TESTOSTERONE vs. DHT : Can testosterone directly cause Baldness? | COMPLETE GUIDE

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male pattern baldnes is due to DHT the active metabolite of Testosterone. But as evidenced clinicaly, does tesosterone have a direct role to play as well? Androgenetic alopecia causes explained in great detail by Dr Bhatti, hair transplant surgeon who runs darling Buds Clinic in Chandigarh, India.
There is no doubt it is a genetic problem but does DHT cause baldness and is there a role for testosterone acting independently to express its effect on the androgen receptors on the scalp?
People note low DHT levels and high testosterone levels in people who may be bald.
Patients using DHT blockers even Dutasteride that blocks 95% of DHT still are not happy. In these patients, though DHT is rock bottom, but testosterone levels are high.
So is there a direct role for testosterone in baldness. Or is it mere upregulation or downregulation of androgen receptors that causes the continued hair fall even with DHT blockers.
Well the jury is still out on this complex topic.
Just a quick recapitulation to revise our knowledge about male hormones and baldness.
Testosterone is the male sexual hormone and the majority of it is present in the blood stream bound to SHBG. And a much smaller amount called free testosterone. Free testosterone is what is available to us to exert its benefits to organs like the prostate, the scalp, the bone and joints, the the synaptic and dendritic pathways of the brain, etc.
We also know that 5AR enzyme is crucial to convert testosterone to DHT which acts on the scalp and prostate tissues alone.
Well, nature has various ingenious mechanisms and they all exist for a reason.
It has been seen that males with 5α-reductase deficiency developed ambiguous genitalia or female external genitalia at birth. They also had poor development of the prostate. It was also noted that these 5AR deficient children went on to have normal bone & muscle development during the pubertal transition phase of development. So from the phenotype of 5AR children it was inferred that the enzyme 5α-reductase is crucial for the development of the prostate and male external genitalia.
But what we see in clinical practice does suggest that 5α-reduction of testosterone is not obligatory for mediating androgenic effects in tissues in men. It has been seen that people who are 5AR deficient do continue to bald.
So the commonly held theory that testosterone needs to be converted to DHT has loop holes. It can be logically inferred that testosterone and DHT can both exert androgenic effects in all androgen-sensitive tissues. That their relative effects in any tissue are contingent upon their relative concentrations and potency.
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#testosterone #baldness #DHT
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I love this Channel. Fact-based and always following a scientific approach. Respect.

Ferelmakina
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Since testosterone can also cause hair fall than I believe it is safe to assume that only having a DHT blocker like finasteride or dutasteride isn't enough to stop hairloss, since the increase in testosterone can cause more hairfall.. What do you suppose is the best possible course of action that can be done along with a DHT blocker? Is there an anti- androgen that is well tolerated and available in India???

theraconteur
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Doctor, what topical antiandrogen you see as viable option to add to daily finasteride? CB 03 01/ clascorerone soon ? Fluridil ? Topical spironolactone ? I have tried RU 58841 20mg a day and it is quite effective but the lack of a long term research is concerning .

divinumlumen
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Is it normal to see couple of hairs in the fingers after applying minoxidil post 2 month HT? The hairs are small compared to the existing hair which are in length now, so I’m assuming the hair going are transplanted hairs. What are your thoughts ? Something to be concerned about ?

ajayradhakrishnan
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This question is so important. Many dismiss the idea that testosterone can exacerbate AGA

Marasma
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Hey! It’s been 2 months post HT. I have been applying minoxidil twice a day and I’m massaging it slightly as well wherever I apply minoxidil. Also the sides I didn’t hair and has transplanted, I have been applying there as well. Should I continue applying minoxidil to the transplanted hairs ? I have been doing so for 2 months now. If your opinion is I should stop applying in new HT section, I am concerned if that would cause more shedding. Since stopping minoxidil can increase shedding. Or do you think it’s OK to continue applying minoxidil on the New HT areas?

ajayradhakrishnan
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Doctor, after HT...the implanted hair grows and falls off during shedding phase and it grows again right ? So, will that one fall off again since it’s it super thin and then another one grows again from the same root and finally after couple of shedding, it becomes a thick one and grows? Is that how it works ? Or after the shedding phase, the hair from the root only grows once and as length increases the thickness comes over time ?

ajayradhakrishnan
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What does dht do in the scalp? Why are there receptors there? What does blocking it there topically do? Does it make dht flow more through my body?

AndrewZambetti
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Thank you doc! So also testosterone itself can cause hair loss. Is finastride itself not enough for saving hair then ? Or the effect of testosterone itself on the scalp Is not that strong so that we can not worry about It? Thank you

giorgiobozzoni
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Hello, could you please create a 3D animation video to show the same information?

PrakashPatilPune
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Hi doc! I’m using finasteride from last 2yrs, previous year i.e during the first yr of use it showed good results by growing small hairs &!covering almost part of my bald crown area. But from last 2-3 months I’m noticing that even I’ m following the same dose (3mg per week) the hairs in crown area have become thin & my bald crown is getting visible day by day. Sir any reason behind this? Or any tips on this? I would sincerely request your help on this that what should I do to prevent this?

Abhay_._
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Soo if Testosterone is really High it still acts the same? How high is too high like I'm 701ng/dl like last time I checked but was winter would I benefit from very low dose anti adrogen or increase dutasteride I'm on 0.5mg dutastride everyday for 16months and oral minoxidil 1.25mg for 1 year but now notice hairline very slightly worse again cause I've been walking more and eating more and my testosterone seem to have increased in my blood test so I'm wondering if I need to offset it?

hadhad
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So doctor u are saying that free testosterone can also cause baldness . I am a female and i have taken finasterde in the past and the result was great . But mow i am taking 1 mg of dutasteride but the result is not that great. I heard that dutasteride increases free testosterone . Is it the reason .

nautanki
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Hi
First of all thanks for your informative content!
I have a question:
I have super agressive mpb that started as 16 year old (diffuse thinner). My regiment since I’m 18 is 0.5mg Dutasteride daily and 10% Minoxidil every night. As I was 21 years old I had a hair transplant at the front with 1000 grafts. It costed me so much money. But the hair loss stabilzed between 21 abd 24. Right now I‘m 25 years old and I have never stopped with medication. My hair loss is progressing and I really don‘t know what to do?
I‘m thinking of adding low dose of Oral Minoxidil 0.625mg?
Dermaroller 1.5mm 1x a week?
Maybe something that blocks remaining DHT on the scalp?

I‘m desparate and really need your or someons advice.. I really don‘t understand why the hair loss is progressing so fast now..
Thanks!

simonecusumano
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Hello doctor, my dermatologist prescribed me minoxidil, multivitamin, fish oil, ketoconazole tablet and shampoo

Is it telogen effluvium or alopecia?

Aman-
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Can Dutasteride effect and couse Gyno. And if so. Then what dose of testosterone do you suggest? 100 could be enough?

estebanvicencio
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#askDrBhatti hello dr. bhatti

I have a question concerning a seborhric dermatitis on my scalp a while ago. I got a hair transplant 6 weeks ago and now I get the feeling the seborrheic dermatitis is back because of the itchiness on my head (the itch is wether on the donor area or on the transplanted area, it‘s around the crown area where it started a few years ago, now I am concerned this type of fungus could pretend my transplanted hair from growing.

Is there a danger this could keep my transplanted hair from growing?

Thank you so much for you help sir!

lacosteavenir
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hi mi name is Alex mendoza... I have a question I went to the doctor to check my testosterone levels because I was feeling tired and my sex drive was not good and he told me.to start testosterone replacement to see if that is gona help me.. im 43 years old and 4 months ago I had a hair transplant..I heard testosterone make u lose hair but I been taking finasteride and minoxidil to prevent hair loss. do you think by taking finasteride and minoxidil will block the side effect of hair loss of testosterone?... I don't want to lose my hair more especially that I had a hair transplant... I start today my shots ..it will be one shot every month because Im using sustanon 300mg ..please I will appreciate your response

alexmendosa
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Doctor, starting how many months post HT does the new hair start growing ? I am post 2 months and I see very small tiny and super thin hair strands, like super thin. I’m not sure if it’s driven by minoxidil or it’s the new hairs coming out.

ajayradhakrishnan
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Does masturbation after HT cause issues ? Would it affect The implanted hair, talking from hormone or testosterone point of view. Should men be completely avoiding it post HT?

ajayradhakrishnan