Testosterone Replacement Therapy (TRT)
Testosterone replacement therapy restores testosterone to physiologic levels in men with clinically low testosterone confirmed on laboratory testing. Diagnosis requires two morning total testosterone measurements below the reference range together with consistent symptoms, because a single low result is frequently a normal fluctuation. Common indications include persistent fatigue, loss of muscle mass and strength, increased body fat, low libido, erectile difficulty, depressed mood, and poor concentration. A consultation with laboratory testing is required before any prescription is issued. Prescribed and managed under Medical Director Steven Freedman, MD.
HOW IT WORKS
Your first visit is a consultation with laboratory testing. We take a full history and draw a baseline panel covering total and free testosterone, SHBG, estradiol, LH, FSH, prolactin, PSA, a complete blood count, a complete metabolic panel, thyroid function, lipids and A1c. Testosterone is drawn in the morning, when levels peak, because an afternoon draw can read falsely low.
PSA and hematocrit are checked before starting and monitored throughout. Testosterone raises red blood cell production, and an untreated rising hematocrit is the most common reason therapy has to be paused. This is why TRT is a monitored medical treatment rather than a prescription that is simply refilled.
WHAT TO EXPECT
Libido and mood often respond first, commonly within three to six weeks. Energy and concentration follow. Changes in muscle mass, strength and body composition develop over three to six months and depend heavily on training and nutrition alongside therapy.
You are seen for follow-up with repeat labs at approximately six to eight weeks, again at six months, and every six to twelve months once stable. Those visits check testosterone, hematocrit, estradiol and PSA, and dosing is adjusted from the results.
Testosterone therapy suppresses the body’s own production and reduces sperm count, and for many men that suppression does not fully reverse. If you may want children in the future, tell us at your consultation, because there are alternative protocols that preserve fertility. Therapy is generally avoided in men with untreated prostate or breast cancer, an elevated hematocrit, untreated severe sleep apnea, or uncontrolled heart failure.
FAQs
What does testosterone replacement therapy cost?
Laboratory fees vary by panel and by lab; we default to Quest, which is substantially less expensive than Labcorp for the same hormone assays.
How soon will I feel a difference?
Libido and mood commonly improve within three to six weeks, with energy and concentration following. Muscle mass, strength and body composition change over three to six months, and those results depend as much on training and nutrition as on the therapy itself.
Do I need bloodwork before starting?
Yes, and more than once. Diagnosis requires two morning total testosterone measurements below the reference range alongside consistent symptoms. Fatigue and low libido overlap heavily with thyroid disease, anemia, depression, sleep apnea and poor sleep, all of which need to be identified rather than masked with testosterone.
Will TRT affect my fertility?
Yes. Testosterone therapy suppresses your body’s own production and reduces sperm count, and in some men that suppression does not fully reverse after stopping. If you may want children in the future, raise it at your consultation, because alternative protocols exist that treat symptoms while preserving fertility.
How often will I be monitored?
Repeat labs at approximately six to eight weeks, again at six months, then every six to twelve months once your dose is stable. Each check includes testosterone, hematocrit, estradiol and PSA. Monitoring is not optional; it is what makes the treatment safe.
What should I do before my appointment?
Book a morning appointment if you can, since testosterone is highest early in the day. Bring a list of your current medications and supplements, including anything over the counter for testosterone or muscle building, plus any recent bloodwork and your family history of prostate cancer and cardiac disease.
What should I know once I have started therapy?
Keep your dosing schedule consistent, as levels are steady-state. Report chest pain, shortness of breath, calf swelling and pain, or significant mood change promptly. Attend your follow-up labs even when you feel excellent, because a rising hematocrit produces no symptoms until it is already a problem.
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