Why DHT doesn’t cause hair loss

Dihydrotestosterone (DHT) is often blamed for hair loss, but the truth is far more complex. While DHT is present in balding scalps, it’s not the root cause of hair loss.

Let’s break down why DHT isn’t the villain and why drugs like finasteride don’t address the real problem.

The Myth: “DHT Causes Hair Loss”

DHT is an androgen, derived from testosterone via the 5α-reductase enzyme. It’s more potent than testosterone and is crucial for male development, muscle growth, and libido.

So, why does it cause hair loss in some men but promote beard growth in others?

If DHT were the sole cause of hair loss:
✅ Men with higher DHT would always lose hair faster – (Not true)
✅ Finasteride would regrow all lost hair – (It doesn’t)
✅ Balding men would have higher DHT than non-balding men – (They don’t)

Let’s break down why this doesn’t add up.

No Link Between DHT Levels & Hair Loss

Serum DHT (DHT in the blood) and hair loss

Studies show no direct correlation between serum DHT levels and hair loss.

DHT levels in men with AGA (Androgenetic Alopecia):

• AGA patients: 36 ng/dL DHT (which is low)
• Frontal baldness: DHT = 60 ng/dL, Testosterone = 530 ng/dL
• Vertex baldness: DHT = 77 ng/dL, Testosterone = 626 ng/dL
• Premature balding: DHT = 66 ng/dL, Testosterone = 522 ng/dL

Key takeaway: Many men with higher DHT levels don’t go bald, and many bald men don’t have high DHT.

Scalp DHT and Hair Loss: The Real Story

Some studies show that scalp DHT is higher in balding men, but here’s the key detail:
It has never been proven that 5α-reductase (5AR) is elevated in balding scalps.

Why? Because when researchers extract a piece of scalp tissue from balding men, 5AR disappears and cannot be isolated. This means they are only measuring total testosterone and DHT, without directly analyzing 5AR activity.

So, if 5AR isn’t necessarily elevated, what actually causes higher DHT in balding scalps?

Why Scalp DHT Levels Can Be High (Without Increased 5AR)

1. Impaired DHT Breakdown (Low 3α-HSD Activity)

• Normally, DHT is converted into a weaker metabolite (3α-diol) by 3α-hydroxysteroid dehydrogenase (3α-HSD).
• This enzyme requires NADPH, which gets depleted by oxidative stress and nutrient deficiencies.
• If NADPH is low → Less DHT gets converted → DHT remains elevated in the scalp.

2. Reduced Clearance from the Scalp

• DHT is 10 times less water-soluble than testosterone, meaning it lingers longer.
• If scalp blood flow is impaired, DHT clearance slows down, allowing it to accumulate locally.

3. Impaired Detoxification (Beta-Glucuronidase Activation)

• DHT must be “deactivated” by attaching a glucuronide molecule, making it water-soluble for excretion.
• Inflammation increases beta-glucuronidase, an enzyme that removes glucuronide from DHT, reactivating it.
• This means that even if your body tries to eliminate DHT, inflammation keeps “recycling” it.

4. Scalp Tension and Tissue Compression

• When scalp tension increases, the density of the tissue changes.
• Imagine your scalp is a sponge:
  • A healthy scalp is like a relaxed sponge—loose and flexible.
  • A balding scalp is like a squeezed sponge—more compressed.
• If you add soap (DHT) to the sponge and squeeze it, the soap concentration per cm² increases, but the total amount remains the same.
• This can falsely appear as “high DHT levels”, when in reality, it’s a mechanical compression issue, not excessive DHT production.

5. High DHEA Levels → More DHT Production

• DHEA is a precursor to DHT via this pathway:
  DHEA → Androstenedione → 5AR → 5α-Androstanedione → DHT
• Chronic stress & adrenal overactivation increase DHEA production, indirectly raising scalp DHT.

6. Low Aromatase Activity → More DHT Conversion

• Testosterone has two pathways:
  • Aromatase converts testosterone → estradiol
  • 5AR converts testosterone → DHT
• If aromatase is downregulated, more testosterone is forced toward the 5AR pathway → increasing DHT.

7. Oxidative Stress → 5AR Activation → More DHT

• Hydrogen peroxide (H₂O₂), a free radical, is elevated in balding scalps.
• H₂O₂ stimulates 5AR, increasing local DHT.
• But DHT is actually protecting against oxidative stress, acting as a buffer.

So is 5AR the problem, or is H₂O₂ the real issue?
If you inhibit 5AR, you’re just blocking a protective response—not solving the root problem.
If you lower oxidative stress, you naturally reduce excessive DHT upregulation.

The Bottom Line: DHT Isn’t Just Upregulated for No Reason

Higher scalp DHT isn’t a random event—it’s a response to deeper issues like:
✅ Oxidative stress
✅ Inflammation
✅ Nutritional deficiencies
✅ Mitochondrial dysfunction
✅ Chronic stress

Simply blocking DHT (via finasteride or dutasteride) does nothing to fix these issues.
Instead of blaming DHT, address the root cause.

The Real Reason for Hair Loss: Scalp Inflammation & Tissue Pressure

DHT levels increase in balding areas, but not because it’s “attacking” the hair follicles. Instead, DHT is a response to a deeper issue—scalp tension and inflammation.

What Actually Happens in Hair Loss?

🔹 Scalp tension & skull expansion reduce cushioning around hair follicles
🔹 DHT increases to help the follicle grow deeper (an initial protective mechanism)
🔹 But over time, increased mitotic activity + pressure shortens the anagen phase
🔹 Follicles shrink due to excess mechanical stress & inflammation

How does inflammation play a role?

• ROS (Reactive Oxygen Species) sensitize ARs, making hair follicles hyperresponsive to androgens
• Oxidative stress increases beta-glucuronidase, leading to higher free DHT locally
• High homocysteine (if BHMT enzyme is inhibited) can damage hair follicles

🔹 DHT isn’t the trigger—it’s a secondary response to the real problem.

Finasteride Blocks DHT, but It’s Not Fixing the Problem

Finasteride lowers DHT, but it doesn’t address the actual causes of hair loss (inflammation, oxidative stress, and impaired scalp blood flow).

Finasteride Results (Clinical Trials):

• 48% experienced hair regrowth
• 35% saw no change
• 17% continued to lose hair

Why doesn’t Finasteride work for everyone?
Because DHT suppression alone doesn’t reverse miniaturization—and in some cases, it even reduces scalp IGF-1, making the problem worse.

Fun fact:

• Finasteride increases IGF-1 in only 4 of 9 users → Those men had better hair regrowth.
• The others? No IGF-1 increase = No results.

This suggests IGF-1, not DHT, is the real problem.

🔑 Key Takeaways

✔ DHT doesn’t cause hair loss—tissue response does
✔ Inflammation, ROS, and scalp tension drive miniaturization
✔ Finasteride lowers DHT but doesn’t address the real issue
✔ Improving IGF-1, Wnt/β-catenin signaling, mitochondrial function, gut health, nutritional deficiencies and blood flow are better solutions

The Bottom Line: Don’t Fear DHT—Fix the Root Cause

Blocking DHT is not the best solution. Instead, focus on reducing inflammation, improving scalp circulation, and enhancing growth factors like IGF-1 & Wnt signaling.

If you want a real strategy to keep your hair while optimizing your hormones, fix the root cause—not the symptoms.