Lecture Notes on DHT and Testosterone Delivery Methods

Overview

• Discussion on dihydrotestosterone (DHT) levels in men using different testosterone replacement therapies (TRT).
• Comparison between scrotal application of testosterone cream versus intramuscular TRT injections.
• Consideration of the relevance of DHT levels.

Key Points

DHT Levels and TRT Methods

• Current Research:
  • No legitimate randomized clinical trials comparing scrotal application and injectable testosterone regarding DHT levels.
  • Anecdotal and case studies indicate variations in DHT levels.
• Observations:
  • Improvement in libido reported with transdermal application, possibly related to DHT.
  • Transdermal users often show increased DHT levels compared to injection users.
  • Possible reasons include higher concentrations of 5-alpha reductase in the skin, which converts testosterone to DHT.

Transdermal Applications

• Application Sites:
  • Initially designed for shoulder, back, and arms.
  • Later recommendations include inner thighs and scrotum to reduce transfer risk and possibly enhance absorption.
• Theories and Hypotheses:
  • Higher concentration of 5-alpha reductase in scrotal area may lead to increased DHT conversion.
  • Improved libido might be due to increased intratesticular testosterone.
• Practical Use:
  • Some patients use transdermal applications alongside injections for improved libido.
  • Important to adjust dosing to balance overall hormone replacement.

Measuring DHT Levels

• Relevance:
  • Measuring DHT in serum is not typically useful, similar to estradiol, as it is tissue-level regulated.
  • Useful to measure only if a deficiency is suspected.

Effects of DHT

• Potential Negative Effects:
  • May accelerate male pattern baldness in genetically susceptible men.
  • Correlation with acne observed in individuals with elevated DHT.
• Management:
  • Adjust dosing if DHT-related issues are observed.
  • Use of DHT blockers like finasteride is not generally recommended.

Conclusion

• While increased DHT can have certain benefits like improved libido, it can also pose risks such as hair loss acceleration and acne.
• Decision to measure DHT or adjust TRT methods should consider individual symptoms and genetic predispositions.