual function on aromatization may be conditional on age and obesity and can be overcome by a nonaromatizable androgen.
© 2014 International Society for Sexual Medicine.

 

[Dr Justin Saya MD]

As we know DHT is by far the most potent androgen in our body, but interesting to postulate that it may be "potent enough" to counterbalance or overcome suppression of T and E.

By golly, this:

"DHT treatment increased serum DHT with complete suppression of serum T, luteinizing hormone, follicle stimulating hormone, and estradiol throughout the 24-month study resulting in reduced spinal bone density."

Sounds like unethical torture! I didn't read the actual full study paper, but COMPLETE suppression of T, LH, FSH, and E for 24 months is NOT something I would sign up for (or ever dream of subjecting patients to).

 

[Nelson Vergel]

I agree with Dr Saya.

I do not want to have brittle bones when I get older.

To counteract this study, a case report of a man with a congenital aromatase mutation who did not have any estradiol and that was later given an estradiol cream. He reported improvements in erectile function.

Here is a good paper reviewing the effects of estradiol:

The role of estradiol in male reproductive function

 

[Nelson Vergel]

The effect of estrogen on the sexual interest of castrated males: Implications to prostate cancer patients on androgen-deprivation therapy

 

[Vince Carter]

As we know DHT is by far the most potent androgen in our body, but interesting to postulate that it may be "potent enough" to counterbalance or overcome suppression of T and E.

By golly, this:

"DHT treatment increased serum DHT with complete suppression of serum T, luteinizing hormone, follicle stimulating hormone, and estradiol throughout the 24-month study resulting in reduced spinal bone density."

Sounds like unethical torture! I didn't read the actual full study paper, but COMPLETE suppression of T, LH, FSH, and E for 24 months is NOT something I would sign up for (or ever dream of subjecting patients to).

I read that three times and just shook my head. It's an interesting set of circumstances but 24 months? That's crazy.

 

[PAUL-E]

No way would I volunteer for that I do wish the transdermal DHT was available to us in the USA though.

 

[trt4me]

I have had high range dht levels and not had libidio so I don't think that dht is the holy grail.

 

[MikeXL]

"Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function. In the brain, estradiol synthesis is increased in areas related to sexual arousal. In addition, in the penis, estrogen receptors are found throughout the corpus cavernosum with high concentration around neurovascular bundles. Low testosterone and elevated estrogen increase the incidence of erectile dysfunction independently of one another. In the testes, spermatogenesis is modulated at every level by estrogen, starting with the hypothalamus-pituitary-gonadal axis, followed by the Leydig, Sertoli, and germ cells, and finishing with the ductal epithelium, epididymis, and mature sperm. Regulation of testicular cells by estradiol shows both aninhibitory and a stimulatory influence, indicating an intricate symphony of dose-dependent and temporally sensitive modulation."