Testosterone Replacement Therapy (TRT)

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Understanding low testosterone (Low-T) symptoms, diagnosis, and treatment options


Testosterone, commonly known as the primary male hormone, is essential for supporting many aspects of men’s health. Identifying the signs of low testosterone and exploring replacement options can be key to restoring energy and overall well-being. This can happen any age from birth through adulthood.


Low-T symptoms:

  • Reduced Sex Drive: A decline in testosterone can lead to a noticeable drop in libido, affecting both desire and performance.
  • Decreased Erectile Function: Testosterone plays a key role in erectile function, and lower levels can cause difficulties in achieving or maintaining erections.
  • Reduced Body Hair and Beard Growth: Low testosterone may result in less body hair and slower beard growth.
  • Loss of Lean Muscle Mass: As testosterone is crucial for muscle development, reduced levels can lead to a decrease in lean muscle mass.
  • Chronic Fatigue: Persistent tiredness, even with sufficient rest, can be a result of low testosterone.
  • Weight Gain and Obesity: Low testosterone is associated with weight gain and can contribute to obesity, making it difficult to break the cycle.
  • Depressive Symptoms: Hormonal imbalances may affect mood, potentially leading to symptoms of depression.

Diagnosis:


If you’re experiencing symptoms of low testosterone, your healthcare provider will conduct a physical exam and ask about your medical history, current medications, smoking habits, and any symptoms you’re noticing. Blood tests may also be performed. To make a diagnosis, your provider will take into account your symptoms, physical findings, and blood test results.

The following tests can help confirm low testosterone and identify the underlying cause:


Total Testosterone Blood Test:

This test typically requires two samples taken between 8 a.m. and 10 a.m., when testosterone levels are at their peak. If you’re currently or recently ill, inform your provider, as acute illness can cause falsely low results.

Luteinizing Hormone (LH) Blood Test:

This test helps determine if low testosterone is due to a pituitary gland issue.

Prolactin Blood Test:

Elevated prolactin levels can indicate problems with the pituitary gland or the presence of tumors.

Comprehensive Treatment Options: 

Healthcare providers treat low testosterone (male hypogonadism) with testosterone replacement therapy, which comes in several forms:

Testosterone Gels:

Daily application to clean, dry skin. Most common US treatment. Risk of transfer to family members through skin contact.

Injectable Testosterone

Intramuscular injections every 1-2 weeks. Long-acting options available every 10 weeks. Subcutaneous injections possible for some formulations.

Testosterone Patches:

Daily skin patches with rotating application sites to prevent irritation.

Pellet Implants

3-6 month subcutaneous pellets provide steady hormone release. Specialist insertion required.

Oral Testosterone:

An oral form of testosterone, undecanoate, is available for specific medical conditions like Klinefelter syndrome or pituitary damage.

Alternative Methods

Buccal tablets (applied to gums twice daily) and nasal gels (three times daily) offer unique delivery systems.


You may not be eligible for testosterone replacement therapy if you have a history of:

  • Prostate cancer.
  • An undiagnosed lump on the prostate (prostate screening is required before therapy).
  • Breast cancer.
  • Uncontrolled heart failure.
  • Untreated obstructive sleep apnea.

The side effects of testosterone replacement therapy may include:

  • Acne or oily skin.
  • Swelling in the ankles due to mild fluid retention.
  • Prostate stimulation, potentially leading to urinary issues like difficulty urinating.
  • Breast enlargement or tenderness.
  • Worsening of sleep apnea.
  • Shrinking of the testicles.
  • Skin irritation (for those using topical testosterone).

Laboratory abnormalities associated with testosterone replacement therapy include:

  • Increased prostate-specific antigen (PSA) levels.
  • Elevated red blood cell count.
  • Reduced sperm count, potentially causing infertility, which is especially important for younger individuals looking to have biological children.

Complete Low-T Diagnosis Process

TRT evaluation requires two morning testosterone blood draws (8-10 AM) when levels peak naturally. We also test luteinizing hormone (LH) to determine if low testosterone stems from pituitary issues, and prolactin levels to rule out tumors or other abnormalities.

Expected Timeline & Results (example only)

  • Weeks 1-4: Improved energy and mood typically emerge first
  • Months 2-3: Increased muscle mass and strength become noticeable
  • Months 3-6: Body composition changes and optimal libido restoration
  • 6+ Months: Maximum cardiovascular and metabolic benefits achieved

Monitoring & Safety Protocols

Regular lab monitoring includes PSA levels (prostate health), complete blood count (red blood cell production), and hormone levels to ensure optimal dosing. We screen for prostate cancer before treatment and monitor throughout therapy.

Who Should Avoid TRT

Men with history of prostate or breast cancer, undiagnosed prostate lumps, uncontrolled heart failure, or untreated sleep apnea require careful evaluation before TRT consideration.

Cost & Program Options

Transparent pricing with no hidden fees. Programs include initial consultation, follow-up visits, nutritional counseling, and ongoing support.

Let’s talk!

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    My experience has been amazing! She is the first practitioner who have actually listened to my questions and concerns regarding menopausal symptoms, and the benefits of HRT.

    I am so relieved to have someone on my side in this journey!

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  • I love that she was so knowledgeable and was able to accommodate my schedule…

    …to offer me high quality HRT without the worries you usually get from healthcare or the lack of knowledge or options available from my primary provider. Mie was great! I’ve been on hormones for about 2 weeks and I’m already noticing improvements in my energy and vitality!
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FAQs

Explore common questions for valuable insights.

When properly monitored, side effects are minimal. Potential effects include mild fluid retention, skin changes, or temporary mood fluctuations during initial adjustment.

Diagnosis requires two morning blood draws showing low testosterone levels, plus evaluation of symptoms and overall health. We also test related hormones to determine the underlying cause.

The best method depends on your lifestyle, preferences, and medical needs. We’ll discuss gels, injections, patches, and pellets to find your optimal approach.

Yes. Comprehensive labs including testosterone levels, PSA, complete blood count, and metabolic panels are essential for safe treatment initiation.