The Role of DHT in Hair Loss and the Future in Treatment

admin    Causes and Types of Hair Loss    

Most people are aware of the fact that there is a substance in the body, Dihydrotestosterone (DHT), which is the ultimate cause of Male Pattern Baldness. Unfortunately, the average person doesn’t know enough about this hormone to make an informed decision on how to counteract it to prevent the onset of hair loss, or to stop the progression of it once it has been diagnosed. It should go without saying that a doctor would prescribe treatment; however, it is ultimately the patient who has the responsibility of understanding what they have been prescribed, how it works and what to expect. In terms of treating Androgenetic Alopecia, genetic hair loss resulting from excessive amounts of DHT, it is first necessary to understand the mechanism through which DHT causes loss of hair.

Androgens: Testosterone and DHT

Androgen is actually a general term relating to any compound, synthetic or natural, that stimulates and/or controls male characteristics in vertebrates. Often those substances are referred to as androgenic hormones or testoids, and they need to bond with androgen receptors throughout the body in order to carry out their function. The primary androgenic hormone secreted from the testes is testosterone, and it is responsible for the activity of the primary male sex organs and the development of the secondary male sex characteristics.

Unfortunately, testosterone doesn’t bond with androgen receptors anywhere but in muscle tissue, so in order to carry out its functions in the brain, skin and testes, testosterone needs to be converted by the body to DHT through the activity of an enzyme, 5alpha reductase. Testosterone, in this case, is actually a prohormone that is converted to DHT. Dihydrotestosterone is 3 to 5 times more capable of bonding to androgen receptors than testosterone, so this is where the problem begins in terms of hair loss. Since androgen receptors are located in the skin where hair follicles are located, an excessive amount of DHT accumulates which is the ultimate cause of loss of hair.

DHT and Follicular Miniaturization

Although the mechanism in which DHT actually causes hair loss is not yet fully understood, it is known that it sets off a process called follicular miniaturization. During this process, the amount of DHT that is secreted in the hair follicle begins to ‘squeeze’ the hair shaft so that its width is gradually decreased. Over time, the shaft begins to resemble a vellus hair, commonly referred to as peach fuzz, or simply ceases to exist altogether. The onset of follicular miniaturization can even begin as early as puberty, but is usually determined by genetics (heredity).

While there are various medications that have some degree of efficacy in preventing or slowing the progression of follicular miniaturization, nothing has proven to be effective 100% of the time. Some medications attempt to block the activity of the enzyme 5alpha reductase so that testosterone isn’t converted as readily to DHT. While this has shown significant benefits, there are also some side effects which are extremely unwanted. Scientists are looking for a way to arrest the conversion of testosterone into DHT while preventing those side effects from occurring.

Problems Associated with Regulating Levels of DHT

Since DHT is an androgenic hormone that is responsible for the secondary male sex organ characteristics, increasing available levels throughout the entire body presents a real dilemma. One of the functions of DHT that doesn’t always get a lot of press is the fact that it naturally counteracts levels of estrogen in the male body. When levels of DHT are reduced to any great extent, the body’s natural defense against estrogen is hindered. A common side effect has the medical name, gynecomastia, or enlarged breasts. Now the question arises, which is less problematic for a male, hair loss or enlarged breasts?

Many medications try to reduce levels of DHT topically; however, this presents another set of problems. Since testosterone is converted to DHT in the bloodstream through the action of 5alpha reductase, it is already DHT by the time it reaches the hair follicle. The only hope of preventing hair loss at this point is to find a way to prevent that androgenic hormone from bonding with the androgen receptors. There are currently some topical medications that have a limited amount of effectiveness, but there isn’t a significant success rate as yet. As more knowledge is acquired regarding the mechanisms through which DHT works, it is probable that more treatments will become available that can circumvent problems associated with regulating levels of this hormone.

The Good News: Not All Hair is Sensitive to DHT

Actually, there is a ray of light in the darkness. Not all hair follicles are sensitive to DHT which is why pattern baldness usually affects the top of the head. The progression tends to start at the temples and/or at the crown. In more severe cases it works its way toward the center resulting in the top of the head being bald with hair left in place around the circumference. Hair that is resistant to the effects of DHT can be transplanted to bald areas, but it is both expensive and often not sufficient to fill a significant area of baldness.

At the moment, there is a tremendous amount of research being conducted on hair cloning. It is the hope of scientists that one day DHT resistant follicles can be cloned so that an unlimited amount of grafts can be surgically implanted to fill in larger bald areas. To date, there has not been great enough success in these endeavors, but research is ongoing and results currently being obtained are beginning to look more promising.

In the end, the best approach would be to identify the exact mechanism through which DHT works to cause follicular miniaturization. This, in turn, might enable medical science to find the ultimate ‘cure’ to pattern baldness. This cure would help build a ‘defense’ against DHT in sensitive follicles, thereby preventing hair loss before it is evidenced. Until that time, current medications and surgical procedures can help in restoration with a minimal amount of prevention. The hope for the future is that science will find the missing link that could prevent hair loss once and for all.

If you enjoyed this article please consider sharing it!