Dihydrotestosterone (DHT)

Take-home points

• Dihydrotestosterone (DHT) is essential for developing male characteristics during puberty and young adulthood.
• Although DHT is considered less important in later life, abnormal levels are linked to male pattern baldness, prostate enlargement and low testosterone levels, among other conditions.  
• DHT levels tend to rise in response to testosterone replacement therapy (TRT).
• If you suspect your DHT levels are high or low, we recommend consulting a healthcare professional for proper evaluation and management.

What is dihydrotestosterone (DHT) and what does it do?

One fascinating way the human body achieves ‘hormonal balance’ is by converting one type of hormone into another. Testosterone is no exception. When it interacts with cholesterol and an enzyme known as 5-alpha reductase, it transforms into dihydrotestosterone (DHT)—a testosterone derivative and metabolite. This transformation primarily occurs in the testes, hair follicles, prostate and adrenal glands.  

DHT is a more potent form of testosterone and can affect some tissues in a way that testosterone cannot.¹ It is crucial in the sexual development of males, beginning early in prenatal life and continuing throughout puberty. Traditionally known for producing “manly features”, DHT causes facial and body hair to grow, the voice to deepen, and muscle tissue to develop. It also contributes to the growth and function of glands in the prostate and pelvis.²  

What are normal levels of dihydrotestosterone (DHT)?

Normal levels of DHT depend on age, sex and individual factors, ranging between 30–85 ng/dL in adult males.^3,4,5 It is normal for lower levels to be observed in prepubertal children (< 3 ng/dL) before peaking during puberty; then, a gradual decline with age is expected.⁶

What do high and low levels of dihydrotestosterone (DHT) indicate?

Abnormal DHT levels are associated with various health conditions. High levels are associated with: ^4,7,8,9,10

• Benign prostatic hyperplasia (BPH): an enlarged prostate that leads to frequent and/or difficulty urinating.
• Male pattern baldness (androgenic alopecia): progressive hair loss, particularly in the scalp region.
• Prostate cancer: in many cases, this cancer increases the activity of 5-alpha-reductase and increases the conversion of testosterone to DHT.
• Acne: the increased prevalence of acne with high DHT is more common in women but has been reported in a study with both sexes.
• Cardiovascular disease: DHT has been associated with cardiovascular disease, but a causal relationship has not been confirmed.  

Conversely, low levels of DHT are associated with: ²

• 5-alpha-reductase deficiency: typically a genetic condition from birth, males born with this deficiency may have underdeveloped genitalia, small prostates and non-descended testicles.
• Testosterone deficiency (hypogonadism): as the body converts a small amount of testosterone to DHT, low testosterone levels can result in low DHT.

Does testosterone replacement therapy increase dihydrotestosterone (DHT) levels?

When men present with signs and symptoms of low testosterone levels, healthcare professionals often recommend testosterone replacement therapy (TRT). In doing so, both testosterone levels and DHT are likely to increase. The average increase in DHT in studies of TRT is four to fivefold compared with baseline levels. Some men taking TRT may even see DHT rise to levels approaching that of circulating testosterone¹¹, particularly when using transdermal testosterone gels rather than injectable testosterone esters—presumably due to the high activity of the 5-alpha reductase in the skin.¹²

Learn more about testosterone replacement therapy

Currently, the use of TRT in men with hypogonadism is guided almost entirely by monitoring changes in testosterone levels; DHT is rarely considered when evaluating a patient’s therapeutic response to TRT. However, as individual rates of conversion of testosterone to DHT vary tremendously, some healthcare professionals may recommend checking DHT levels during treatment. Recent evidence has suggested that considering testosterone and DHT levels together allows for a better understanding of a patient's response to TRT than testosterone alone.¹³

Taking a testosterone test? Learn more about how to interpret testosterone blood test results

References

1. Marchetti PM & Barth JH. Ann Clin Biochem 2013;50(Pt 2):95–107.
2. Biochemistry, Dihydrotestosterone. Available from (Accessed February 2024).
3. Pirke KM & Doerr P. Acta Endocrinol (Copenh) 1975;79(2):357–365.
4. Shores MM et al. Clin Endocrinol (Oxf) 2014;81(5):746–753.
5. Sansone A et al. J Endocrinol Invest 2021;44(11):2465–2474.
6. Starka L et al. Neuro Endrocrinol Lett 2008;29(2):201–204.
7. Nacusi LP & Tindall DJ. Nat Rev Urol 2011;8(7):378–384.
8. Carson C & Rittmaster R. Urology 2003;61(4 Supp 1):2–7.
9. Urysiak-Czubatka I et al. Postepy Dermato Alergol 2014;31(4):207–215.
10. Iftikhar U & Choudry N. Pak J Med Sci 2019;35(1):146–150.
11. Snyder PJ et al. N Engl J Med 2016;374(7):611–624.
12. Swerdloff RS et al. J Clin Endrocrinol Metab 2000;85(12):4500–4510.
13. Stephen-Shields AJ et al. J Clin Endrocrinol Metab 2022;107(5):1257–1269.