Androstanolone (dihydrotestosterone, DHT)
5α-Dihydrotestosterone, Andractim, DHT gel, Dihydrotestosterone heptanoate
Forms: Gel (Andractim), marketed in a small number of countries, not the US; injectable esters such as DHT heptanoate were studied in trials but are not marketed.
The body's most potent natural androgen, made from testosterone by 5α-reductase. It cannot convert to estrogen. Not the same as mesterolone, drostanolone or 1-testosterone.
Legal status: Prescription gel in a few countries; a named US Schedule III anabolic steroid and not approved there; status varies by country.
What it gives
What people use it for and what the sources report. Strength is a general category from the literature: mild, clear or strong.
Purpose
Misused in sport for a strong androgenic effect. Medically, the gel treats male hypogonadism and, locally, gynecomastia and lichen sclerosus in some countries.
What people seek and what studies show
In a 2-year placebo-controlled trial of DHT gel in men over 50, lean mass rose by 2.4% and fat mass fell by 5.2%, with no effect on prostate growth versus placebo. In a 3-month trial in older men, strength rose only in knee flexion. No studies exist at the amounts or forms used in sport.
Effects
Evidence: Approved medicine — studied in people for its medical use
Sought effects by goal (as reported)
Possible side effects
Possible does not mean certain: whether they appear depends on dose, duration, individual response and monitoring. Below — what to watch for and how to notice it early.
13 possible side effects
level · how often it is reportedWhat the levels mean
Level: general category from the literature, not your personal risk
How often
- common
- reported often
- possible
- reported in some people
- rare
- reported occasionally
How to lower the risks
For 12 of 13 possible side effects there are specific ways to lower the chance: everyday measures, supplements and options a doctor may consider. For the rest — general advice. No measure removes a risk completely. Prescription medicines are listed only for a doctor to decide on, after tests — they have side effects of their own.
Check hormones before and after; if they stay low, see an endocrinologist.
How each option helps (7)
- Regular blood tests — LH, FSH and testosterone show how deep suppression is and whether natural production has recovered afterwards.
- Working with a doctor — Assesses how deep suppression is and guides recovery afterwards, including fertility testing.
- Clomiphene — A doctor may consider it after stopping, guided by hormone tests; recovery after long use can still take months. Risks: vision changes, mood swings, rare clots. Has side effects of its own.
- Human chorionic gonadotropin (hCG) — A doctor may consider it to preserve fertility (in men it keeps the testes working); it does not restart the pituitary, so natural LH still has to recover. Risks: higher estradiol, gynecomastia. Has side effects of its own.
- Tamoxifen — A doctor may consider it after steroids are stopped, guided by hormone tests; it has not been tested for this after steroid use. Risks: blood clots, vision changes. Has side effects of its own. Not offered to women: in the women’s view it adds to a risk this substance already carries.
- Follicle-stimulating hormone (follitropins, menotropins) — A fertility doctor may consider adding it to hCG when semen tests and FSH stay low; it does not restart the pituitary. Risks: gynecomastia, acne. Has side effects of its own.
- Toremifene — A doctor may consider it after steroids are stopped, guided by hormone tests; it raised testosterone in subfertile men but was never tested after steroids. Risks: QT prolongation, clots. Has side effects of its own. Not offered to women: in the women’s view it adds to a risk this substance already carries.
Avoid controlling estrogen blindly; adjust only by blood tests with a doctor.
How each option helps (1)
- Regular blood tests — Testing ends guesswork use of aromatase inhibitors — prescription drugs that can push estrogen too low and harm joints, libido, mood and lipids.
Check the blood count regularly; if hematocrit stays high, a doctor decides — usually stopping or reducing the cause, sometimes therapeutic phlebotomy, never blood-bank donation. Avoid dehydration: it thickens the blood further.
How each option helps (3)
- Regular blood tests — A blood count shows hematocrit and hemoglobin climbing toward the range where clot and stroke risk rises.
- Therapeutic phlebotomy prescribed by a doctor — Only on a doctor's decision, never at a blood bank. Lowers hematocrit quickly but temporarily; repeated sessions drain iron, and a lower clot risk is unproven.
- Working with a doctor — Manages thick blood by changing what you use or, if justified, by therapeutic phlebotomy.
Strength and weight-bearing training, enough calcium and vitamin D from food, no smoking; with long-term use a doctor may order a bone density scan.
How each option helps (1)
- Calcium — With vitamin D it lowered stress fractures in female recruits; in older adults, supplement trials show weak and inconsistent effects on fractures.
Ketoconazole shampoo, minoxidil, a dermatologist early if you are prone to it.
How each option helps (1)
- Minoxidil (topical) — Slows thinning and regrows some hair; scalp itching and early temporary shedding are common, unwanted facial hair possible. Gains fade once stopped.
Products obtained without a prescription are often fake, mislabeled or non-sterile, and there is no way to check at home. For legal supplements, look for third-party testing (Informed Sport, NSF).
Regular cardio, blood pressure control, an echo as a baseline and then yearly.
How each option helps (4)
- Heart screening: ECG and echocardiogram — Echocardiography shows wall thickening and reduced pumping early, while stopping AAS and treating BP can still help.
- Working with a doctor — Orders ECG and echocardiography and treats early heart changes.
- Home blood-pressure monitoring — Keeping BP controlled is one of the main ways to limit heart-wall thickening.
- Regular cardio training — Supports heart and vessel function, but does not reverse steroid-related heart thickening or weakening.
Stop at the first voice change and see a doctor — early stopping matters.
How each option helps (1)
- Working with a doctor — Steroid labels say to stop at the first mild signs (hoarse voice, facial hair, clitoral growth) to prevent permanent change; checks catch them early but do not make use safe.
Low-level side effects
How each option helps (8)
- Home blood-pressure monitoring — Seated, rested readings on several days show your true BP; persistently high values are a signal to see a doctor.
- Regular cardio training — Regular aerobic training lowers resting BP by a few mmHg, more in people with high BP.
- Working with a doctor — Diagnoses persistent hypertension and prescribes treatment when needed.
- Avoiding alcohol and other liver stressors — Regular drinking raises blood pressure; cutting it out lowers it.
- Coenzyme Q10 — Inconsistent: some analyses show a small systolic drop in cardiometabolic disease, but a Cochrane review found no clinically meaningful effect.
- Magnesium — Meta-analysis of trials: about 2 mmHg lower systolic pressure on average.
- Omega-3 (fish oil, EPA/DHA) — Small drop of a few mmHg, mainly in people with untreated high blood pressure.
- Taurine — Meta-analysis of 20 small trials: about 4 mmHg lower systolic pressure on average.
How each option helps (1)
- Working with a doctor — Finds the cause of low libido or erectile problems instead of masking it.
How each option helps (3)
- Adapalene — Reduces spots in many users. Redness, scaling, dryness and stinging are common early and usually ease; acne may look worse at first. Rarely, allergic swelling.
- Benzoyl peroxide — A first-line acne option. Dryness, redness and peeling are common at first; it bleaches hair and fabric; rarely, serious allergic reactions. Severe steroid acne needs a dermatologist.
- Zinc — Trials show a modest drop in inflamed spots, weaker than antibiotics; steroid acne is driven by androgens.
How each option helps (1)
- Regular blood tests — PSA tracks prostate changes on androgens — most relevant after 40 or with urinary symptoms.
How each option helps (8)
- Regular blood tests — A lipid panel with ApoB shows how far HDL has dropped and LDL risen — changes you cannot feel.
- Working with a doctor — Interprets lipids and ApoB and decides whether a statin or other therapy is warranted.
- Avoiding alcohol and other liver stressors — Alcohol raises triglycerides; its small HDL bump does not lower heart risk.
- Regular cardio training — Raises HDL a little and lowers triglycerides; it cannot offset a steroid-driven fall in HDL on its own.
- Berberine — Placebo-controlled meta-analysis: LDL about 0.5 and triglycerides about 0.4 mmol/L lower; HDL unchanged. Trials are mostly small; no statin substitute.
- Citrus bergamot — Pooled small trials show lower LDL and triglycerides, but certainty is low to very low; it is no replacement for statins.
- Omega-3 (fish oil, EPA/DHA) — Clearly lowers triglycerides but does not fix the steroid HDL drop, the main lipid harm; DHA-containing oils may even raise LDL slightly.
- Psyllium husk fiber — Lowers LDL by about 0.2–0.3 mmol/L (roughly 5–10%), also on top of doctor-prescribed statins; no effect on HDL.
Check-ups and blood tests
Which tests and check-ups to do and when. This is a guide — agree the exact schedule with your doctor.
Which doctors can help
At home
- Home blood pressure: 2–3 times a week in the morning, keep a log
Get medical help at once if
- Swelling, pain or redness in one leg; sudden shortness of breath or chest pain; sudden one-sided weakness or numbness, trouble speaking or seeing — seek urgent care.
- Chest pain or pressure, breathlessness on light effort, swollen ankles, fainting — seek urgent care.
- Deepening voice, new facial hair, clitoral enlargement — stop and see a doctor: changes can become permanent. (women)
In an emergency, call your local emergency number.
For women
Its label forbids systemic androgen therapy in women because of virilization; voice deepening, facial hair and clitoral enlargement may be permanent. Local use for vulvar lichen sclerosus is a separate medical indication. The label also rules it out in pregnancy, possible pregnancy and breastfeeding.
Myth & fact
“DHT cannot turn into estrogen, so it is harmless for bones and libido.”
Because it suppresses natural testosterone and forms no estrogen, estradiol stayed low in a 2-year trial: spine bone density fell and sexual desire dropped mildly.
Combinations
DHT-derived steroids, trenbolone and trestolone act without 5α-reductase, so finasteride and dutasteride do not lower their effect on hair or prostate; they only reduce DHT made from testosterone, while finasteride and dutasteride keep their own side effects.
DrostanoloneMetenolone1-TestosteroneOxandroloneStanozololOxymetholoneMesteroloneMethasteroneTrenboloneTrestoloneMethyl-1-testosterone (M1T)Desoxymethyltestosterone (DMT, Madol, Pheraplex)Epistane (methylepitiostanol, Havoc)ProstanozolMestanoloneStenbolone1-Andro (1-androsterone) and related prohormonesEpiandrosterone (Epi-Andro)Sources
Possible side effects by body system, combinations, how to lower the risks and which tests to do — free.
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