DHT insensitivity (and sleep)

General Discussion
#1

I wonder what the whole sleep thing, and Mew’s improvement in sleep, can teach us about the underlying cause of what is going on.

I’m going to visit a top endo here in the UK soon, to talk about the whole post-Propecia thing.

Having spent time here looking at various cases, I think we have to conclude that we have in some way become insensitive to DHT. I know androgen insensitivity of some kind is not new as a theory, but aren’t we getting closer to concluding that some kind of insensitivity has to be what is going on?

There are quite a few guys here who post low T but high or even supra-high DHT levels. With DHT like that they should have great libido and be full of energy. High or supra-high levels with no physical response points to an insensitivity of some kind. Supra-high levels in particular seem to point to a body that is no longer responding properly.

Insensitivity to DHT also explains other typical and diverse set of symptoms we often see, such as soft muscles (DHT helps muscles harden), no sebum, and - considering the NO connection - bad sleep. We’ve even got guys in here with high DHT and no or little hairloss (when they obviously had hairloss before).

Maybe insensitivity to DHT can also explains why total T becomes low? DHT is the androgen that opposes estrogen in most of the tissues of the body. I think that when the body stops responding to DHT, you’re then left with a lot of unopposed estrogen. Hence chest pain, gyno, etc. I’ve had gyno type chest pain even though my E has never been that high: because I’m no longer sensitive to the DHT that should oppose E. The brain recognises that there is too much estrogen, so downregulates the whole T/E production: that’s why we usually see low T in guys here.

It can help explain why guys here don’t respond normally to TRT. How many times do we hear: I tried TRT, gave me a temporary lift, then one week in I started to feel bloated, terrible, gyno pain, etc? Maybe because you raised T, E and DHT: in a normal guy raised DHT would oppose the raised E. In a DHT insensitive guy, there is nothing to oppose E in many tissues of the body, hence you get an E dominance and feel terrible.

Ability to get an errection is more about total T than DHT. Libido is about DHT. Over time total T in guys here can creep up, restoring some erectile ability. We often see a gradual return of some function, but no improvement in libido. This gradual T increase happens slowly, so that the body is not overwhelmed by unopposed E.

But check out what happens when you hike up T using Tammox to block E, like you did Quint. You posted really good T and DHT, and then tapered off the Tammox. In a normal man, the high DHT would oppose the E, and you’d maintain high T and DHT as desired. But because our bodies are insensitive to DHT, the body is overwhelmed by unopposed E and quickly downregulates T/E production, so T quickly collapses.

This theory has problems. For example, I know that you Mew are still losing hair, which indicates some sensitivity to DHT. Then again, I’ve read that T alone can be enough to cause hairloss (albeit slower) in suseptible guys like us.

Quint, what about your three week recovery on Tammox? Could that really happen if you were insensitive to DHT? Maybe. I sometimes think these recovery windows are simply a function of blocking the unopposed E that we have, which shifts the balance in favour of T for a while and gives a temporary lift. In other words, it shifts the T/E balance in our favour, and gives relief from the tendency towards E dominance that we have now that we are insensitive to DHT. If you look at all the treatments that have helped guys here, they are all E blockers, from Tammox, to the brocolli treatment, to Quercetin. On these treatments T is raised and can run wild for a while because E is being blocked, but we remain insensitive to DHT.

The question is, can sensitivity to DHT be restored? The fact that you are sleeping better Mew might point to the idea that slowly sensitivity is returning. That DHT is doing its job on NO a little better.

Mew: has better sleep been coupled with other small improvements in symptoms under the control of DHT, such as libido, skin oil, body hair, energy, and hair loss? Are you seeing a really slow upward trend in those areas, or no change?

Quint: do you see yourself responding to DHT in any area? Skin oil, energy, body hair? What about during your three week Tammox recovery?

Sorry for the length of this. Anyway, I’m going to discuss these ideas with my endo and report back.

#2

One of the things which drives me on this idea is that guy on AskDocWeb claiming that research found his DHT receptors had been reduced in quantity.

Just to remark on a few of your points, I don’t think we can conclude that someone with super-high DHT and low T still won’t have impotence, ED, and all the other lovely perks of hypogonadism. DHT is not a substitute for T.

I think a more curious inquiry is, why is all that T being converted, leaving such little T? With all that DHT already circulating, the body should know DHT is awfully high and T is awfully low, and ease up on the conversion. (But does the body control the conversion amount, or is that predetermined by the amount of 5AR enzyme in the body?) So perhaps it is simply a response to DHT not registering, as what happens in cases of AR insensitivity, causing the body to respond with high amounts of the hormone (as you and a few others have suggested).

Also, I think it needs to be determined how DHT impedes Estrogen (ie if binding to DHT receptor is necessary for the inhibitory effect on E). Supposing high E is a result of DHT not doing it’s job makes sense (only reason I can think of too), and yes this will contribute to shutdown of T production. Many pitfalls in using fin.

Sleep has a lot to do with hormonal production, and there are GABA receptors in the pituitary gland (which for one, modulate the release of Growth Hormone). I’m very interested in the role of the GABA receptors relative to endocrine function, because there may be a significant interrelation. Also the important place Nitric Oxide - the very substance depleted by DHT reduction - has in allowing for sleep to occur.

What we need to focus on is getting examined for this possible insensitivity.

#3

What sorts of tests are even available for that, though?

#4

That’s one of the things I want to discuss with this endo.

I’m a little confused, for example, about Adiol-G. If I’ve understood my reading properly, it is used as a measure of the metabolism of DHT. So when DHT is acting on receptors in the proper way, you get normal or high levels of Adiol-G. But what I read on this forum suggests that Adiol-G is a measure of 5AR activity. I don’t quite get that. I mean, 5AR converts T to DHT. Aren’t simple T and DHT blood tests enough to establish, then, that 5AR is working properly? Seeing as lots of guys here have normal or high DHT, can’t we dispense with the theory that 5AR has been inactivated? I’ll ask my endo about all this.

I’ve only seen one guy with an Adiol-G test on this site (can’t remember who offhand) and it was like 3 ref range 2-20 or something, so pretty low.

Quint, what’s your take on DHT insensitivity? One of the reasons I’m keen to try Tamox is for the chance to observe small changes that give further clues about what is going on. For example, if I get very oily skin on Tammox then that cd be a sign that I am not DHT insensitive, because
the sebacious glands are pretty much driven by DHT.

What have you observed when it comes to hairloss, skin oil, libido changes over time? And what did you observe on Tamox?

Also, what do we make of guys who seem to slowly improve and then get over this entirely? Does this point to the idea that DHT insensitivity is not at the heart of what is going on? Or maybe it is a type of insensitivity that slowly reverses with time?

3pm: I remember reading about that guy, too. I wonder how it was established that his DHT receptors had been reduced in number? I’ll talk to my endo.

Thanks everyone.

#5

I remember when I quit fin, there was this period of six weeks, maybe close to two months, where I felt completely great. Erections were probably 85% at least, and libido was through the roof. I also felt actually miles better than my old normal self in mood and mental clarity. Then total crashout.

When I first got blood tested six or seven months after that my DHT was through the roof. It’s possible, I think, that the DHT rebound was so intense that it wore out my receptors. That’s a totally unfounded guess, but I’ve heard or TRT guys says that they worry about high DHT levels for this very reason, but that there is not any safe alternative to fin in order to bring it down. If that’s the case, then I have no idea what can be done, or if they ever bounce back, etc. But it is something for all of us to consider, especially those like myself (and Mew, as I recall) who expericenced the initial rebound period after fin, or who have typically high DHT.

#6

I went through that recovery stage, too, around two weeks after coming off. Mine lasted about two weeks before I declined again.

But on Tammox, you had really good libido for around three weeks? “Horny like a dog” if I remember the post right.

Was that coupled by other DHT-related changes such as more oily skin, faster beard growth, even increased hairloss?

For that matter, how is your hairloss now at two years off? Are you losing at a decent rate, or much slower than before fin?

I used to look in the mirror and will my hair not to fall out. Now I’m looking in the mirror willing signs that loss has started again.

#7

As far as DHT receptor testing, a google search turned up this. I haven’t registerd to read the full article, but just to say that such tests appear to exist.

biomedexperts.com/Abstract.b … ibroblasts

From the abstract:
The receptor assay was carried out on the supernatant; the antibody-sepharose was used to remove both unbound and nonspecifically bound DHT. Experience showed that the antibody did not entirely remove the nonspecifically bound and free DHT. A blank (sample heated at 60 degrees C for 3 min) was therefore subtracted to obtain an accurate value of specifically bound DHT.

I know nothing about this, or whether it’s available by commercial testing, but it looks like it’s not out of the realm of possibility. What could be done from the results afterwards is another story I guess.

#8

Good find. That looks like a description of the penile skin fibroblast tests that are sometimes mentioned around here. I have a feeling that may be the only way to test whether DHT is binding with receptors properly.

And as you say, even if we find out is not what are we going to do about it?

If DHT insensitivity is the answer, I think the best we can do in terms of treatment is get total T as high as possible, and eliminate E dominance via Arimidex. I remember that you were feeling pretty good on Arimidex before you had to stop.

Anyway, I’m going to ask my endo about all this stuff. He’s one of the most eminent endos in the UK, so it will just be a case of persuading him to engage with me on all this stuff.

But Quint, keen to hear your answers to my questions above. Anything you can tell me?

This endo suggested Tamox for me, so I’m keen to be able to tell him as much as I can about the experience of other guys here who have tried Tamox. Including the DHT related stuff.

Thanks.

#9

Don’t recall any increased hairloss (nothing major, at least), no oily skin or more beardiness. I did develop a little grey patch in my goattee, which has since gone. Not a lot of hairloss since then, but definitely some. On Tamox, yeah, I felt quite normal as far as libido. Erection strength was pretty decent, though I think that, as a muscle, that type of thing would take a month or two on its own even after recovering. It wasn’t exactly a three week type of everything-is-great mini-recovery – there were some bad days in there here and there – but overall it was very promising at the time. The reast of the eight weeks on Tamox was a bit of a mixed bag – some bad, some good, as far as I remember it.

#10

Interesting, thanks very much.

I remember that you were on Arimidex on a really high dose: ever tempted to go for a lower dose and see if you can get benefit without hurting your eyes?

Two more boring questions that I’ll quit bugging you:

You didn’t notice an increase in skin oil on Tamox, but does your skin produce the amount of oil it did before fin? Or is it dry especially in the nose forehead T-zone (God I sound like some kind of advert for moisturiser)?

Does your facial hair grow slower and thinner than before fin?

It also ocurrs to me that, given that you saw some improvement on Tamox, you might try Quercetin. As you know, it also works by blocking E. Cdnuts and Italy have tried it and seem to have found small improvements that stayed with them after they came off. But maybe you’ve already given it a shot.

#11

I did take Arimidex again at a lower dose (like 1/3 what I was prescribed), but when I had to get labs I stopped it a few weeks before to get a better picture. My T levels were mid and so were E2. Not long after I was asked by Crisler to get the Rhein panel. I didn’t want to mess with Arimidex anymore at that point because of the labs but also becuse I seem to rebound poorly from stopping anti Estrogens. The Rhein panel showed low T levels.

I’m no more or less oily than before Fin or Tamox. Facial hair is the same also.

Don’t know anything about it, but I’ve heard the name mentioned in here. It’s a natural anti Estrogen?

#12

Yes I think so. A herbal anti-E that acts in the same way as Tamox, by binding to E receptors.

Check out the long thread started by a user called Cytochrome who says he recovered from post-fin sides twice using Quercetin.

Italy and Cdnuts decided to follow his protocol, which was basically high dose Quercetin and a couple of other herbals.

Both Italy and Cdnuts reported improvements, mainly related to ED and physical condition of the penis. What’s interesting is that both say the improvements were maintained once they got off Quercetin. I think they’re both now cycling back on it, in the hope of further improvements.

I’m def going to give it a shot if Tamox doesn’t help me.

#13

I may look into it, then, although I’ve sort of shied away from anti E’s since they seem to pound my T levels afterwards. And since the idea for me is never to be taking them for a long or indefinite term, I have to come off them eventually and then try and see how my Testosterone is doing, which is usually not great.

The frustrating thing is that, one year ago my T levels nearly doubled – went from lower third to top third of the range in a roughly six week period. Then I was prescribed Tamox for eight weeks, and my next test (in the summer) showed my lowest T levels yet. I wonder if I’d be better now if I’d never taken the Tamox, since it really wasn’t necessary, IMO. The main objective of a Tamox treatment is to raise T, but mine was already very good. Maybe if I’d have been patient and waited a few more months with good T numbers I would have come around. Who knows. Although, feeling better while on it at least gave me some encouragement, I guess. But that seems like so long ago now.

#14

Yeah, I’ve always wondered about that with your case. You took Tamox off the back of T numbers that were already very good. Then again, the T was good but you didn’t feel good, so what were you supposed to do? I’ve got bloodwork coming before I start Tamox, but to be honest I am inclined to try it pretty much whatever the blood work says.

It can’t have been increased T that made you feel better on Tamox, because you didn’t get a big increase in your already high T. That seems to suggest that it was lower E that made you feel better. That speaks to my theory about DHT insensitivity: lower E relieved the E dominance that we suffer from because DHT is not opposing our E as it should. Problem with that is, why did lower E make you feel better for only a few weeks, before the effect wore off? You were still on Tamox, still blocking E, T still has the upper hand thanks to blocked E, but benefits start to disappear. Weird. Didn’t Crisler ever try to puzzle that out, or discuss this stuff with you?

Quercetin has got to be a much more gentle anti-E than Tamox, so you might not have the same rebound problem.

#15

Well I was tapering off the dose over time, so that alone may account for why I felt better in the first few weeks than the last few. But then again, I still do remember having great days until the end, and then almost like clockwork, I crashed a few days after stopping it. That was like in June, and here we are.

#16

God knows. Maybe a longer cycle that tapers off really slowy might help to maintain improvements. Sounds like Crisler has Thissucks back on Tamox; maybe that is his plan.

I’m following Oneday’s progress. He seems to be reporting better erections, libido and even sleep. Be interesting to see if that is maintained: hope so for him.

#17

Yeah, but eight weeks, tapering down every two weeks seemed like long and slowly enough. I mean, I don’t think it’s desirable or reccommended to take a SERM for extended periods. Not sure why, but I’m sure we could all guess (i.e. the suppressive effects of any drug, or whatever).

At times I’ve been tempted to try the Tamox treatment one more time once I have been into the adrenal treatment, thinking that better adrenals might help maintain higher levels. That’s the reason I’m using Sustain Alpha again. It was after Sustain last year that I had good numbers, so maybe it’s just a better, safer route for me and something my body responds to versus the SERM. Fingers crossed. But after that, there’s still likely the issue that higher T levels alone have not resulted in any magical recovery.

#18

have very high E, Wow reading your posts this makes so much sense.
I recent did a saliva day test and my DHT registered very high, my Estraidol registered almost 3x above my reference “normal” range for my age group"

DHT was on the low range just about 6 months ago when i did the same test. Estraidol still very high.

Shortly after taking Propecia i had severe acne and oily skin (the acne was possibly caused b the oily skin) Ever since i recovered from the acne have been clear and have no oily skin at all. My hair has slowed down and not falling down that quickly. I am suffering from high estraidol and low test throughout the day.

Possibly adrenal fatigue also as my cortisol levels are very low throughout the day. Can we tie cortisol into this mix???

#19

Libido - no real improvement. Still pretty much absent unless I force myself to look at porn and “try” to turn myself on.

Skin oil - still dry, but slight improvement in forehead oil

Body hair - same, except for loss of scrotal hair and white pigmentation of some pubic hairs on scrotum (where 5AR2 and thus DHT was present before Fin and no longer seems to be active post-Fin)

Scalp hair - still losing, albeit not at as fast a rate as Pre-Fin.

Sebum production - before Fin, I had massive dandruff (seborrheic dermatitis) and a VERY itchy and oily scalp. While on Fin and since quitting, I no longer have massive sebum production there, and my scalp is never itchy or oily anymore. What do I think it means? Lowered androgen (T --> DHT) activity in 5AR2 tissues, or downregulated androgen receptor activity or impaired binding.

Energy - not as fatigued as I was while on drug or after coming off and T levels crashing and elevated TSH/E2, or compared to first 2 years off. Slowly improving with time.

Regarding rest of your theory, I recommend you have a read through the user Awor’s thread as something similar was already proposed…

propeciahelp.com/forum/viewt … sc&start=0

propeciahelp.com/forum/viewtopic.php?t=1295

Also – Testosterone is primarily recognized as the androgen responsible for libido in males, although DHT certainly plays a role too, as we all found out.

#20

Was there a connection being made between DHT and sleep in this thread that I’m missing? Was curious about the title. I really want to get to the bottom of my sleeping issues. Tempted to even go the GHB route like others have, or at least getting the sleep study done that I guess is required and go from there. Maybe there are other less drastic alternatives. So far what I’m using ain’t cutting it.