Dihydrotestosterone: paracrine role in the prostate and endocrine systemic effects.

What is it about?

There has been significant confusion about potential negative effects of elevated levels of circulating DHT in men. This review provides a detailed summary of key clinical data that demonstrates elevations in DHT, secondary to, for example, testosterone replacement therapy in men, should not be of clinical concern. In essence, DHT acts principally as a paracrine hormone. Consequently, circulating levels of DHT have essentially no meaningful impact on intracellular DHT concentrations due to local mechanisms that tightly regulate its concentration and activity -- particularly in androgen sensitive tissues.

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Why is it important?

Testosterone replacement in men (regardless of mode of administration) is generally associated with an increase in circulating levels of DHT. Due to DHT's greater androgenic potency compared to T, concern about potential deleterious effects of DHT in androgen sensitive tissues have been raised. Until now, there has not been a comprehensive and objective review of DHT biochemistry, physiology and clinical implications of elevated levels. This review sheds important light on misconceptions that elevations in DHT secondary to testosterone replacement therapy in men should be of clinical concern.