TRT alone will sometimes NOT help.
Why because sometimes DHT levels return to normal post Finasteride, but often results its use results in elevated Sex Hormone Binding Globulin (SHBG).
SHBG is the protein that binds to testosterone in the blood and renders it unavailable to the body.
In a typical male only 2% of their total testosterone is bioavailable or known as free testosterone. It is this level that is crucial.
It only takes small increases in SHBG to greatly lower this crucial level of fee testosterone and sometimes Finasteride greatly increases SHBG up into the upper normal range.
At such levels it often causes low free testosterone or borderline low free testosterone.
Testosterone replacement therapy in such instances isn’t really what is required or helpful. That is because much of the testosterone can still be bound up in the blood and rendered unusable by SHBG. In these cases what is required is a medication that reduces SHBG such as Danazol.
In other instances this issue relates to elevated estradiol, again TRT is not the answer, rather a limited course of an aromatase inhibitor such as Arimidex is more appropriate.
When LH is low and SHBG, estradiol and DHT are normal, the problem maybe purely down to the hypothalamus/pituitary in which case TRT maybe the answer, but it might also be possible to re-start the HPTA via Clomiphene Citrate or GnRH therapy.
All of the above under the guise of a competent endocrinologist/andrologist.
