Dihydrotestosterone (DHT) is a hormone that’s central to male development, but it’s also a key driver of pattern hair loss. Both high DHT levels and heightened follicle sensitivity can cause balding. But several treatments are available to stop DHT attacking your hair follicles and help you retain your hair. Treatments include systemic and topical DHT blockers, natural remedies, and specialist options, each with varying effectiveness and potential side effects.
In this article, you’ll learn how to control your DHT levels to minimise the impact of this hormone on your hair. We outline the science behind DHT, clarify myths about DHT levels vs sensitivity, and evaluate the medical, topical, and natural DHT blocking treatments currently available.
Key takeaways
DHT supports male sexual and physical development, but also contributes to male and female pattern hair loss.
Hair loss can result from elevated DHT levels or genetically high follicle sensitivity.
DHT control methods include systemic blockers (such as finasteride and dutasteride) and topical treatments.
Natural DHT blocking options exist, but these are generally less effective than pharmaceuticals.
Reducing DHT can lead to adverse effects in a minority of patients, including sexual performance issues and mental health problems.
Stopping treatment usually causes hair loss to resume, unless you replace it with another effective hair restoration solution.
Dihydrotestosterone is an androgen, or male sex hormone, that occurs naturally in the body. Both men and women produce DHT, though men naturally have higher levels. That’s because men have higher levels of testosterone, which is metabolised to DHT via an enzyme known as the 5 alpha-reductase (5AR) enzyme.
DHT plays an essential role in male physical and sexual development [1]. In the womb, DHT is involved in the formation of the male sexual organs. In adolescence, DHT levels increase, promoting prostate growth, facial hair growth, and other changes associated with male puberty.
DHT is also a significant factor in the development of male pattern baldness. It binds to androgen receptors in your hair follicles, causing them to shrink. Eventually this leads to permanent miniaturisation, and the follicle becomes unable to produce hair.
There’s some debate around whether hair loss is caused by high DHT levels or high sensitivity to DHT [2-3]. If you have particularly high DHT levels, it’s likely you’ll be affected — but many people with normal DHT levels also experience frontal balding and crown thinning. This is likely due to having a particularly high sensitivity to DHT.
Your sensitivity to DHT is genetically programmed, which is why male pattern baldness is often hereditary. The AR gene determines how sensitive your follicles are to DHT (though it’s far from the only gene involved in hair loss genetics) [4]. A high level of AR gene expression can mean you have more androgen receptors in your follicles, so more DHT can bind to them, increasing the impact on your hair.
Circulating DHT levels are also partly down to genetics, though other factors including stress, diet, and hormone levels also play a part [5]. These can affect the activity of the 5AR enzyme, leading to fluctuations in DHT levels.
Ultimately, both high DHT levels and high DHT sensitivity can lead to hair loss. So it’s not just a case of stopping DHT from ‘attacking’ your follicles. It’s understanding your genetic predisposition to hair loss, and which factors you can control to slow ongoing balding.
DHT is a major driver of male pattern baldness, and both DHT sensitivity and DHT levels have a role to play in the development and progression of this condition. So controlling DHT levels can help slow hair loss and, in some cases, even promote hair regrowth [6].
Most methods of controlling DHT are split into two categories: systemic and topical. Systemic DHT blockers generally inhibit the activity of the 5AR enzyme, reducing the amount of testosterone that’s converted to DHT. This lowers your circulating DHT levels, so there’s less of it to affect your hair.
Topical treatments can reduce DHT levels locally. For example, topical finasteride has been shown to limit scalp DHT levels, without affecting your overall DHT levels [7]. This can minimise the risk of side effects associated with a drop in circulating DHT.
Hair loss is a big issue for many men, and there are products out there to help you stop DHT from attacking your hair follicles by controlling your DHT levels. Here are some of the most effective.
Finasteride is a drug known as a 5AR inhibitor, and it works by limiting the activity of the 5AR enzyme. This stops your body from converting as much testosterone into DHT, so there’s less DHT to bind to your hair follicle receptors.
Finasteride 1 mg is a licensed oral drug for male pattern baldness. It has been shown to be a safe and effective treatment for this type of hair loss [8]. However, a small proportion of finasteride users do experience significant side effects including depression and erectile dysfunction, so it’s important to be aware of the risks of this type of treatment.
Topical finasteride is also available as an unlicensed treatment. While studies show promising results and a strong safety profile compared with systemic finasteride, there isn’t yet enough evidence for regulatory bodies to license topical finasteride for hair loss [9]. But some doctors will prescribe this off-label to eligible patients.
Like finasteride, dutasteride is a 5 alpha-reductase inhibitor. It works the same way: reducing DHT by inhibiting the activity of the 5AR enzyme.
Dutasteride is a more potent 5AR inhibitor compared to finasteride [10]. While finasteride only inhibits the type 1 5AR isoform, dutasteride inhibits both type 1 and type 2. As a result, it tends to be considered the most effective way to control DHT for hair loss [11].
That said, dutasteride isn’t licensed for treating hair loss, so it’s not usually prescribed as a first-line treatment. Your doctor or trichologist may prescribe it if you don’t see acceptable results from finasteride and/or minoxidil after several months of use.
Other medical therapies can help you control DHT and therefore reduce hair loss. The table below shows the DHT control mechanism and potential effectiveness of ketoconazole for hair loss, spironolactone for hair loss, and clascoterone for hair loss:
These pharmaceutical options are generally considered safe for certain subsets of patients. If you’re interested in trying these treatments for hair loss, it’s best to consult with a qualified trichologist who can discuss the benefits and risks based on your specific symptoms.
Many natural DHT blockers are available without a prescription, with varying degrees of research to support their use. While natural remedies for hair loss aren’t generally as effective as pharmaceutical DHT blocking agents, some patients prefer to try these before seeking medical intervention.
The following natural products have been shown to help with hair loss, likely by reducing DHT or stopping it from affecting your hair [16]:
These oils and extracts must be applied to the scalp regularly to maintain their DHT-inhibiting effects.
Women are less affected by pattern hair loss than men, but it’s still the most common hair loss condition affecting women, especially after the menopause [17]. Like male pattern baldness, female pattern hair loss is at least partly caused by a hormone imbalance. As female sex hormone levels dip after menopause, DHT levels can rise, leading to increased hair loss.
But DHT blockers for women aren’t always considered safe. They have been linked with menstrual cycle irregularities and problems with foetal development, which is why it’s important to consult with your doctor before using any DHT reduction treatments.
Female hair loss can be complex, with many potential causes contributing to your symptoms. So other effective treatments for female hair loss may be more appropriate than DHT blockers.
Stopping DHT from attacking hair follicles can be an effective way to reduce hair loss and even promote regrowth. But there are some risks and potential side effects associated with DHT reduction, including [18]:
These risks are relatively low, with one study showing that finasteride adversely affected less than 1% of 3177 male participants [19]. That said, other studies have found higher rates of adverse effects, particularly related to finasteride and dutasteride treatment [20-21]. So it’s important to be aware of the potential for side effects when controlling DHT production in your body.
Topical treatments tend to produce milder side effects, so they may be worth considering if you’re worried about the systemic effects of DHT controlling medications.
No. There are no treatments that will lead to a permanent reduction in DHT levels. This is actually a good thing, because men need a certain amount of DHT to maintain regular body function (including sexual performance and energy metabolism).
To sustain the effects of DHT reduction on your hair, it’s best to continue taking your preferred medication, as long as the side effects are tolerable for you. Discuss any problematic side effects with your doctor or qualified hair loss consultant; they can advise you on the best course of action for maintaining your hair while minimising the systemic effects.
You need a blood test to measure your DHT levels. This isn’t routine, especially if hair loss is your only symptom and concern.
Speak to your GP or a trichologist if you’re concerned about your DHT levels. They can discuss potential treatments based on your symptoms and what you’ve tried so far.
Yes. If you’re particularly sensitive to the effects of DHT, even normal DHT levels can lead to hair loss. That’s one reason why it’s not routinely advised for hair loss patients to test their DHT levels.
If you stop taking finasteride, dutasteride, or any DHT blocking treatment, you can expect your hair loss to resume after a few weeks.
That said, some studies have shown promising results replacing oral finasteride with combined minoxidil and topical finasteride to maintain hair density [22]. So while it’s not advisable to completely stop DHT blocking treatments if you want to keep results intact, you may be able to switch to a different treatment with more acceptable side effects.
At the Wimpole Clinic, we take a personalised approach to every patient we see. So if you’re still searching for the right solution to manage your hair loss, our specialists are ready to support you.
Voted Hair Transplant Clinic of the Year several years’ running, we’ve earned the trust of thousands of individuals seeking lasting, effective hair restoration. We combine surgical with non-surgical approaches to achieve exceptional outcomes for our patients.
To explore how we can help you regain your confidence and restore your hair, book a free consultation at your preferred clinic location.
Discover more about how to control DHT in these frequently asked questions.
It’s possible for your hair to regrow if you respond positively to DHT blocking treatment, but this is more likely if you start it in the early stages of hair loss [6].
DHT doesn’t affect facial hair in the same way as scalp hair. DHT is responsible for beard hair growth during adolescence and adulthood. When DHT binds to androgen receptors in facial hair follicles, it tends to increase hair growth, rather than reducing it [23].
If finasteride doesn’t work for you, there are other options you can try. Dutasteride is a more potent drug that can help control DHT levels. Dutasteride may carry a higher risk of side effects compared with finasteride. Find out more in this comparison of finasteride vs dutasteride.
A hair transplant is another option if you’re not responding to medical therapy for hair loss. While a hair transplant won’t stop ongoing or future hair loss, it can replace follicles that have already been miniaturised thanks to DHT. The replacement follicles are extracted from an area on your scalp that’s immune to the effects of DHT, so the transplanted hair shouldn’t fall out.
Minoxidil’s primary mechanism is as a vasodilator; it widens the blood vessels in the scalp to allow more blood, oxygen, and nutrients to flow to the hair follicles. However, some recent evidence suggests minoxidil may also help reduce DHT levels, although it’s unlikely to limit DHT production as significantly as finasteride and dutasteride [24].
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Dr Chirag Gadhia (GMC: 7926627) is one of our specialist FUE hair transplant surgeons, focusing on restoring natural-looking hairlines and enhancing hair density by combining the artistic nature of hair transplants with advanced surgical techniques. Dr Gadhia trained at our prestigious Wimpole Training Academy and has had experience working from our elite Wimpole Platinum service, where he gained and refined his knowledge to advance his hair restorative surgeries.
Dr Gadhia completed his medical degree at the renowned University of Pavia, Italy. He then honed his skills in various NHS surgical departments in Oxford, including upper gastrointestinal, bariatric, and colorectal surgery. This diverse experience has shaped his personalised approach to patient care. He takes the time to understand each patient’s unique goals and concerns before recommending a tailored treatment plan.
Dr Gadhia is committed to providing compassionate care and empowering his patients to regain confidence and self-esteem through transformative hair restoration treatments. He is dedicated to staying at the forefront of advancements in the field and ensuring that his patients receive the highest standard of care.
