Finasteride, DHT levels and preliminary blood test

[Swooping]

Saw this on another forum. What do you guys think of this? Does it hold some truth, or not at all?

 

Hi everyone. I came across this post on balding blog which is written mainly by the FUE pioneer Dr William Rassman MD. It was put up only a few days ago. I have quoted it below.

 

I am writing this post from the ISHRS annual meeting in Chicago. I have just heard a wonderful and informative discussion on the use of of the drug finasteride. As we know, the hormone DHT is 40 times as powerful an androgen as testosterone. The treatment of genetic hair loss is to address block the DHT hormone. One of the worlds experts, Dr. Mohit Khera from the Baylor College of Medicine, told me privately that when DHT levels are in the low normal range, the use of DHT blockers such as finasteride will have little value and may not be effective in the treatment of genetic hair loss. With this as a suggestion, we will now optionaly offer DHT blood tests for any person who wishes to have this test prior to going on finasteride (Propecia). If the blood levels are low, we may not advise the use of this drug as the goal of using this drug is to drop DHT levels, which may already be low. This lecture is based on considerable research both in animals and human studies but it is not absolutely definitive as there was much controversy at the meeting that the doctor may have had a conflict of interest in the opinions he drew.

[KO]

Did they present evidence that those with low DHT levels did not respond to fin?

[Dr Blake Bloxham]

Hmm, very interesting.

 

Dr Rassman is the man, so it's interesting that he's excited about this.

 

A few things:

 

First, I think that regardless of DHT levels, the most important aspect of the androgenic alopecia (AGA) process is how the dermal papilla cells of your hair follicle express the androgen receptor (AR). Without the AR, you could have DHT coming out of your eyeballs and it shouldn't make a difference (theoretically). If you don't have the receptors, there is really nothing to bind with and kick off the AGA cascade. In these gentlemen, DHT levels wouldn't really matter.

 

However, I recall DHT testing falling out of favor a few years back because researchers found no good correlation between DHT levels and AGA. What I mean by this is DHT wasn't necessarily found to be elevated in those with male pattern baldness. Nor did the DHT levels correlate with the level of hair loss. Which I think references back to what I said about the ARs earlier: the way your body expresses these is really what will determine how your follicles react to DHT.

 

So I think this relates to reducing DHT with finasteride/dutasteride as follows: if there isn't a correlation between DHT blood levels and AGA, I'm not certain how finasteride/dut would make any difference in guys with AGA who happen to have normal blood DHT levels. And, as I previously thought, studies have shown that you can have normal blood DHT levels and still have active AGA.

BUT, maybe what they are saying is those with high levels of DHT may be good fin/dut responders compared to those with normal levels? Meaning it may be a new way to screen guys to see how you may respond to finasteride. Maybe it turns out that they guys who respond well are the ones who have high DHT to begin with? BUT, they don't know about it because DHT testing has generally fallen out of favor.

 

Then again, maybe this all has more to do with the actual activity of the 5-alpha-reductase enzyme at the follicular level, so testing blood levels of DHT -- whether they are high or low -- doesn't correlate??

 

It'll be interesting to see how this unfolds in the next few years. Maybe it means we could predict how one may respond to finasteride/dutasteride?

Edited September 18, 2015 by DrBlakeBloxham
Trying to make my ramblings make sense

[win200]

My take on what Rassman is saying is that the surgeon he's paraphrasing believes that further suppression of naturally low DHT levels will not have a meaningful impact on AGA. I.e., the lower an AGA sufferer's DHT is normally, the more diminishing his returns from finasteride/dutasteride. Personally, I would want corroboration of that before opting out of a DHT inhibitor. I've been on fin/dut for three years and didn't obtain a DHT measurement first, and I'm sure as hell not going off the drug just to find out.

[KO]

^Yeah, that and even if the effect for Low DHT people if muted, it could still be better than going without. You never know....