Testosterone, DHT, Acne, and Propecia

First, I would like to Thank you doctor for having this blog. I just have a couple of questions that I can’t seem to get an answer too, and I decided to ask an expert like you. I would really appreciate it if you answered this question, as it is stressing me out lately. Firstly im 23 year old male with thinning hair, and these 2 questions are a reason I am reluctant in using propecia. My dermatologist prescirbed me the propecia but he was in such rush the day I went, and I coudnt ask him my questions. I still have my prescription but I am reluctant to use it.

If DHT(the by-product of testosterone) is responsible for angrogenetic alopecia in genetically predisposed males, then why does the increase in testosterone (or even normal levels testosterone) from taking propecia aggravate more hairloss or even aggravate more hairline hairloss(as I have read in numerous internet hairloss forums, from people complaining of more hairloss from propecia)? Isnt DHT suppose to cause the hairloss and not just testosterone by it self? Or does testosterone cause hairloss as well by itself? If the testosterone will cause hairloss then what is the point of taking propecia as it will only block DHT but that will just let the testosterone or sometimes the increased testosterone that results from propecia take over and continue the hairloss in genetically predisposed males.

Also doctor I also suffer from acne as I take topical clindoxyl gel and topical differen to correct that problem. I have read numerous medical articles that DHT is a cause of acne, then why does propecia sometime cause acne as a side affect? I know its a rare form of side affect but I have read people complaining from propecia causing acne or increasing there acne. If propecia inhibits DHT, and DHT is a culprit for acne, then shouldn’t propecia help out with clearing the acne problem instead of aggravating it? Or does the testosterone cause acne and propecia raises testosterone and thus cause more acne.

I Am really confused here. I really do want to start using propecia so if you can take the time to reply and answer my question, I would really appreciate it Doctor. Thanks again

These are questions you should ask your doctor, not us here. There is a feedback loop in the human body so when the DHT drops, the testosterone goes up to compensate for it. This is the best explanation I can give on the process. Testosterone does not cause hair loss until it is converted to DHT. That is just the way it is.

I am not an expert on acne so you should see your doctor or dermatologist on these questions. I haven’t a clue why Propecia might cause acne. I haven’t seen that in my patients, and as hormones aren’t fully understood, the connection is difficult to make.