Do men get higher DHT, that is dihydrotestosterone, with scrotal application of testosterone cream, that versus intramuscular TRT injections? Are there any studies on that and is it even relevant to have higher or lower DHT? So once again we welcome back Gil T on our show.
Welcome Gil. Thank you, Steve. Thank you for doing this for us each week.
Thank you. Pleasure. So first question this week, do men get higher DHT, that is dihydrotestosterone, with scrotal application of testosterone cream, that versus intramuscular DRT injections? Are there any studies on that? And is it even relevant to have higher or lower DHT?
So I don't believe that there are legitimate... random clinical trials on transcrotal applications of creams compared to injectable formats of testosterone, specifically relating to DHT. But we have seen anecdotal studies or case studies, if you will, in individual people who come onto the groups as well as lab results.
And the first thing that you'll notice is a lot of people will report an improvement in libido. Again, we don't know if this is a placebo effect or if it is directly related to DHT, because while we do know that DHT is a powerful sex hormone, and it's one of the ones that is more greatly responsible for converting a young male into an adult male in puberty, we do know that it does have positive implications in libido or positive effects on libido. However, we also know libido is far more complex than a single hormone or even a complex of several hormones. There's many factors, including psychological and sleep and interest and other aspects that go into libido.
We can't ignore the fact that labs do seem to show greater amounts of DHT in people using transdermal applications than injectables. And one of the theories behind this is that the 5-alpha reductase enzyme, which is responsible for converting the testosterone molecule into a dihydrotestosterone molecule, is supposedly found in greater concentrations in the subcutaneous layer of the skin. And therefore, there is a theory that when you're using a transdermal application as part of the absorption process, the hormone must pass through this process. high concentration of 5-alpha reductase, and therefore you're going to get an elevated conversion. We don't know if this has to do with a different absorption rate or if it actually has to do with a greater concentration of the enzyme.
What we do know is that people that use transdermal applications do seem to have elevated DHT levels as compared to the injectable counterparts. Now, transcrotal applications. is not really something that was initially designed by the manufacturers on a pharmaceutical level.
Transdermal applications were initially designed for gels, and I believe that they were indicated to be used on the shoulders, or on the upper part of the back, or on the back of the arms. And then as the compounding pharmacies began to produce creams with varying different bases, they found that to avoid the transference risk to partners or children, In areas that are exposed, they started recommending the inner thighs for application. And then over time, I've noticed in some of the groups, guys have suggested that they have noticed improved libido by using it on their scrotum.
Now, again, we're going back to the previous idea that possibly there are greater concentrations of 5-alpha reductase in that area, or it could just be where you're getting a boost of intratesticular testosterone. in the initial absorption, which we know HCG is known for via the endogenous mechanism. And this could also have a positive impact on libido. So everything that we're discussing is purely theory. There are no actual studies that I've seen, at least actually controlled studies showing that one is more effective than the other.
But these are all anecdotal. So I guess if you're going to look at case studies, which is the best we have at the moment, that could be the only factor. We do find, and we know for several reasons, and I've mentioned this in other videos, I personally prefer the injectable route for stability and long-term use over transdermals. But we do have a handful of patients who have claim to experience improved libido, and these are injection patients, when they add in a very low dose of a few times a week or every other day transcrotal applications. Now, remember, this is just for that increased libido boost.
This is not for their total TRT dose. So it's a much smaller dose, and therefore it lasts them a lot longer. And then they're relying on their injections for their actual replacement dose. So we do have a handful of guys who experience positive results on using both simultaneously. So that is certainly an option to consider.
The only caveat there is you want to adjust your dosing accordingly so that you're not just topping off, but you're actually kind of balancing out that level of replacement. Is it ever worth it, in your opinion, to measure DHT? Because I see a lot of guys in the group have those numbers in their labs.
But here in Belgium, at least, it's very difficult to get your DHT levered by a lab. DHT is another one of those hormones that, just like estradiol, is not an endocrine hormone. We don't produce it in a gland and then spill it into the bloodstream.
It is converted by the breakdown of the original testosterone molecule via an enzyme. To measure DHT levels in serum is really kind of moot. It's kind of like measuring estradiol because it is regulated at the tissue level of various organs.
I would say it can show a deficiency, similarly to estradiol. So a DHT deficiency may be indicative of a need to possibly elevate DHT levels. And there are synthetic DHT derivatives out there. As we know, in Europe, you have proviron.
In the U.S., we have oxangelone. and a handful of others, but there are DHT derivatives that may work on a short-term basis in a deficiency. I would say it's extremely rare to have someone with an enzymatic deficiency where they're not really converting well. Sometimes it's really modifying their medication.
But to measure DHT levels, again, I would do it for deficiency. The only time I would say the spillover really matters in serum is if we know that DHT may increase the rate at which the male pattern baldness gene takes effect on guys who are susceptible to hair loss. It does not cause hair loss, but it may accelerate it if you have the gene. And if you do have the gene, some guys would want to try to inhibit DHT. I'm not a fan of any of those blockers like finasteride and whatnot.
However, you know, you can always adjust dosing as needed, perhaps, if it is a concern. And then right up your alley, the second one would be acne, because we do know that there is a direct correlation from elevated DHT. and acne in a lot of guys because this is quite common when guys use DHT derivatives.
So outside of those two specific signs, for the most part, I don't worry about DHT. We don't usually test it unless we suspect a deficiency. Similarly to estradiol.
Okay. Thank you.