What did @pa_courtney actually say?
The claim is straightforward: when you take testosterone and experience hair loss, acne, or unwanted body hair, it's because your testosterone is "taking a DHT pathway" through the 5-alpha reductase enzyme. The creator says this conversion is worsened by insulin resistance, PCOS, and high sugar intake, and can be reduced with supplements like saw palmetto and spearmint, plus dietary changes.
Credit where it's due: this is a PA (physician assistant) explaining a real biochemical pathway in plain language. The core mechanism isn't invented. DHT is a real androgen, 5-alpha reductase is a real enzyme, and the connection to androgenic side effects is well-documented in endocrinology literature. The framing is simplified, but the direction is mostly correct.
Does the science back this up?
Mostly yes, with some important gaps. DHT (dihydrotestosterone) is produced when testosterone is converted by the 5-alpha reductase enzyme, particularly type 2 in hair follicles and skin. This is not contested. What is less settled is whether insulin resistance directly upregulates 5-alpha reductase activity in a clinically meaningful way for most TRT patients.
A 2012 study by Fassnacht et al. in Journal of Clinical Endocrinology and Metabolism confirmed that hyperinsulinemia can increase androgen bioavailability, but the specific link to 5-alpha reductase upregulation is more nuanced than the video suggests. Research by Moghetti et al. (2000, Journal of Clinical Endocrinology and Metabolism) showed insulin influences androgen metabolism in women with PCOS, but extrapolating this directly to TRT patients of all sexes is a stretch.
Saw palmetto's evidence is real but modest. A 2020 systematic review by Evron et al. in Skin Appendage Disorders found saw palmetto showed some benefit for androgenetic alopecia, though effects were considerably weaker than pharmaceutical 5-alpha reductase inhibitors like finasteride. Spearmint's role is primarily anti-androgenic via a different mechanism, mainly studied in PCOS populations.
What did they get wrong (or right)?
The biggest issue is the phrase "your testosterone is taking a DHT pathway after it becomes testosterone." This phrasing implies that elevated DHT is primarily a conversion efficiency problem driven by lifestyle, which oversimplifies reality. Genetic sensitivity of hair follicles to DHT, baseline 5-alpha reductase expression, and androgen receptor density all matter, sometimes more than conversion rate.
The creator also conflates two distinct populations: people on TRT and people with PCOS. While both involve androgen metabolism, the clinical picture is different enough that grouping them in one tip risks being misleading. Someone with PCOS is not on exogenous testosterone by default.
What they got right: the connection between insulin resistance and worsened androgenic symptoms is clinically observed. Reducing refined sugar intake has real downstream effects on insulin and androgen signaling. These are not fringe claims. The supplements named, saw palmetto and spearmint, have actual mechanistic rationale, even if the evidence for them is weaker than the confident tone suggests.
What should you actually know?
If you're on TRT and experiencing hair loss or acne, DHT conversion is a legitimate thing to discuss with your prescriber. Pharmaceutical 5-alpha reductase inhibitors (finasteride, dutasteride) have actual clinical trial data behind them. Saw palmetto has modest evidence. Neither should be started or stopped without a conversation with whoever manages your hormones.
The metabolic angle is worth taking seriously. Insulin resistance does affect androgen metabolism, and dietary changes that improve insulin sensitivity, reducing refined carbohydrates, improving sleep, resistance training, are not snake oil. They're standard-of-care adjacent recommendations for people with hormonal dysregulation.
Do not assume supplements will fully block DHT conversion. They won't replace pharmaceutical options if your symptoms are significant. And if you're experiencing rapid hair loss on TRT, that conversation belongs in a clinical consult, not a comment section.