Low DHT can cause hypogonadism symptoms even in eugonadal men

Seemingly contradictory title, but the study findings are pretty clear. Namely, even in males with normal testosterone levels there is a direct inverse relationship between DHT levels and symptoms of hypogonadism such as sexual dysfunction and “aging male” syndrome. For every 10% increase in DHT levels there was a 4.67% decrease in hypogonadism symptoms of eugonadal males. So, once again, this is evidence that testosterone (T) is little more than a pro-hormone produced in the gonads and peripheral tissues and that its metabolite DHT is the primary androgen responsible for health of males.

https://pubmed.ncbi.nlm.nih.gov/33811609/

“…Results: Serum total/free T as well as dihydro-T (DHT) was associated with IIEF-EF and AMS scores in the overall population using univariate analyses. Multivariate approaches revealed DHT concentrations in subjects with normal T levels (n = 416, Total T > 12 nmol/L) to be significant predictors of AMS scores. A 0.1 nmol/l serum DHT increase within the eugonadal range was associated with a 4.67% decrease in odds of having worse symptoms (p = 0.011). In men with biochemical hypogonadism (Total T < 12 nmol/L), total and free T rather than DHT were associated with AMS results. This association was not found for IIEF-EF scores. Indirect effects of age and BMI were seen for relations with hormone concentrations but not questionnaire scores. Conclusion: DHT can be associated with symptoms of hypogonadism in biochemically eugonadal men. Serum DHT measurement might be helpful once the diagnosis of hypogonadism has been ruled out but should not be routinely included in the primary diagnostic process.”