Thanks for such an informative article.
I had read somewhere that eating too much of protien(whey, animal etc.) increases the testosterone levels in men. Not sure if it’s free testosterone. Do you think this might be a factor responsible for increased DHT in scalp regions causing more hairfall in men suffering from MPB.

Thanks,
Chandan

Hey Johnny,

Thanks for the info. The waning efficacy of finasteride, dutasteride, and other 5-AR inhibitors for androgenic alopecia is well-documented in the literature. The reality is that if you’re already taking dutasteride — and took finasteride for 10 years — I wouldn’t recommend looking for more ways to reduce DHT.

Rather, I’d look for treatments that work synergistically with finasteride or dutasteride — even for people who have stopped responding well. Have you tried microneedling?

Best,
Rob

Hey Anthony,

It’s hard to determine what’s going on at a tissue-level (scalp skin) with serum hormone panels. Low serum testosterone is potentially a consequence of several different issues — medications, alcohol, diet, lifestyle (i.e., a lack of sleep), etc. Without more information, it’s hard to delineate.

In cases of low testosterone and high DHT, this is often seen in people with some source of systemic inflammation. This might be a food allergy, or any of the things we’ve covered above. Everyone’s body is different so it’s hard to extrapolate beyond this.

Best,
Rob

Great article!

So, I was on Propecia for 10 years. It worked well, but lost its effectiveness the final 2 years. I have since gone on Avodart, and on it for 1.5 years now.

Unfortunately, Avodart has not been as helpful as my prime days on Propecia. My free testosterone has increased, but my DHT must be close to nil (since I’m on .5 mg of Dutasteride every day, from the pharmacy).

What are some ways to reduce free testosterone? I suspect, since my scalp is oily and inflamed, that the tree testosterone is negatively impacting the hair.

Thank you!! Btw, I’m 32.

I would like to share my personal experience (which may help other by the way) and would appreciate your point of view.

I’m 28 and here are my serum results :
Free Testosterone : 31.2pmol/L (reference : 31pmol/L => 94pmol/L)
Total Testosterone : 14.9nmol/L (reference : 8.64nmol/L => 29nmol/L)
DHT : 3.48nmol/L (reference : 1.13nmol/L => 4.13nmol/L)

I do suffer from MPB (only vertex balding).

It’s interesting to notice that :
1)my free T is really low (the minimal reference)
2) my total T seems okay (although still low considering I’m only 28)
3) my DHT pretty hight.

I don’t think reducing my free T would be a great idea because it’s already low. And here are my two questions :

1) Do you think my low free T is a consequence ? I mean if my free T is low it’s because a lot of it has been used to be turned into DHT so there’s no more free T ?

2) If I have a lot of T -> DHT conversion it is because my total T production is not that high. So my body is trying to compensate this “weak” total testosterone by producing more DHT ?

-Menstrual irregularities
-Weight gain (pear shape weight gain)
-Mood changes (depression or anxiety)
-Breast tenderness, breast fullness
-Fatigue
-Bloating and/or water retention
-Decreased muscle mass (inability to gain muscle mass even while lifting weights)


Low SHBG is most often seen in women who are hypothyroid (meaning they have low thyroid function) and women who are menopausal. 

We know that both thyroid hormone and estrogen stimulate SHBG release, so low levels are often associated low hormone levels. 

Hey Sina,

Thanks for reading. These are great questions and deserve full blog posts for answers. Given that this is just a comments section, I can’t do the answers full justice — but I’m happy to give directional insights where possible.

A) Keto’s effects on acne likely have to due to microbial die-off from a decrease in calorie count. At least, that’s probably what happened to me when my acne went away while trying keto. See this article:

https://perfecthairhealth.com/the-truth-about-low-carbohydrate-diets-and-hair-loss/

B) Interestingly, acne is likely both androgen-dependent and estrogen-dependent — meaning the ratios of both in any tissue matter significantly. It’s also connected to the microbiome. I’ve got a lot of articles on this, but I’d recommend starting here:

https://perfecthairhealth.com/p-acnes-bacteria-may-cause-hair-loss-heres-what-to-do-about-it/

https://perfecthairhealth.com/small-intestinal-bacterial-overgrowth-hair-loss-sibo-gut-health/

The book advocates for a moderate carbohydrate paleo-based diet (with modifications). It helps some readers with their acne, but since acne’s pathology varies for each individual, you might need to focus more on SIBO and/or the gut.

C) Potentially (see above answers), but in general, acne is often more complicated than just a change in diet.

D) Not at all. In fact, the research indicates that mechanical stimulation + finasteride and/or minoxidil are all synergistic.

Best,
Rob

Great points, Charlie! The issue isn’t with serum DHT, it’s with DHT bound to androgen receptors in scalp tissues. Have you tried any other androgen receptor blockers / binders?