The hormone DHT can be broken down into two categories. Firstly, there’s serum DHT (the kind that circulates in your blood). Secondly, there’s tissue DHT (the kind that binds to your skin, your scalp, and many other places in your body).
Many people assume that all kinds of DHT – both serum and tissue – are bad for your hair. But research on this is mixed.
Let’s start with serum (blood) DHT. Some studies suggest serum DHT has no correlation with pattern hair loss. Others suggest that serum DHT is higher in young men without hair loss! This contradicts the widely preached dogma that DHT is universally bad for hair. Based on the evidence, serum DHT is either uncorrelated to or protective against male pattern hair loss.
But what about tissue DHT? Is tissue DHT correlated with baldness?
Yes. The distinction between serum and tissue DHT matters. It turns out that tissue DHT is elevated in the scalps of balding men. Tissue DHT in the scalp is linked to pattern hair loss. Where DHT collects in the scalp, hair loss tends to follow.
Beyond this, DHT gets extremely complicated.
For one, tissue DHT is associated with hair loss in the scalp, but paradoxically, tissue DHT also encourages body and facial hair growth. How can that be? How can tissue DHT encourage both hair growth and hair loss, depending on location? (Note: many theories have tried and failed to answer this).
Here’s another paradox… While men’s testosterone tend to decline with age, their serum DHT levels stay about the same. At face value, that doesn’t make much sense. DHT is made from testosterone. When testosterone decreases, we’d expect DHT to also decrease. But it doesn’t. Why?
It turns out that testosterone (specifically, free testosterone) converts to many byproducts aside from DHT. As men’s testosterone levels decline, their bodies also begin shifting the conversion of free testosterone toward DHT and away from other testosterone byproducts. This is how serum (blood) DHT levels remain constant, even when men’s testosterone levels plummet.
The point of all this is… DHT’s role in pattern hair loss is still debated. Men produce more DHT than women. Men bald more often than women. Tissue DHT is present in the scalps of balding men. But beyond that, it’s still unclear whether DHT is the root cause of hair loss, or just a symptom of inflammation.
So what happens when we extend our scope beyond DHT and ask, “Based on the evidence, is there a hormonal profile specific to a balding person?”
Yes. The big picture is that in both sexes, if we look beyond DHT, hair loss is closely connected to a hormonal imbalance. Specifically, an imbalance of the testosterone:estrogen ratio.