is a metabolite of testosterone that’s recommended by some Metoidioplasty surgeons to encourage genital growth in transgender men. DHT can be topically applied in a transdermal cream, but is not to be confused with testosterone cream or testogel/androgel. DHT is at least three times more potent as an androgenic compound and is therefore the preferred choice for FTM genital growth.
DHT plays a vital role in virilization. When a trans man injects testosterone, his body converts some of it into DHT. It influences facial and body hair growth, voice changes, sex drive, and growth of muscle and genital tissue. Unlike other androgens, DHT cannot be converted to estradiol, and it’s not anabolic, so it doesn’t build up in tissues, muscles and bones.
DHT for Dick Growth
For genital growth, a 10% DHT concentration, non-alcoholic cream is desired. A typical dosage is 20 mg administered three times a day. Rub the cream onto the glans, shaft and foreskin; it absorbs quickly. A typical length of treatment is three months.
Topical DHT shouldn’t drastically affect blood pressure or testosterone levels, but it may be a good idea to get blood work done while you’re using DHT. Observe your moods and adjust your testosterone dosage if required.
Getting a Prescription for DHT
To get a prescription for DHT, ask your doctor or endocrinologist for “10% Dihydrotestosterone cream.” If they grant your request, take the prescription to a compounding pharmacy. Be sure to specify that the cream should not contain any alcohol.
In North America, DHT had been available to compounding pharmacies through the PCCA. In July 2009, the PCCA announced that they were out of stock and that the manufacturer had ceased production of DHT. It’s unknown if there are other sources available. It’s very difficult, if not impossible, to get a prescription for DHT filled in North America at this time.
Buying DHT Online
You can buy a 2.5% DHT gel called Andractim online and without a prescription. However, this product is alcohol based and may cause a temporary burning sensation. It’s also important to note that DHT is a Schedule III Controlled Substance. In North America, it’s illegal to import DHT. Purchase at your own risk. If you do buy DHT online, check off “female” for gender on the order form, otherwise you’ll be required to purchase a prostate test kit.
Side Effects of DHT
Hair Loss
Despite being responsible for facial and body hair growth, one of the potential side effects of DHT is hair loss. DHT leaves a waxy substance at the root of hair follicles on the scalp that can inhibit hair growth. One possible solution is saw palmetto berry extract tincture, a natural herb that’s been shown to block DHT. The tincture can be mixed with water and topically applied to the scalp to prevent that build up in the hair follicle roots. Dosage is 30-60 drops daily. A one month supply of saw palmetto tincture costs about $25 USD.
Secondary Exposure
Like Androgel, DHT cream presents a risk of transference and requires diligence to prevent accidental secondary exposure to sexual partners, children, and pets. Washing well 1 hour after application reduces—but does not eliminate—chance of exposure. The only safe form of protection is zero exposure.
DHT Research
While there aren’t any clinical studies about DHT and transgender men, we can look to related studies for some guidance, particularly with regard to safety.
Transdermal dihydrotestosterone therapy and its effects on patients with microphallus.
All patients demonstrated growth of the penis during treatment. The mean increase rate (153%) in the first 4 weeks of treatment was higher than that (118%) of the second 4 weeks… In conclusion, transdermal dihydrotestosterone therapy is an effective and relatively safe modality in the treatment of microphallus.
We conclude that 3 months treatment with transdermal dihydrotestosterone gel demonstrates expected androgenic effects, short-term safety, and limited improvement in lower limb muscle strength but no change in physical functioning or cognitive function.
…percutaneous DHT administration is a relatively safe modality of androgen replacement therapy as far as atherogenicity is concerned.
Absorption of dihydrotestosterone (DHT) after its intramuscular administration.
…suitable for long-term substitution therapy.
DHT offers trans men the potential for genital growth that exceeds the promises of testosterone therapy alone. While dedicated research is lacking, related studies and anecdotal accounts suggest that DHT is a safe and promising treatment.
Thanks for taking the time to write, test and report your experience.
Joshua,
Please tell us what growth (length and girth) you experienced? Did you administer typical dosage of 20 mg three times a day? If you are in USA, could you recommend a doctor and/or pharmacy? Thank you.
Fred, I haven’t done my official final measurement, but I achieved about 1/2″ to 3/4″ of extra length. Not sure I got much extra girth though. It might not sound like much, but it could mean the difference between clearing my fly or not post-op, so I’m pleased. Yes, I used 20mg of 10% DHT three times a day.
I’m not in the US. I obtained a prescription from my primary care provider here in Canada, and had it filled at a compounding pharmacy, with DHT sourced from the PCCA.
Hey Joshua
I got the andractim gel online and found that if I use lidocaine ointment before I apply the gel it doesn’t sting at all. My question is, should I use it more than 3 times a day because it’s only 2.5%?
Lidocaine is a great idea! Someone on YouTube suggested Orajel. (Note: Anbesol has alcohol in it, apparently Orajel does not.) However, Orajel is not intended for genital use, while lidocaine is, so again, great idea Key!
Given that the Andractrim is only 2.5% concentration, yes you could use more safely. Rather than increasing frequency (I found 3x day inconvenient enough!) I would increase dosage.
It would be great if you could report back with your own anecdotal experience with DHT!
Thanks for the info Joshua. I will definately report back. I started about 3 days ago and I forgot to measure first but i’m gonna go ahead and do that now. I’ll report back in about a month.
This is great and incredibly interesting to me. I have had significant growth from my T shots alone so hopefully I’ll be able to acquire this prescription (I live in the states).
Thanks, again for posting this, Joshua.
Hello Joshua.I would like to know if I use DHT cream only my genital parts it will be possible to growth hair in my face and my voice could be changed.Thanks.
Max, some of the DHT that’s topically applied will be absorbed into your system, so yes there’s a good chance that using DHT for genital growth will produce other masculinizing effects.
I don’t recommend using DHT to acheive other masculinizing effects as there’s supposed to be a specific ratio of DHT to T in your system, so one probably wouldn’t want to be on it for long periods of time. It’s a good idea to get DHT levels checked in addition to T levels when using DHT.
Hello Joshua, and thanks for this great article. There are a few questions I’d like to ask you about DHT:
– Can DHT be taken only untill the penis has achieved a comfortable length, or must I take it for the rest of my life to maintain the size? I really hope that I can just take it untill I am satisfied, and then go off it with confidence that my penis won’t start to shrink back.
– Did you experience any hair loss? Can hair loss be estimated based on genetics? If you did experience hair loss, did you do anything to counter it?
– How long had you been on T before trying DHT? And how old were you when you started DHT? Are you still applying DHT?
– This one is really important. If my penis has stopped growing from the T, and I start to apply DHT, will it start to grow again?
– Lastly, does age effect hair loss probability? For example, if I apply DHT for a set number of months and I am 17 years old, will I be less likely to experience hair loss than if I were applying DHT as a 30 year old?
Sorry for the multitude of questions. Don’t feel obliged to answer every single one, they are probably better suited for my endocrinologist, I just have a lot of trouble asking them. If you do happen to answer my questions, then hats off to you, you’re a life saver.
Hey MC, I’m happy to answer your questions. Some endos wouldn’t be able to answer these anyway…
You do not need to take DHT for life. I haven’t come across any information that suggests that growth achieved with DHT goes away after treatment has stopped. (It has not in my case.) I wouldn’t take DHT for periods longer than 3 months anyway, for several reasons including…
Yes, I experienced hair loss. I noticed it quite immediately. I started using the topical saw palmetto and that stopped the hair loss. However, I didn’t continue the saw palmetto after I was done the DHT, and I wish I had because the hair loss picked up again at that point and lasted a few more months. In the future, I will use the saw palmetto for an additional 3 months after finishing the DHT. I don’t think age is much of a factor with DHT related hair loss. Lastly, DHT is one aspect of hair loss, while genetics is another.
I started using DHT when I was about 14 months on T, at age 35. I wouldn’t recommend using it until hormone levels are balanced (ie, after 1 year of T.)
No, I’m not using it now. I used it for 3 months, and will use it again twice more, pre-op and post-op (if I op!)
It’s possible that you will experience growth with DHT despite the fact that you’ve stopped growing from T. I say it’s “possible” not because of this fact, only because some of this is genetics too: not everyone experiences measurable growth from DHT. Also, I’ve heard plenty of guys say that they had growth spurts 3, 4, even 5 years after starting T, long past when it seemed like growth had stopped.
Hope that helps!
Yes, it does help. Thanks a ton for all the information, I copied and pasted it into a word document to save and reference in the future.
Cheers!
Hey Joshua, after a couple of months I have come back to this article, and after re-reading my questions and your answers, another question came up.
You said that you used DHT for 3 months, and plan to use it again for another 3 months pre-op. You were pre-op the first time you used it, so why would you need to use it again, for another 3 months?
My question is: If I use DHT for a 3 month period, and then go off it and wait, and then use it for another 3 month period, will I grow even more? And why would I need to take a break?
Either way, could you explain to me why you went on DHT for 3 months, stopped, and now plan to do it again (if you decide to have surgery)? I realize what the purpose of applying DHT is (genital growth for metoidioplasty), but I don’t understand the need for multiple treatments.
Thanks a ton once again Joshua, I really can’t express my gratitude.
I don’t know that another 3 month treatment would provide additional growth or not, but I would use DHT again simply to ensure that I could get all the growth possible before surgery. No harm trying! I would take a break between treatments because the systemic build up of DHT can cause hair loss.
testosterone gel helps to dick growth too?
@Cilene I’ve heard that plain testosterone cream (compounded, not gel) can provide growth, but it’s just the same stuff that’s injected and generally speaking more T doesn’t equal more or faster changes. (In fact, too much can cause feminization.) DHT is a bit of a different beast and more effective for this purpose. Also, I believe there’s a warning in the Androgel leaflet that it should NOT be used on genitals. I *think* this is because of alcohol content, but don’t quote me on that.
DHT is in the US. For the guy in the UK, perhaps you need to travel here to get it.
@Rik Do you know if you obtained DHT from a pharmacy that had it in stock, OR if it’s actually being manufactured again? What’s the DHT concentration that you obtained (%)?
Could DHT be used as a replacement for T therapy. Why and why not? Benefits and disadvantages.
@Dee First, be sure to read the excerpts above (highlighted in blue) from the journal articles. There’s some info there pertinent to your questions. I’m not an endo, but I don’t think DHT is suitable as the sole source of HRT for trans men because I imagine that it’s necessary to get a full spectrum of testosterone for optimum health, not just certain metabolites. Secondly, DHT is pricey and hard to get. It’s also transdermal (representing an accidental transference risk) and needs to be applied several times a day (read: inconvenient.) Personally, I wouldn’t want to use DHT for longer periods than three months because of the high likelihood of hair loss. I think it has it’s place for male enhancement, but only as an adjunct, not as the sole FTM HRT medication.
Regarding Rik’s comment above about DHT being available in the US: I contacted Rik via email for more info and learned that he obtained DHT from a pharmacy in the US that happened to still have some in stock. Given that DHT is not common and is no longer available in North America, Rik got very lucky! The only hope of buying DHT in North America (with a prescription) is if you can find a pharmacy that still happens to have some in stock, like Rik did.
Joshua: Thank you so much for your posts! I am 1 year on T shots now and wanting to use DHT however my doctor is unsure of DHT? Do you know where can I get some w/o prescription. Is the site to buy andractim safe? What else can you recommend?
@Jecx: Yes, my doctor had never heard of DHT either, but he wrote me the prescription when I brought him journal articles and information about it. The only commerically available DHT gel is Andractim. Because it’s a controlled substance in Canada and the US though (just like T is) it’s illegal to import it. They didn’t reply to my emails, but lots of guys order it without problems. It’s wise to know the risks though.
Unfortunately, I have no other recommendations for obtaining DHT at this time.
The age management company I work with has a compounding pharmacy in the States and we prescribed it for our patients. We don’t sell it to anyone except our patients however. If your interested go to our website and if you want to become a patient let me know. I will give my email then.
Josh: I finally got DHT..from mexico thou.. not in North America .. ill probably use the cream in conjunction with pumping. How long did it take you to see growth? ..
Hey Joshua, I asked my therapist about DHT cream and she said that it is Illegal in Canada how do i do what you did? What do i specifically ask for? Could you please let me know so that i can get it and started with using it right away?? Thanks
Mitchell, your therapist’s comments are inaccurate: DHT is not illegal. It is however a controlled substance that requires a prescription, and it’s illegal to import it. Here’s the problem: you can get a prescription if your doctor is willing, but you probably won’t be able to get it filled because there’s currently no manufacturer supplying Canada (and the US.) You’d need to locate a pharmacy that already has DHT in stock, and since DHT isn’t common, that’s going to be a long shot. Your only other option is to buy 2.5% DHT cream online, it’s the stuff that’s surgeon recommended and used in research settings, BUT it’s still illegal for you to import it! Unfortunately, this is the state of things at this time.
hi i am takeing propecia to prevent hair loss, witch is working, but i was wondering if it might stop dick growth as well,? and if i were to try DHT cream would i need to stop propecia? any info will be good thanks
@NeoN: Hmm, it’s a little “chicken and egg,” I think. Propecia will block your body’s production of DHT, and can inhibit certain aspects of virilization, like facial hair, and maybe dick growth too. If you add DHT to the mix, you’ll won’t know how much it will increase your systemic DHT levels, which if elevated enough could further contribute to hair loss. I don’t think I’d mix the two.
Hi, first of all, thank you for this site, looks great!
Just for clarity’s sake: do you mean 20mg of DHT 3x/day or do you mean 20mg of the DHT-cream (which I don’t really think, though, as it seems it would be difficult to figure out the correct amount of gel?)?
I’m currently in Europe and Andractim is available here, so that’s why I’m asking. I have a bunch of questions, hope that’s OK (of course, you don’t have to answer all of them!). I’m afraid they’re a bit special.
You’ve mentioned pausing the application: due to concerns about building up high DHT-levels? Isn’t DHT eliminated naturally, anyway, and does it really take weeks to let DHT-levels drop to ‘normal’ levels?
Do you have any information about what kind of (range of?) elevation of DHT-blood levels we’re talking about here?
In transguys with hypertrophy of the clitoris already present before starting on T, could the effects of DHT differ, e.g. be diminished? I’m not sure but I think the micropenis treatment is only possible up to a certain age? Of course, there are differences regarding both conditions but I’m wondering if this still could be a factor to consider?
A doctor (surgeon) told me that in his experience clitoral growth only takes place during the first 6 to 9 months of HRT (with T). Others say that it keeps growing.
Is the prevention of hair loss under finesteride solely due to the inhibition of converting T into DHT and the resulting lower DHT levels? I thought the exact mechanism hasn’t been established yet and that finesteride seems to protect the root somehow, perhaps similiar to the saw palmetto extract?
Loads of questions and I could come up with even more!
Thank you for your questions, Seti! Here goes…
My dosage was 20mg of DHT topically applied three times a day. My pharmacist wisely packaged the cream in syringes which made dosing really easy: at 20mg / 0.2ml, one line = 0.2ml = 20mg.
DHT is naturally processed, but since you’re adding additional DHT, above and beyond what one would get from a normal T dose, I think it makes sense to cycle it. And, from what I understand about cycling DHT, it does take a couple of weeks to drop. (Though admittedly, most of the information I’ve found relates to those recognized male at birth, not trans men.)
For information about DHT blood serum levels, see the diagrams from this journal article, under “hormonal and biochemical effects”: http://jcem.endojournals.org/content/86/9/4078.full
The effectiveness of DHT with regards to trans male penis enlargement depends on the number of active DHT receptors in the genital tissues. Over time, these receptors “burn out.” (This is why treating microphallus with DHT is less effective in adult males.) When a trans man injects T, some of it is converted to DHT and acts on those receptors. Since there’s a limit to how much DHT the receptors will process, it’s logical to think that the longer one is on T, the less effective DHT will become as an option for enlargement. And, this is also why the most growth from DHT will happen very quickly, while subsequent rounds of treatment will be less effective, if at all.
I have heard many, many anecdotal accounts of (penis) growth spurts years after starting T, and after hysterectomy. Certainly though, the majority of growth happens in that first year.
From what I understand, Finasteride works by blocking conversion of T to DHT , via inhibition of the 5-alpha reductase enzyme. (I wouldn’t touch the stuff, personally.) Saw Palemetto works similarly, but when used topically on the scalp alone, it specifically targets the DHT that accumulates at the root of hair follicles.
Hope this answers your questions!
Hi Joshua:
Thanks for the explanation.
Hm, maybe cycling DHT could address the diminishing susceptability of the androgen receptors, too? Number and ‘density’ of receptors shouldn’t be always constant, as up/down regulation of the receptor’s expression takes place? So that things pick up a bit again when resuming DHT. While anecdotes are not evidence, growth spurts after hysterctomy could point in the same direction.
I’ve no idea what my DHT-levels look like. I could try to get some blood-work done and maybe could share my observations here on the topic. If you guys out there are interested, that is.
Personally, I thought that hormonal treatment of microphalli was only effective up to a certain age because growth of the tunica albuginea isn’t possible later in life. Or maybe other structures are involved, too. That’s why I was wondering if a pre-existing condition of clitoromegaly would mean that further growth under HRT and/or DHT-administration is limited.
I know that finasteride blocks 5-alpha-reductase, but I thought that it’s effectivity in treating MPB was thought to have other underlying mechanisms here. Prevebting the accumulation of these waxy deposits which sort of suffocate the follicle. OK, I’ll have to read up more on the subject.
Maybe I can get hold of an endocrinologist or urologist who would answer some of the questions. I know they’re a bit of the beaten track.
Thanks again.
I’m not certain. In cis gender men, the body compensates for the extra DHT by down regulating the androgen receptors, but I don’t know exactly how this is expressed in trans men.
Since I have blood work covered here in Canada, I looked into getting my DHT levels checked. Unfortunately it’s a rare blood test, not covered, and very expensive. (Samples are shipped on dry ice to… Idaho, interestingly.)
Growth of the tunica albuginea later in life is highly disputed, but those in the jelqing/pumping camp will tell you it’s possible.
I’m guessing that trans men also have a lower number of DHT receptors (or perhaps less active receptors) than cis gender men, which would limit results.
I’m not aware of other underlying mechanisms behind Fin’s effectiveness.
I have found very few medical professionals who know anything about DHT, but that’s a conversation I’d love to have with a trans knowledgable endo!
Ultimately, some guys will have success with DHT and others won’t. For me, it was worth the expense to try, given that even a 1/2″ of growth could mean the difference between clearing my fly or not STPing post-op. I’ve had what I consider success with it, and I plan to do one more round of treatment to see if I can squeeze any more results from the effort.