Optimal T:DHT ratio for libido and erections?

[TrevorTRT]

Hoping a few of you can share your insight here, in particular those who have experience with exogenous DHT.

In your experience, what has been your most optimal T/DHT ratio for erections and libido?

I’m on 150mg/week Test E (split MWF), and have been experimenting with using DHT gel to alter my T/DHT ratio.

The DHT I’m using is transdermal and very concentrated (alphagels brand 20%) so more than a few drops of it sends my DHT > 800ng/dL. I’ve been microdosing it to try get my DHT to stay below 400ng/dL.

I’ve found that I tend to operate best sexually when my T/DHT ratio is between 1:2 and 1:3 but I’ve been told by some that this is way too heavy on the DHT side of things and not sustainable.

Is there any reason why I shouldn’t maintain a ratio like that long term? Does anyone have any experience that they could share with regards to this?

Much appreciated.

 

[Nelson Vergel]

Great question, Trevor, and I'm glad you're approaching this methodically rather than just cranking the DHT sky-high and hoping for the best.

First, let me validate your observation: you're absolutely right that DHT plays a significant role in libido and erection quality. DHT is a significantly more potent androgen than testosterone. It binds to androgen receptors with about 3 to 5 times the affinity of testosterone and doesn't aromatize to estrogen. The penile tissue, prostate, and brain are all rich in 5-alpha reductase, which means they're particularly DHT-sensitive. So the idea that optimizing your DHT relative to testosterone can improve sexual function is biologically sound, not bro-science.

Now, to your actual ratio question. There's no formally established "optimal T/DHT ratio" in the clinical literature for sexual function. What I can tell you from years of tracking this with members here is that naturally, most men without TRT run a THT ratio somewhere in the range of 3:1 to 5:1, meaning testosterone is typically 3 to 5 times higher than DHT. When you're on testosterone injections, that ratio often shifts because injected T converts to DHT via 5-alpha reductase somewhat differently depending on the route and dose.

Your reported sweet spot of 1:2 to 1:3, meaning DHT is 2 to 3 times your testosterone level, is quite high on the DHT side, and yes, it's outside the range most men would see naturally or even on TRT. That said, if your DHT is sitting under 400 ng/dL and your T is, say, around 150 to 200 ng/dL total at trough, that's a very unusual but not inherently catastrophic ratio. The question is what's your total testosterone actually running at mid-week, and what is your estradiol doing alongside this?

Here are the legitimate long-term concerns I'd want you to think through honestly.

Prostate is the biggest one. DHT is the primary driver of prostate growth. Running chronically elevated DHT, even below 800, does carry an increased risk of benign prostatic hyperplasia acceleration over years, and in men with any predisposition, potentially worse. I'd want a PSA baseline and annual monitoring at minimum if you're going to do this long-term.

Hair loss is another obvious one. If you're genetically predisposed to androgenetic alopecia, elevated DHT will accelerate it noticeably. That may or may not matter to you, but it's worth knowing.

Polycythemia risk is somewhat elevated with higher androgens overall. Make sure your hematocrit stays under 52 to 54%.

Estrogen suppression is counterintuitive but real. DHT actually competes with aromatization and can lower your estradiol over time. A lot of men who chase DHT for libido accidentally crash their estrogen, which paradoxically tanks libido and destroys erections. Make sure your sensitive estradiol is staying in a healthy range, somewhere around 20 to 35 pg/mL.

The other honest question to sit with: are there other upstream issues you haven't fully addressed? Sometimes men start layering on DHT gel because TRT alone hasn't fixed sexual function, but the root cause is estrogen imbalance, sleep quality, dopamine/prolactin issues, or vascular problems. DHT doesn't fix those, it just temporarily masks them.

If you're going to continue with the alphagels long-term, I'd suggest getting labs every 3 to 6 months including PSA, hematocrit, sensitive estradiol, and a full metabolic panel. Keep a symptom journal alongside your labs so you can spot drift before it becomes a problem. And honestly, a urologist who's open-minded about hormones would be worth a visit just to have a prostate baseline evaluation documented.

The fact that you're being careful with microdosing and monitoring your levels puts you ahead of most people experimenting with this. Just don't let the sexual function wins make you complacent about the monitoring side. That's where guys get into trouble.

 

[Cataceous]

The cited "natural" T: DHT ratios seem too low. I always figured more like 10-to-1. Long-term effects of being far from this are unknown. Per Grok:

In healthy young adult men (typically ages 18–40), serum total testosterone levels generally fall in the range of about 300–1,000 ng/dL (often cited as 300–1,200 ng/dL in broader adult references, with young men tending toward the higher end, e.g., averages around 450–600 ng/dL in many studies).Serum total dihydrotestosterone (DHT) levels are normally 30–85 ng/dL (some labs reference 12–65 ng/dL or similar).The ratio of total testosterone to total DHT (T: DHT) in healthy adult men is typically around 8–16:1 (or DHT is about 1/10th to 1/8th of testosterone concentration). This corresponds to circulating DHT levels being roughly 7- to 10-fold lowerthan testosterone. ​

• One lab reference provides a male T: DHT ratio range of 6.2–17.2.
• In diagnostic contexts (e.g., evaluating 5-alpha-reductase deficiency), normal ratios after stimulation are often cited as 8–16, with ratios >30–35 considered elevated (indicating low DHT relative to T).

These values can vary slightly by lab assay method (e.g., LC-MS/MS is more precise), population, and age within the young adult group. The ratio is used clinically mainly to assess for enzyme deficiencies rather than routine health screening.​

 

[TrevorTRT]

Thanks very much for the detailed response, so far I haven’t noticed any bloodwork parameters changing negatively in my bloodwork with DHT being elevated this high but I’m more worried about what will happen in 10+ years time, I’m monitoring closely with a full bloodwork every 2 - 3 months. Is there any members here which have used exogenous consistently over 10+ years and kept their DHT this high?

 

[FunkOdyssey]

Is there any members here which have used exogenous consistently over 10+ years and kept their DHT this high?

The population whose experience you're looking for isn't exogenous DHT users - they're far too few and the whole concept is too new. You're looking for long term scrotal cream users, of which there are many. Your stated DHT target of very supraphysiologic but below 400 ng/dL describes the vast majority of men on scrotal cream.

 

[TrevorTRT]

The population whose experience you're looking for isn't exogenous DHT users - they're far too few and the whole concept is too new. You're looking for long term scrotal cream users, of which there are many. Your stated DHT target of very supraphysiologic but below 400 ng/dL describes the vast majority of men on scrotal cream.

I’m assuming whether DHT levels are elevated through exogenous DHT use or through scrotal T cream wouldn’t make any difference in terms of symptoms and long term health effects as long as comparable DHT levels were sustained long term.

 

[FunkOdyssey]

I’m assuming whether DHT levels are elevated through exogenous DHT use or through scrotal T cream wouldn’t make any difference in terms of symptoms and long term health effects as long as comparable DHT levels were sustained long term.

That would be my assumption as well. Whether the DHT is manufactured in your scrotal skin or a Chinese lab should make no difference, assuming the purity and lack of contamination of the Chinese source.

 

[SS1LE]

I will also chime in there is also a widely popular injectable DHT out there , that users complain of low libido and ED after awhile that may very between a few weeks to months depending on person. The makers of that DHT then recently released injectable estradiol to counter act the affect of low E2 caused by DHT. But some have had no luck with that either. Some of the thoughts are DHT actually kicks E2 out of the receptor or its just one of those honeymoon phases caused my a change of hormone parameters that at first give the benefit then goes away with time. There has also been a few members on here use the injectable DHT and have quit because of certain side effects. I think your best bet would be to use gel as a boost here and there. Also be aware alpha gels has been known to just send out testosterone gel randomly here and there.

 

[SS1LE]

I’m assuming whether DHT levels are elevated through exogenous DHT use or through scrotal T cream wouldn’t make any difference in terms of symptoms and long term health effects as long as comparable DHT levels were sustained long term.

Also with DHT you get no E2 conversion and with testosterone scrotal cream you get E2 conversion.