Hair loss testosterone finasteride DHT & estrogen
Relating to hair loss and the medical also, careful treatment of going bald in all kinds of people. Hi everyone, my name is Dr. Vikram Jayaprakash, and welcome to The Hair Loss Show. No episode number today, I'm flying solo because this is a blog I thought we just sort of, we'll call it like, an in-between-soda and I just thought I'd do it on my own because it doesn't really fit in with what exactly Russell and I want to sort of, the message we're trying to convey and what we're trying to, you know, the content that we're trying to promote. But I've been getting enough questions on the channel and thank you very much for the questions, please do keep them coming, and I thought it'd be worthwhile just quickly doing this Article specifically, on Testosterone, Finasteride, DHT, and biochemistry. We get a lot of questions on that and the impact of all of those things and Estrogen as well. So this is just, you know, quick blogs on that topic. Now I wanna preface this by saying that this is not something that I talk about regularly with my patients. So it doesn't fit into my normal consultation process because I think it probably lies out of the sphere of what we're trying to achieve within the consultation but I think there were enough of you that asked the question that I thought well, okay, let's have a chat about it and go from there. So here goes, so the first thing I mean in the essence of trying to keep, you know, lower the amount of time it takes, I've drawn out the biochemical process this is how hormones, steroid hormones, are created in the body. Okay and as you can see from here, hopefully you can see, Cholesterol is the starting point. So all steroid hormones are made from Cholesterol and Cholesterol gets a bad rep, you know, everyone's on Statins to try and lower Cholesterol but you need Cholesterol to start this process. You need something, for it, to convert into Pregnenolone, Pregnenolone is really important for the brain. Pregnenolone is also called the Mother Hormone, it converts to Progesterone which converts to Aldosterone, important for kidney function. Pregnenolone, you know, converts into 17 Hydroxy Pregnenolone which then converts into Cortisol. Cortisol and Adrenal hormones are probably some of the most important hormones in your body you cannot live, it's a stress-related hormone, and you cannot live without Cortisol. So you can see all these things really important that you have cholesterol in order to make this.
Think of this as the recipe Guide and how you make these things. 17 Hydroxy Progesterone converts into DHEA. A lot of you heard about DHEA, DHEA stands for Dehydroepiandrosterone, you don't need to remember that. But the important thing is DHEA converts Androstenedione into this thing, Testosterone, okay. Now Testosterone is a fantastic hormone. It is useful and it's vitally important both in men as well as women, women just don't need as much as men and a lot of people think that Testosterone is just about, you know, building muscle or for libido and sex drive and it's not the case, you know, it has those functions but it also, we know that it is a of prime importance for protecting the heart. So people who have low levels of Testosterone have an increased risk of Heart Disease. It protects the brain, we know that people who have low testosterone have an increased risk of Strokes and Cerebrovascular accidents.
We also know that also, Alzheimer's, they've done studies where they've looked at populations with Alzheimer's and without Alzheimer's, the population that has Alzheimer's generally has a lower level of Testosterone. Testosterone is linked to Prostate Cancer. So men with Prostate Cancer generally have lower levels of Testosterone and we've also found that levels of Testosterone are associated, low levels of Testosterone, are associated with Depression as well. So, yes, Testosterone is of vital importance. But if we go back to the board Testosterone and this is, this is the bit that I, you know, I normally focus on in a consultation. I don't talk about any of this. This is the bit that I talk about and we've talked about it in previous episodes as well. Testosterone converts into Dihydrotestosterone or DHT. Now DHT is Really important, we've talked about this before. It's important certainly as you're going through puberty it's important, too, with the generation of all the sex organs and going through Puberty. So DHT is important but Testosterone converts the DHT with this enzyme called 5-Alpha Reductase Enzyme and if you convert that you have the gene for Hair Loss, okay, so you need the gene as well if you've got the gene for hair loss and you've got higher levels of DHT that can cause miniaturization of hair and result in Male Pattern Hair Loss.
Alright, so, that's where we focus on when I, certainly, when I'm speaking to patients and doing consultations with patients. So 5 Alpha reductase Enzyme is important and we use a medicine called Finasteride, there's also Dutasteride as well. So there's Finasteride and Dutasteride, it blocks that enzyme, if we block that enzyme, you block the conversion of that to that and you lower the DHT in the system, alright. Coming back to the biochemistry of things because
Testosterone also converts into Estradiol or Estrogen. Estrogen is important, ok, men need Estrogen as well. We don't need a lot of it but we need some Estrogen, it's important for brain function and also it's important for bone health. Alright so, we need good adequate amounts of estrogen and there is an enzyme called the Aromatase Enzyme that converts Estrogen to Estradiol and there is a medication and I don't want to go too much into it, called Arimidex, and Arimidex blocks that enzyme. You block the enzyme, and you bring the conversion of Testosterone into Estrogen alright. So that's simple- I mean that is effectively the biochemical pathway alright but I mean that's not, just, that's not all of it as well
Because you know we talk about how this is produced but there is another pathway with which I haven't drawn, which is about how that is controlled, how the production of Testosterone is controlled and so what we'll do real quick, we've got the Hypothalamus here, now, the Hypothalamus is part of, is in the brain and it's constantly checking levels and it will check the levels of not Estrogen, but the Estrogen receptor. So Estrogen is a hormone, that binds to a receptor so it will check the amount of that Estrogen receptor that is bound to Estrogen. So if you've got enough Testosterone, you're going to convert a bit to Estradiol or Estrogen, for the sake of this discussion, and you will have high amounts of the compound, of the receptor and the enzyme. But if you have low Testosterone, you will get low amounts of the Estrogen receptor, Estrogen Complex, and if the body detects low amounts of the Estrogen Receptor Complex, what it will do is, it will send a message over to the Pituitary Gland, okay, and it will release something, I don't want to get caught up in this, but it'll release something called Gonadotropin-Releasing Hormone, alright, don't worry too much about it, but it will stimulate the Pituitary Gland, okay, and then the Pituitary, what it will do, is it will stimulate the Testicles, all right, through two different signaling pathways, one of the pathways are FSH and one is called LH. LH is from the Leydig cells, FSH from the Sertoli cells and it will increase sperm. Basically, it stimulates the testicles and the testicles will stimulate the increase, will produce more Testosterone and that will increase the Testosterone floating around in the bloodstream. There's a feedback mechanism, so what happens is you've got more Testosterone
Then the Testosterone converts into Estrogen, the Estrogen combines with the Estrogen Receptor Complex and what happens is, then you've got normal amounts and that has a negative feedback on the Hypothalamus and therefore that stops that cycle from happening, all right. So I hope that explains what's going on there.
So let's put that into perspective or certainly in terms of where the questions came in. So when we're talking about hair and we're talking about Finasteride and Dutasteride as well, so people are asking well you know, one of the common questions that I get is does taking Finasteride lower levels of Testosterone? Well no, because if you're taking Finasteride, you're blocking the conversion of Testosterone into DHT. If you're blocking that, then you're going to leave more Testosterone. So basically, the response is no, it doesn't reduce the amount of Testosterone in the bloodstream or in the body but will it increase the level? Because, you know, arguably, if you're blocking that and not converting that into that then you should be increasing that, and technically speaking if you're looking at that diagram, then the answer is yes. But it's not so simple because A) there's that negative feedback but more importantly and more importantly, is that if we're talking about using Finasteride for Hair Loss, we're talking about small doses, alright, we're not talking about using it in the dose that we would use for say, someone with prostate issues which is a five-milligram tablet per day.
We're talking about one milligram about three times a week. So we're not talking about thirty-five milligrams a week, we're talking about three milligrams. At that low dose, it's not really going to change the amount of Testosterone that you've got running around the system, all Right, and that brings me to, my apologies for moving around a little bit, but that brings me to what do we talk about when we're talking about Testosterone? Okay, because Testosterone, it's not just this one thing. Testosterone exists in multiple different forms so Testosterone exists in a free form, okay, when it's free then it does everything that we talked about it, you know, helps, you know, boost muscle growth, it helps, you know, the heart, the brain, all that sort of stuff. So free testosterone is the only bit that can do that okay. Testosterone also exists in other forms. It can be bound to something called Sex Hormone Binding Globulin or SHBG, it can be bound to, and once it's bound to that, that's it, you can't use the Testosterone anymore. But you can - it's also bound to Albumin as well which also makes it relatively inert. So, you know, just looking at when you do a blood test for example, and you measure the
Total Testosterone, doesn't tell you, doesn't give you an accurate idea of how much your Testosterone is because realistically, it's the free testosterone that's important and in order to calculate that you need to know the albumin, you need to know what the level of SHBG as well. So, but going back to my point, Finasteride or Dutasteride, if you take it in the doses that we're talking about, you know, only trying to reduce this level of DHT below a threshold level, you're not trying to bring it down to zero, we don't need to do that. We just need to bring below the threshold that results in miniaturization of hair, all right. And that will vary from person to person but we found that three milligrams per week is kind of like the sweet spot, where that happens. So no it doesn't, it certainly doesn't lower the level of Testosterone. Does it increase the level of Testosterone? Well I've seen studies where
What they've done is they've taken guys
With low levels of Testosterone and then they've given them Testosterone and they've given them Finasteride and they had higher grip strength. But the fallacy there okay, is that they gave them five milligrams of Finasteride a day, massive doses, so if you're giving them more Testosterone and you're blocking this then yes, you're going to increase the Testosterone, and by consequence, you're going to get the increased Muscle Hypertrophy. One of the other questions that we get, sorry I normally don't take notes but I thought I'd write down the list of the questions that we commonly get asked so I don't want to forget any of them. So the next question is if you're on Finasteride should you be on Arimidex? Alright, and I think this is, you know, there are a lot of people and they are taking a lot of this to heart and being, you know, focusing on that and again it comes To the point where are you measuring the right thing. Are you measuring free Testosterone? But the principle thereof that question is, well, if you're blocking this, all right, in theory, you have more Testosterone. If you have more testosterone, are you driving the equation more to this side, are you going to be producing more Estrogen? Now, like I said at the beginning of this episode, Estrogen is really important guys. However, having too much Estrogen is problematic and can cause issues. It can cause things like Gynecomastia but it can also cause Prostate issues and Prostate Hypertrophy.
So, you know, yes, you don't want the Estrogen to go sky-high alright. So again, it comes down to the dosing, all right, so if you're just taking a small dose of Finasteride, I don't think you're going to increase the Testosterone level significantly and so as part of our practice, both Russell's and myself, we don't give people
Finasteride and Arimidex
To block the Aromatase Enzyme to try and keep it as Testosterone. That's not the goal. The idea is just to focus on this, we just need to get that level below the threshold so that's not part of our normal practice there. Next question, I hope that answers that question. The next question is, is there an increased risk of prostate cancer with Finasteride? The answer is no in essence, and they've studied that and they've shown that that's not the case.
The proponents of that idea I, again, coming back to blocking that, increasing that level, and then subsequently increasing Estrogen which causes issues with the Prostate. But if you're giving a small dose of Finasteride right, then generally the answer is no. That said, the other thing to be mindful of is that Finasteride also Lowers your PSA, your Prostate Surface Antigen which is a marker of, which is used to monitor people that have enlarged prostates. Okay now, generally it is not used as a diagnostic tool. It should not be used, PSA should not be used as a diagnostic tool to measure the general population to see if they've got Prostate Cancer or not. That should be done, you know, you see your doctor, you talk about your symptoms, you get examined properly and then they check up if you've got symptoms. The next thing to do is to check PSA and the reason that's the case, just as a side note, is that there are lots of other things that can cause an elevated PSA. If I rode my bike here to work today, that would cause an increase in my PSA today all right. So PSA, yes is useful, but is a poor marker. But if you've already got an issue with your Prostate, you've got an elevated PSA for whatever reason, you know, associated with the Prostate then Finasteride can artificially lower it so you got to be mindful of that. But again, in the dosing that we're talking about, we're not talking about five milligrams per day, we're talking about one milligram three times a week. It generally doesn't have too much of an impact okay. The next question is, does Exogenous Testosterone require the need to increase the dose of Finasteride? Potentially, okay, because if you're adding more of this - I say potentially because it depends on the individual, all right, if they have normal Testosterone anyway or they're Hypogonadal just depends. If you're adding more Testosterone there then you're more likely to drive traffic down this way so, maybe, you need a higher dose of Finasteride to to reduce the amount of DHT below that threshold level. That said, if you're taking Exogenous Testosterone, so if you're adding more testosterone here, Then, at that point, what you will do is you're going to promote that negative feedback which is going to reduce your own production of Testosterone anyway and so what some people do which I'm not advocating is they're using drugs like Clomid or Selective Estrogen Receptor, Laser Septum Modulator drugs, basically what that does is it blocks Estrogen receptor and therefore the Hypothalamus can't detect that. But in essence, adding more Testosterone may require and so, a higher dose of Finasteride so that's taken on a case-by-case basis. So if I've got someone who is on Exogenous Testosterone, we will try them on low dosing and see how they go. I always, you know, counsel patients saying that look, hair loss is not a rapidly occurring phenomenon. It happens slowly and so we can, you know, wait three, four, six months and see how things are progressing, and if we find that it's not moving as we want to, then we can adjust the dose appropriately. Okay, I think I've said enough there. Hopefully, that answers those questions and again, I just want to reiterate, that this is not something that I think everyone who's suffering from hair loss should know, it's not. It's just that enough of you asked the question that I thought it would be probably easier if I'd talk about it here and then that will, sort of, give you another pool of information for which to hopefully get educated on. But hopefully, that makes sense, the take-home point is Testosterone, really important okay. It's the conversion of Testosterone to DHT that we're focusing on with hair loss. Generally, it's, you know, we're just trying to get the level of DHT below that threshold level and we generally don't need very much Finasteride to do that. I've said Finasteride but you know we can also use Dutasteride,
We can interchange that as well to block the 5 Alpha Reductase Enzyme. So hopefully that answers those questions, like I said, this is just a quick sort of episode in between everything else. Russell will be back and we'll get back to our regular scheduled broadcasting soon. But I hope you find that useful. Thanks again for watching, keep the comments coming, please like the channel,.
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Thanks very much.
