Dihydrotestosterone (DHT) is an androgen, synthesized primarily in the prostate gland, testes, hair follicles, and adrenal glands by the enzyme 5α-reductase by means of reducing the 4,5 double-bond of the hormone testosterone.

Approximately 5% of serum testosterone produced in men undergoes 5α-reduction to form the more potent androgen, dihydrotestosterone. DHT has three times greater affinity for androgen receptors than testosterone and has 15-30 times greater affifinty than adrenal androgens. During embryogenesis DHT has an essential role in the formation of the male external genitalia, and in the adult DHT acts as the primary androgen in the prostate and hair follicles leading to hair loss.

An example illustrating the significance of DHT for the development of secondary sex characteristics is the congenital5-α-reductase (5-AR) deficiency which can result in pseudohermaphroditism. This condition results in underdeveloped male genitalia and prostate. These individuals are often raised as girls due to their lack of conspicuous male genitalia. In the onset of puberty, although their DHT levels remain very low, their testosterone levels elevate normally. Their musculature develops like that of other adults. After puberty, men with this condition have a large deficiency of pubic and body hair, and no incidence of male pattern baldness.

Unlike other androgens such as testosterone, DHT cannot be converted by the enzyme aromatase to estradiol. Therefore, it is frequently used in research settings to distinguish between effects of testosterone caused by binding to the androgen receptor and those caused by testosterone’s conversion to estradiol and subsequent binding to estrogen receptors.

Pathology

DHT is the primary contributing factor in male pattern baldness. However, female hair loss is more complex, and DHT is only one of several possible causes. Women with increased levels of DHT may develop certain androgynous male secondary sex characteristics, including a deepened voice and facial hair. DHT plays a role in the development and exacerbation of benign prostatic hyperplasia, as well as prostate cancer, by enlarging the prostate gland. Prostate growth and differentiation are highly dependent on sex steroid hormones, particularly DHT.

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Heart Health and Hair Loss

There has been increased interest and funding in cardiovascular health and there has been correlations shown between androgenic alopecia type hair loss and heart disease. Much more research is being done to better understand the correlation between heart health and losing hair.

Baldness may be more than just a cosmetic indignity: it could be a marker of heart disease risk, especially in men with other risk factors such as high blood pressure or elevated cholesterol. Heart attacks, chest pain due to blocked arteries (called angina), and the need for balloon angioplasty or bypass surgery all are forms of heart disease, the researchers explained.

In men with high cholesterol and severe androgenic alopecia type baldness at the vertex, or crown of the head, heart disease risk was increased nearly threefold compared to men who had high cholesterol but were not bald, says senior author JoAnn E. Manson, MD, Dr PHD.

High blood pressure was associated with an 80% increase in heart disease risk if the men were also bald. Mild and moderate vertex baldness were also associated with an increased risk of heart disease, but to a lesser extent. Frontal baldness — a receding hairline — had little relationship to heart disease. “To our knowledge, this is the first large-scale study showing a relationship between a specific pattern of baldness and heart-disease risk,” Manson says. The researchers, in addition, saw that the men with more severe hair loss developed more heart disease during the 11 years they were watched than men with only mild to moderate hair loss, suggesting a link between the degree of hair loss and heart disease risk.

The biological link between hair loss and heart disease could involve elevated levels of male hormones, says Manson, an endocrinologist and chief of preventive medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. Hair loss research has shown that the scalp has a higher density of male-hormone receptors, and high levels of hormones such as testosterone and dihydrotestosterone (DHT Hair Loss) are associated with an increased risk of hardening of the arteries and blood clotting. Although this study did not include women, Manson says that true male-pattern baldness in women, which is associated with an increase in male hormones, has been linked to an increased risk of high blood pressure, diabetes, and abnormal cholesterol, all of which raise the risk of heart disease. She cautions, however, that this finding has not been well studied.

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