Total & Free DHTMALE
The most potent androgen, converted from testosterone by 5-alpha-reductase in skin, hair follicles and prostate.
DHT drives libido, erectile function and body hair — and also male pattern hair loss and prostate growth. It sits at the center of the hair-loss conversation in the TRT world.
Check a Total & Free DHT result against this range →
What Total & Free DHT actually measures — the analyte, and the assay
DHT is the hardest common steroid to measure, and the reason is one hydrogen bond. Dihydrotestosterone differs from testosterone only by the saturation of a single ring double bond, so an antibody raised against one binds the other. Immunoassays for DHT therefore require a chromatographic separation step before the antibody sees the sample, and where that step is skipped the result is partly a testosterone measurement Wang 2008.
LC-MS/MS solves the specificity problem and creates a chromatography problem. Testosterone and DHT are 2 mass units apart and share fragment ions, so the method depends on baseline chromatographic resolution plus a deuterated internal standard for each. Validation work on a combined testosterone and DHT assay is explicitly framed around interference and comparison with the older methods, because that is where these assays fail Wang 2008.
Free DHT, where it is offered, is a calculation. DHT binds SHBG with a higher affinity than testosterone does, so the same SHBG concentration holds a larger proportion of it — and a free DHT computed with testosterone's binding constants is wrong by construction.
Concentrations are roughly a tenth of testosterone's, which puts the female range and the range on a 5-alpha-reductase inhibitor close to the lower limit of quantitation on many methods Fanelli 2011 Rothman 2011.
Total & Free DHT: what changes the blood, and what only changes the reading
What changes the DHT in you:
- Substrate. DHT is made from testosterone, so anything that moves testosterone moves DHT with it, with the ratio roughly preserved.
- 5-alpha-reductase inhibition. Finasteride inhibits the type 2 isoenzyme and dutasteride both isoenzymes; the serum DHT falls sharply and the serum testosterone rises slightly, and the PSA falls with it, which is the whole reason a PSA on a 5-ARI has to be interpreted differently Andriole 2011.
- Route of testosterone administration. Transdermal delivery exposes the drug to skin 5-alpha-reductase before it reaches the circulation, so a gel produces a higher DHT for a given testosterone than an injection does.
- Tissue conversion you cannot see. Most DHT acts where it is made — prostate, skin, hair follicle — and never enters the circulation in a measurable way.
- Menstrual cycle phase, in women. Mass-spectrometry reexamination of testosterone, DHT, estradiol and estrone across the cycle and after menopause is the reason single-value female intervals are unsafe Rothman 2011.
What changes only the reading:
- Testosterone cross-reactivity on any DHT immunoassay without prior separation. Since testosterone is present at roughly ten times the concentration, even a few percent cross-reactivity is a large proportional error Wang 2008.
- Which laboratory, and which reference interval. A systematic review of mass-spectrometry steroid reference intervals exists because the published intervals differ enough to change interpretation Tavita 2017 Kunz 2023.
- Being near the limit of quantitation. On a suppressed value, imprecision is proportionally largest, so a DHT on finasteride bounces for analytical reasons Fanelli 2011.
- Within-person biological variation, quantified for five plasma steroids by LC-MS/MS: a difference smaller than the reference change value is not a signal van der Veen 2019.
- Draw time, inherited from testosterone's diurnal rhythm rather than generated by DHT itself.
Reference interval or decision threshold — which kind of number Total & Free DHT is
Reference interval, and one of the least standardized on any hormone panel. The intervals in circulation were derived on different platforms with different specificity, and the systematic review of mass-spectrometry-derived steroid intervals exists precisely because the older ones do not transfer Tavita 2017.
There is no decision threshold for DHT. No guideline treats a DHT number, no dose is titrated to it and no outcome study defines a target. It is used to confirm that a 5-alpha-reductase inhibitor is working, or to explain a phenotype — not as a goal.
The testosterone-to-DHT ratio has no interval at all. It is computed after the fact from two numbers with different assay characteristics, and its spread in healthy people has never been established the way the parent intervals have van der Veen 2019.
In women the interval is phase-dependent and often ignored. Values across the menstrual cycle and after menopause differ enough that a single female range is a simplification Rothman 2011 Kunz 2023.
How you would know your Total & Free DHT was wrong — and when to redraw
Six to eight weeks after a change in 5-alpha-reductase inhibition, and morning like its parent. Serum DHT falls within days of starting finasteride, but the downstream numbers that matter — PSA above all — take months to settle, which is why the conventional PSA correction is applied after 6 to 12 months of therapy Andriole 2011.
For anything else, three months. DHT tracks testosterone, so its retest window is testosterone's: long enough for a change in gonadal output or body composition to have happened.
Conditions that must match: the same method — and specifically not an immunoassay one time and LC-MS/MS the next Wang 2008; the same laboratory's interval; the same morning hour; and in women the same cycle phase Rothman 2011.
What would have to change for the second number to mean something:
- DHT high? Look at total testosterone first. If the parent is high, the DHT is arithmetic and not a separate finding.
- DHT high with a normal testosterone on a gel? That is the route, not the person, and switching route is the test.
- DHT unexpectedly low? Confirm the 5-ARI exposure, then check that a PSA has fallen too — the two should move together, and a PSA that did not fall is the more informative result Andriole 2011.
- DHT normal but hair loss progressing? The circulating number was never the mechanism. Follicular DHT is made locally, and receptor sensitivity is the AR-CAG question.
What Total & Free DHT cannot tell you
It cannot tell you what is happening in a hair follicle or a prostate. DHT is an intracrine hormone; the concentration inside androgen-target tissue is set by local 5-alpha-reductase, and serum is the overflow.
It cannot be compared across methods. An immunoassay DHT and an LC-MS/MS DHT are different measurements of different things Wang 2008 Fanelli 2011.
It cannot explain androgenetic alopecia by itself. Men with identical serum DHT differ completely in scalp phenotype, and the variance sits in receptor density and sensitivity rather than in ligand.
It cannot be interpreted against a general reference interval in a woman without her cycle phase Rothman 2011.
The wrong inference readers actually draw is that suppressing serum DHT is the objective. It is a measurement, not a target: the serum number falls fast on a 5-ARI while the tissue effects that motivated the drug take many months, and the low serum DHT is not itself the benefit Andriole 2011 van der Veen 2019.
Sources read for these sections
- Wang C, et al. Validation of a testosterone and dihydrotestosterone liquid chromatography tandem mass spectrometry assay: Interference and comparison with established methods. Steroids 2008 · PMID 18579171
- Rothman MS, et al. Reexamination of testosterone, dihydrotestosterone, estradiol and estrone levels across the menstrual cycle and in postmenopausal women measured by liquid chromatography-tandem mass spectrometry. Steroids 2011 · PMID 21070796
- van der Veen A, et al. Development and validation of a LC-MS/MS method for the establishment of reference intervals and biological variation for five plasma steroid hormones. Clinical Biochemistry 2019 · PMID 30922617
- Fanelli F, et al. Serum steroid profiling by isotopic dilution-liquid chromatography-mass spectrometry: comparison with current immunoassays and reference intervals in healthy adults. Steroids 2011 · PMID 21112348
- Tavita N, et al. Systematic review of serum steroid reference intervals developed using mass spectrometry. Clinical Biochemistry 2017 · PMID 28733189
- Kunz S, et al. Age- and sex-adjusted reference intervals for steroid hormones measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) using a widely available kit. Endocrine Connections 2023 · PMID 37938144
- Andriole GL, Bostwick D, Brawley OW. The effect of dutasteride on the usefulness of prostate specific antigen for the diagnosis of high grade and clinically relevant prostate cancer in men with a previous negative biopsy: results from the REDUCE study.. J Urol 2011 · PMID 21074214
The plan of attack
In this order. Most people start at step four, which is why they change five things at once and learn nothing.
- Confirm the number is real
Time of day. Tracks testosterone's morning peak, since DHT is derived from it. Morning draw, consistently. - Read it with its partner
Interpret alongside total testosterone and PSA. Draw it alongside: Total Testosterone, PSA (Total + Free + % Free), Estradiol, Standard (ECLIA). - Work out which direction is yours
If it's high — Accelerated androgenic hair loss in genetically susceptible men; prostate growth.
If it's low — Usually iatrogenic from 5-AR inhibitors — low libido, erectile difficulty, blunted mood; a well-documented and sometimes persistent downside. - Fix it in this order
Nutrition. No strong dietary lever. Adequate zinc supports normal androgen metabolism.
Lifestyle. For hair: minoxidil (topical, works independent of DHT), microneedling, and ketoconazole shampoo carry evidence without systemic DHT suppression.
Supplements. Saw palmetto and pumpkin seed oil are weak 5-AR inhibitors — gentler than finasteride but far less effective. Topical approaches limit systemic DHT suppression.
Hormones. Finasteride/dutasteride are effective for hair but suppress DHT systemically. Understand the tradeoff, and know they'll halve your PSA readings. Topical finasteride reduces systemic exposure.
Compounds. If on TRT and considering finasteride, test DHT first and understand what you're trading.
Work down the list, not across it. Adding a compound on top of an unfixed diet is why generic protocols fail. - Retest
8–12 weeks after starting or stopping a 5-AR inhibitor. Change one thing at a time, or the retest can't tell you which thing worked.
How to fix it
📚 Traish AM et al., J Sex Med 2011 — adverse effects of 5-alpha-reductase inhibitors.
This page can tell you what could have made your Total & Free DHT wrong. It cannot tell you whether it did.
Everything above is free and stays free — the assay, what changes the reading rather than the blood, the retest window and the sources. What no page can do is look at your draw: which laboratory ran it, at what hour, what you were taking that week, and what else was flagged beside it. Every one of those changes the answer, and none of them is on any page. Bringing a real result to people who know that list is what the members' area is for.
Bring your result — $10/mo →🩸 Test your Total & Free DHT
Order directly through Marek Diagnostics — no doctor's visit needed, drawn at any Quest location in the US. Code CAMERON applies 10% off automatically.
Order this test — 10% off → Browse all 103 markers →What Total & Free DHT is usually tested alongside
One marker is a data point. These panels add the markers that make Total & Free DHT interpretable, name why each is on the list, and load the set into your cart at 10% off.
includes this + 6 more markers · built for men — Over 45, or over 40 with a family history. Also anyone with urinary changes — weak stream, frequency, waking at night to urinate.
What people use Total & Free DHT to decide
Nobody orders a test for its own sake. Total & Free DHT is on the test list for these pathways — each one links to what the pathway claims, and what its test list is read for before you spend anything on it.
The androgen-receptor CAG repeat length is a one-time genetic test that predicts how sensitive your follicles — and your prostate — are to a given DHT level. It explains why two men with identical bloods have completely different outcomes.
Test before you treat, because diffuse shedding and pattern loss have different causes and different fixes. Ferritin under 70 causes shedding in women constantly and is missed because hemoglobin is normal.
What moves your Total & Free DHT
1 supplement in the Vault have a documented effect on this marker, or are a reason to have measured it first:
Browse all 278 compounds & 371 supplements →
Would you feel it? Symptoms Total & Free DHT helps explain
People search for how they feel, not for a marker. These are the complaints where this one is worth checking, and whether it is first-line or a follow-up.
Why your Total & Free DHT might be wrong
Most abnormal results are interference, not disease. Check these before you change anything. Each says whether the number is wrong (repeat it), badly timed (redraw it), or real with a cause.
5-alpha-reductase inhibitors are designed to crush DHT — finasteride by roughly 70%, dutasteride more. A low DHT on these drugs is the treatment working.
Interpret only against what you are taking.
Tracks testosterone's morning peak, since DHT is derived from it.
Morning draw, consistently.
What Total & Free DHT means in combination
One marker tells you a little; combinations tell you the story. These are the named patterns this one takes part in.
Both effects are the drug working. The one that matters clinically is PSA: these drugs roughly halve it, so a PSA of 1.5 on finasteride corresponds to about 3.0 untreated. Failing to double the value has caused missed cancers.
Double your PSA if you have been on a 5-ARI for more than six months, and tell whoever reads it. Track the trend rather than the absolute.
What to test next
These put Total & Free DHT in context — each with its own full breakdown.
Frequently asked questions
30–85 ng/dL (assay dependent). Ranges vary by laboratory and assay — always compare to the range printed on your own report.
Mid-range, balanced against hair-loss and prostate considerations. Suppressing DHT aggressively has real costs to libido and erectile quality.
Accelerated androgenic hair loss in genetically susceptible men; prostate growth.
Usually iatrogenic from 5-AR inhibitors — low libido, erectile difficulty, blunted mood; a well-documented and sometimes persistent downside.
You can order Total & Free DHT directly through Marek Diagnostics without a doctor's visit — drawn at any Quest Diagnostics location in the US. Code CAMERON applies 10% off automatically.
Where this goes next
This page is the free framework. The protocol itself — the dosing, the order to correct things in, the week-by-week schedule and what to retest — is a lesson inside Skool.