DHT (Dihydrotestosterone)

What is DHT (dihydrotestosterone)?

DHT (dihydrotestosterone) is a hormone that plays a key role in the sexual development of people assigned male at birth (AMAB). More specifically, DHT is an androgen — a hormone that stimulates the development of male characteristics.

DHT affects the sexual development of people AMAB throughout their lives, beginning as early as in fetal development. The role of DHT changes as people AMAB progress through different life stages. Scientists aren’t sure if and how DHT affects people assigned female at birth (AFAB), but they think it may play a role in body hair and pubic hair growth.

As an adult, your body converts about 10% of your testosterone (the main androgen) into DHT each day. This takes place in the genital skin and prostate in people AMAB and in the skin in people AFAB. It also happens in other parts of your body, such as your liver.

Levels of DHT are naturally much higher in people AMAB than in people AFAB because they naturally have more testosterone.

What does DHT do to your body?

DHT has different roles in different life stages for people AMAB — mainly during fetal development and puberty.

Unlike testosterone, DHT doesn’t play a significant role in maintaining male physiology in adulthood. Effects mainly include prostate enlargement and male pattern hair loss in adulthood.

DHT and fetal development

During fetal development, a specific and unique environment of hormones results in male or female differentiation of sexual anatomy. In males, DHT acts with other hormones (including testosterone) to block the formation of the female anatomy and to promote the development of the male anatomy.

DHT is essential for the formation of the male external genitalia, including the penis and scrotum, in a fetus. DHT also helps with the formation of the prostate.

DHT and puberty

During puberty for children AMAB, DHT promotes further growth of the penis and scrotum. It’s also the main androgen that’s responsible for:

• Facial hair.
• Body hair.
• Pubic hair.
• Prostate growth.

What happens when DHT levels are high?

Certain health conditions are associated with high levels of DHT, including:

• Benign prostatic hyperplasia.
• Prostate cancer.
• Androgenic alopecia (male pattern hair loss).
• Polycystic ovarian syndrome (PCOS).

DHT and benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a condition in which your prostate grows in size. It’s very common in people AMAB over the age of 50.

Your prostate can produce large amounts of DHT. This local DHT production stimulates normal prostate activity but also commonly leads to prostate growth. BPH can cause difficulty with peeing and sexual dysfunction.

DHT and prostate cancer

People who have prostate cancer usually have an increase in DHT levels. An increase in DHT activity in your prostate, in addition to certain genetic mutations that cause prostate cells to grow uncontrollably, leads to prostate cancer.

DHT and androgenic alopecia

Androgenic alopecia is commonly known as male pattern hair loss. The hair loss usually happens on the top and frontal regions of your scalp, causing your hairline to recede over time.

Increased DHT activity at your hair follicles is partly responsible for this hair loss, in addition to other factors, including genetic ones. High levels of DHT can shrink your hair follicles and shorten the hair growth cycle, resulting in hair loss.

DHT and PCOS

Polycystic ovarian syndrome (PCOS) is a hormonal imbalance that affects people AFAB. It happens when their ovaries create excess androgens, including testosterone, which leads to increased DHT levels. This causes a variety of symptoms, including irregular periods, excessive hair growth (hirsutism) and acne.

What happens when DHT levels are low?

Certain conditions are associated with low levels of DHT, including:

• 5-alpha reductase deficiency.
• Low testosterone (male hypogonadism).

Lower-than-normal DHT levels mainly affect people AMAB. Some scientists think low DHT levels in children AFAB may delay the start of puberty.

DHT and 5-alpha reductase deficiency

5-alpha reductase is an enzyme that helps convert testosterone to DHT. A genetic mutation (change) that affects the production of the enzyme can cause low or no levels of DHT. This is called 5-alpha reductase deficiency. People inherit this condition in an autosomal recessive pattern.

5-alpha reductase deficiency affects the sexual development of genetically male (XY chromosomes) fetuses. Males born with the deficiency typically have:

• Underdeveloped external genitalia.
• Undescended functional testicles.
• A small or absent prostate.

In cases of severe 5-alpha reductase deficiency, genetically male babies with XY chromosomes have external genitalia that appear female. Low DHT doesn’t affect the development of the testicles (they can still produce sperm) and internal sexual organs and structures. This is different from androgen insensitivity syndrome. People with this condition have normal testes with normal to high testosterone levels — they just lack androgen receptors. This causes them to not have secondary sexual characteristics and to have infertility.

During puberty, children who are genetically male with 5-alpha reductase deficiency experience a lack of facial hair growth. Because their body still makes testosterone, they still experience voice deepening, muscle mass increase and penis enlargement.

DHT and low testosterone

As your body converts testosterone to DHT, if you have low levels of testosterone, you’ll have lower-than-normal levels of DHT as well. Another name for low testosterone is male hypogonadism.

There are two main types of male hypogonadism: classical (congenital or acquired) and late-onset. Male hypogonadism can cause different issues depending on your age.

When should I see my doctor about my DHT levels?

If you think you or your child may have a condition related to low DHT or excess DHT, talk to your healthcare provider. They can order some tests or refer you to a specialist, such as an endocrinologist.

A note from Cleveland Clinic

Dihydrotestosterone (DHT) is an essential part of sexual development for people assigned male at birth. But if levels are too high or low, they can cause certain issues like underdeveloped external genitalia, prostate enlargement and hair loss. If you’re concerned about your DHT levels, talk with your healthcare provider. They can order tests and recommend treatments that may help.