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A notable case in this regard is the ProstateCancer Prevention Trial (1), which evaluated the effectsof 5AR-I treatment but did not directly measure serum DHT in the men treated with finasteride.Instead, serum 5α-androstane-3α, 17β-diolglucuronide, a distal metabolite of DHT, was used as a surrogate measure of intraprostatic DHT(5). This points to a weakness in some studies of TRT or SRD5A inhibition, namely,the absence of data on circulating DHT levels. To assess the clinical significance of modest elevations in serum DHT and DHT/T ratioobserved with some delivery systems of TRT, we performed a comprehensive review of thepublished literature to identify relevant data. This review on dihydrotestosterone (DHT) biology and the clinical implications of serum DHTconcentrations clarifies concepts that are of importance in clinical practice. Regardless, it is clear that counterfeit medications have reached an industrial level scale. 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