well it could simply be more convertion of t and dht into tissues in some people. Like maybe they have high sensitivity but they enzymes are low so once you lower their endogenous androgens they dont have much of them in tissues. What if in poor responder 17βHSD and 3βHSD is upregulated and same with 5ar?
This study shows this:
''The concentration of DHT along with 5 α reductase and androgen receptors are increased in the balding scalp. The other enzymes involved in conversion of weak androgens to potent androgens are 3 β hydroxysteroid dehydrogenase (3 β HSD) and 17 β hydroxysteroid dehydrogenase (17 β HSD) also show increased activity in Androgenetic Alopecia. The higher the concentration of androgen and androgen receptor, more the effect on expression of genes which control follicular cycling.''
Maybe there are people whose activity is so high that it surpasses the effect of everything else.
It is so scary that all this can be upregualted and even low systemic androgens mean nothing and we have high androgen on scalp.
View attachment 189996
I think biopsy is really important, which I never did and I urgently need one