Dihydrotestosterone (DHT) and its role in sexual health

[chrisis]

I'm trying to get to the root cause of some sexual side effects as a direct consequence of taking finasteride for 2 months and quitting 3 months ago.

So far I've discovered that dihydrotestosterone plays a key role in sexual development, but is also integral to male health into adult life.

According to the following study, "differences in concentrations of circulating dihydrotestosterone within the normal range may represent a major predictor of sexual activity in healthy young men

http://www.bmj.com/content/310/6990/1289

If it is true that by blocking 5-alpha reductase, finasteride blocks the conversion of testosterone into DHT, then surely we have identified the cause of sexual side effects. It's because, as the study concludes, difference in concentrations of DHT appear to predict sexual activity in healthy young men. Doesn't this mean that to overcome sexual side effects, we must simply address the levels of DHT? Or is something else going on?

Is it possible to ask a doctor to measure DHT when getting hormone levels checked? And then is it possible to increase levels of DHT?

[bob13]

wasn't there a huge thread with this already?
Why start another one?

Chris you ought to go to medical school.

[chrisis]

Awesome feedback as ever bob.

[bob13]

Awesome feedback as ever bob.

I guess that means Im right.

[chrisis]

My question evolved from another discussion, yes. But I wanted to ask it directly.

I'm confused a bit here: is there some sort of limit on how many posts we can post in a day?

Is there a rule about which topics are appropriate?

Are there members here in an appointed position to dictate which topics are suitable and which aren't?

I'd really prefer to stick to the topic at hand. In future please don't get involved in my topics unless you have something constructive to say. This is just another useless distraction from substantial issues I'm concerned about.

[CurlyBird]

Results: Serum dihydrotestosterone concentration was the only independent hormonal predictor of the frequency of orgasms; an increase in concentration of 1.36 nmol/l (about 2 SD) corresponded to an average increase of one orgasm a week.

Two standard deviations = +1 orgasm per week. Two standard deviations on either side of the mean includes something like 96% of all people. I don't count my weekly orgasms but +/- 1 doesn't bother me.

[SoothSayer]

If you are interested in hypothesizing about the causes of the persistent sexual side effects from taking finasteride, I suggest you visit other forums that are more responsive to this type of thing. Many of the guys on this forum taking finasteride are doing so without facing any problems and it greatly upsets their sense of security to consider this unfortunate outcome.

Additionally, the majority of these guys are not really educated on the physiology of taking finasteride or the endocrine system. Even those that are really do not have a clear understanding of the mechanism of action involved in how finasteride causes side effects since little of it is truly disclosed in Merck's safety literature. There are medical professionals and scientists that have been studying this issue for probably half a decade, with increasing focus designated to the problem every year, but the rate at which they are deriving insights is progressing slowly.

I suggest you get a work-up from a proper doctor (endocrinologist/urologist) ASAP in hope that your problem stems from an issue other than your finasteride use and may be something that is treatable. Otherwise, you will struggle to find answers or even open-minded people on forums like "the Bald Truth".

[bob13]

Well said best answer Ive seen in these forums.

[the_charger]

yes Soothsayer thank you for your post. as you maybe saw, chrisis and I were debating the role of DHT in adult men and its impact on normal sexual functioning.

If you are interested in hypothesizing about the causes of the persistent sexual side effects from taking finasteride, I suggest you visit other forums that are more responsive to this type of thing. Many of the guys on this forum taking finasteride are doing so without facing any problems and it greatly upsets their sense of security to consider this unfortunate outcome.

I think I know what forum you are referring to. from what I can see, there isnt much talk there that DHT is responsible for sexual issues. this is especially the case because after guys quit finasteride, it looks like their hormones come back to normal, but still have sexual problems. im curious what is your take on the role DHT has in adult sexuality? from what I have seen, its testosterone that seems to be key in erections and libido. but even then, most of the theories are that the persistent problems dont have much to do with hormones at all, and more to do with other chemicals like neurosteroids?

[SoothSayer]

yes Soothsayer thank you for your post. as you maybe saw, chrisis and I were debating the role of DHT in adult men and its impact on normal sexual functioning.



I think I know what forum you are referring to. from what I can see, there isnt much talk there that DHT is responsible for sexual issues. this is especially the case because after guys quit finasteride, it looks like their hormones come back to normal, but still have sexual problems. im curious what is your take on the role DHT has in adult sexuality? from what I have seen, its testosterone that seems to be key in erections and libido. but even then, most of the theories are that the persistent problems dont have much to do with hormones at all, and more to do with other chemicals like neurosteroids?

Many of the men who face persistent side effects after quitting Propecia/Proscar do actually show abnormal hormone levels. However, it is not a requirement to have a hormone profile taken before patients start treatment with finasteride so it isn't possible to compare before/after snapshots but it does seem that they commonly have very low levels of DHT and sometimes free testosterone relative to their healthy male cohorts.

There are other forums other than PropeciaHelp which are more interested in exploring these issues, but TBT is not one of them. I think it is valuable for him to report his study, but it makes sense to be diplomatic in doing so. As I mentioned, men who are on the drug become very defensive when pushed on the subject and it may drive stubborn individuals to engage riskier decisions than they would have otherwise. It is unfortunate, but people don't always make the most rational choices when it comes to potentially emotional issues like hairloss.

I do think that DHT does play a role in adult human sexuality. It is a more potent androgen that testosterone and found in many sexual male organs such as the prostate, epididymis, and seminal vesicles. DHT has been a neglected hormone and it usually coexists at similar levels to T in men so it is difficult to separate out the function of T and DHT.

Nobody currently knows why Propecia causes persisting side effects in a minority of men but there are so many case reports detailing the same symptoms that it is very unlikely to be explained by random chance.

People have theorized that Propecia persistently alters neurosteroids, which are crucial hormones for cognitive functioning but they are difficult to measure. They have also speculated that introduction of the drug has silenced genes that code for the androgen receptor which prevents existing androgens from working in the bottom. Starving the body of DHT could lead to some specific tissue/nerve damage. All of these explanations are very possible we really need more studies to test each scenario to determine which one explains the connection and offer potential treatments if they even exist. It is even possible that a combination of some or all of these are true. However, medical research is extremely expensive and time consuming and those who have demonstrated these symptoms have largely been orphaned by the medical community due to the confusing nature of their problem, their small population size, and hesitation to offend the pharmaceutical industry which often directly or indirectly plays a role in medical research.

[the_charger]

If it is true that by blocking 5-alpha reductase, finasteride blocks the conversion of testosterone into DHT, then surely we have identified the cause of sexual side effects. It's because, as the study concludes, difference in concentrations of DHT appear to predict sexual activity in healthy young men. Doesn't this mean that to overcome sexual side effects, we must simply address the levels of DHT? Or is something else going on?

Is it possible to ask a doctor to measure DHT when getting hormone levels checked? And then is it possible to increase levels of DHT?

Im honestly not trolling you here dude, but just want to give you some advice.. I read on propeciahelp that 5-alpha reductase doesnt ONLY convert Testosterone to DHT, but it also converts other important chemicals as well.

if it were really so simple that DHT was all a person needed to boost their libido, then everyone would be taking DHT supplements and men into their 80's would be as sexually active as teenagers! same would be said for people with problems after propecia, testosterone injections and dht supplements would cure the problem for everyone. This obviously isnt whats happening... along with the other points I made in the other thread, it is just fact that DHT has little to nothing to do with any of this.

you might have heard of Dr. Chrisler, who treats people that have these problems with hormones. if increasing DHT levels was all that was needed, everyone who gets treated would feel 100% better, but I dont think ive heard of anyone cured or even feeling significantly better after his treatments..

its very obviously a complicated problem, if it were as simple as DHT alone being the solution, then everybody would already be treating themselves. I havent seen many hormone reports from people after stopping propecia (maybe soothsayer can comment on this) but it looks like for the most part testosterone and DHT go back to normal even in people that still have side effects.

[SoothSayer]

(maybe soothsayer can comment on this) but it looks like for the most part testosterone and DHT go back to normal even in people that still have side effects.

I addressed this in my previous post, but it looks like many men have hormone levels that are below the normal range of hormones or at the very bottom level. It does seem that a deficiency of DHT is in part responsible for causing lasting problems in these patients. If you are interested, you can take a look on PropeciaHelp where a lot of patients post the results of their hormone profiles. However, as you mentioned it is not as simple as supplementing DHT or T since this does not seem to easily work. It is also possible that Propecia use causes an acquired androgen insensitivity. If this is true, hormone supplementation will not reverse the problem even if the problem is hormonal, similar to the relationship between Type I diabetes and insulin injections.

[ryan555]

You can get a blood test for DHT. I had a few of them after I stopped finasteride. Make sure you take it first thing in the morning or you'll get some crazy results. Anyway, in all likelihood, your DHT levels will be normal, unless you have hypogonadism (and you would definitely know if you did). When you slow the production of hormones, the receptors for those hormones become downregulated and it takes a while for them to readjust for some people.

[chrisis]

Sorry for slow response here, had a busy weekend.

ryan555, just to get to your reply first, why did you get your DHT checked? Can you tell me your full story? How long did it take for you to go back to normal and what did you do to help?

[ryan555]

Sorry for slow response here, had a busy weekend.

ryan555, just to get to your reply first, why did you get your DHT checked? Can you tell me your full story? How long did it take for you to go back to normal and what did you do to help?

I got my DHT checked because I was terrified of coming of 12 years of finasteride after reading all the crazy shit on the internet. I quit cold turkey and all my hormonal levels went back to normal for me within a week or so. As far as sides go, I had a few that I was unaware of when I was on the drug because I never read anything about them the whole time I was on it. I just ignored them and they didn't really bother me. Those all corrected themselves within a few days, maybe a week after stopping.