Discussion on DHT (Dihydrotestosterone) levels in men using different forms of testosterone replacement therapy (TRT).
Comparison between scrotal application of testosterone cream and intramuscular TRT injections.
Consideration of the relevance of high or low DHT levels.
DHT Levels: Transdermal vs. Injectable
No legitimate randomized clinical trials specifically comparing transcrotal application versus injectable testosterone in relation to DHT.
Anecdotal cases and lab results show:
Anecdotal improvement in libido with transdermal applications.
Higher DHT levels observed with transdermal applications compared to injectables.
Possible explanation:
Greater 5-alpha reductase enzyme concentration in the skin, leading to more conversion of testosterone to DHT.
Transcrotal Applications
Not originally designed for pharmaceutical use; emerged from transdermal applications intended for shoulder, back, or arm.
Compounding pharmacies shifted application areas to avoid transference risks.
Some anecdotal evidence of improved libido with scrotal application due to high 5-alpha reductase concentration or increased intratesticular testosterone absorption.
Injection vs. Transdermal
Personal preference for injectable route due to stability and long-term use.
Some patients report improved libido by combining injections with low-dose transcrotal applications.
Important to adjust dosing accordingly to balance total TRT dose.
Measuring DHT Levels
Measuring DHT in serum considered moot; DHT is regulated at the tissue level.
May indicate deficiency, prompting a need to elevate DHT with synthetic derivatives like Proviron (EU) or Oxandrolone (US).
Situations where measuring DHT might be relevant:
Male pattern baldness acceleration if genetically predisposed.
Acne correlation with elevated DHT levels.
Generally, DHT is not routinely tested unless deficiency is suspected.
Conclusion
While increased DHT is noted with transdermal applications, the importance varies depending on individual health concerns like hair loss or acne.
No conclusive evidence on superiority of one method over the other.
Personalized approach recommended based on symptom management and hormone balance.