Dorough had a passion for the entertainment business since he was 3 years old, when he would jump on his grandparents bed, singing Baby Face while strumming his tiny guitar. At the age of 6, Dorough participated in an Orlando production of The Wizard of Oz to get his start in show business, this would only be the start of a string of musicals he would do in the local Orlando scene. Throughout high school he was actively involved in theatre and chorus. He rented out the production equipment often, having participated and created a show by the name of Macho & Camacho during his high school years.

He later auditioned for the Backstreet Boys, where he reached worldwide fame along with group mates AJ McLean, Brian Littrell, Kevin Richardson and Nick Carter. After the group reached stardom, Dorough and the rest of the band became staples on the covers of such magazines as Tiger Beat and 16 In 1998, Howie's sister, Caroline Dorough, died of the Lupus form of cancer. After her passing, Howie helped create The Dorough Lupus Foundation, in which he is still involved. His foundation helps raise awareness about the disease, financial support for those who cannot afford treatment, and money for research. To date over half a million dollars have been raised for finding a cure.