Program · TRT
Testosterone replacement therapy
For men with symptoms and two low morning testosterone readings. Prescribed only after a clinician reviews your labs, and monitored for as long as you take it.
In plain words.
Testosterone falls slowly with age, and faster with weight gain, poor sleep, some medications and some medical conditions. Low testosterone can bring tiredness, a lower sex drive, low mood and less stamina. So can a dozen other things.
That is why we do not start with a prescription. We start with two early-morning blood draws on different days, a full history and an exam. If the numbers and the symptoms line up, testosterone therapy is one option. If they do not, we tell you, and we look for the real cause.
What men usually notice first
- Tired most afternoons, even after a full night in bed
- Less interest in sex than you used to have
- Fewer morning erections
- Low mood, irritability or a shorter fuse
- More weight around the middle without a change in habits
- Workouts feel harder to recover from
What it might also be
We check for these before treating anything.
- Untreated sleep apnea
- Thyroid problems
- Depression or long-term stress
- Side effects of opioids, steroids or some antidepressants
- Type 2 diabetes or prediabetes
- Heavy drinking
Candidacy
Decided by your labs and a licensed clinician.
Not by a quiz, and not by what you ask for. These are the questions the clinician works through with you.
It may fit if
- You have symptoms, and two separate early-morning readings come back low
- Other causes have been looked at, or ruled out, by the labs and your history
- You are not planning to have children in the next year or two, or you want to talk through options that protect fertility
- You are willing to come back for labs on a schedule, for as long as you are on treatment
Not the right call if
- Your levels are normal. We will not prescribe testosterone to a man with normal levels
- You have prostate or breast cancer, or an untreated prostate nodule
- Your hematocrit is already high, or you have untreated severe sleep apnea
- You are trying to conceive now. Testosterone lowers sperm counts
- You had a heart attack or stroke in the last six months
How it works here
What happens, and when.
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Day 1
Book labs and a consult
Online or by phone. A short health form takes about 6 minutes.
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Days 2 to 5
Two morning draws
About 10 minutes each, before 10:30 a.m., on two different days.
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About day 7
Results visit
40 minutes with a clinician, in person or on video. Every number explained.
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If it fits
A written plan
Dose, form, monitoring dates and what we will watch. Or a plan with no testosterone at all.
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Weeks 6 to 8
First recheck
Testosterone level and hematocrit. Dose adjusted if needed.
Forms of testosterone we prescribe.
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Weekly injection at home
A small injection under the skin or into the muscle, once or twice a week. Our nurse teaches the first one in person.
Most common choice. Lowest medication cost.
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Injection visits in the clinic
If you would rather not do it yourself, a nurse gives it here. Visits take about 10 minutes.
Visits included in the monthly fee.
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Daily gel
Rubbed on the shoulders or upper arms each morning. No needles.
Can transfer to a partner or child by skin contact. We go over how to prevent that.
What we do not offer Pellets
Pellets are placed under the skin and last months. Once they are in, the dose cannot be lowered if your blood count or PSA rises. We prefer forms we can adjust.
Safety
Risks and side effects, stated plainly.
- Fertility
- Testosterone therapy lowers sperm production and can cause infertility. It often recovers after stopping, but not always, and it can take a year or more. If you may want children, tell us first. There are other options.
- Blood counts
- Testosterone raises hematocrit, the share of your blood made of red cells. Thicker blood raises the risk of clots. We check it before you start and at every monitoring visit, and we lower or pause the dose if it climbs too high.
- Prostate
- Testosterone does not appear to cause prostate cancer, but it can make an existing one grow, and it can raise PSA. Men 40 and over get a PSA check before starting and on a schedule after.
- Ongoing labs
- This is not a one-time prescription. You will need blood work at 6 to 8 weeks, at 3 to 6 months, at 12 months and then every 6 to 12 months. We do not refill when labs are overdue.
- Other side effects
- Acne or oily skin, fluid retention, breast tenderness or growth, smaller testicles, worse sleep apnea and mood changes. Research on heart risk has been mixed, so we review your heart history and blood pressure before starting.
- Stopping
- When you stop, your own production can take months to return, and symptoms often come back. We plan a taper with you rather than stopping cold.
Hematocrit · illustrative year on TRT
49.6%
Not a real patient
| When | Hematocrit (%) |
|---|---|
| Start | 44.2 |
| Wk 8 | 47.1 |
| Mo 5 | 50.3 |
| Mo 8 | 54.6 |
| Mo 10 | 50.8 |
| Mo 12 | 49.6 |
Monitoring
Your calendar, from the first draw on.
Week 0
Baseline
Before anything is prescribed.
What we check
- Two morning testosterone levels
- Complete blood count
- PSA (40 and over)
- Metabolic panel and cholesterol
- LH, SHBG, estradiol
What we decide
Whether treatment fits at all, and which form. Fertility plans and sleep apnea come up here, before the first dose.
Weeks 6 to 8
First recheck
Is the dose right?
What we check
- Testosterone, timed to your dose
- Hematocrit
- Blood pressure
- Side effects check
What we decide
Raise, lower or keep the dose. Most dose changes happen here.
Months 3 to 6
Settling in
How are you, and how is your blood?
What we check
- Testosterone
- Hematocrit
- PSA (40 and over)
- Estradiol if symptoms suggest it
What we decide
Whether the treatment is worth continuing. If symptoms have not changed, we say so.
Month 12
Year review
The full panel, again.
What we check
- The full baseline panel
- Blood pressure and weight
- A sit-down visit
What we decide
Keep going, adjust, or plan a taper. Your call, with the numbers in front of you.
Every 6 to 12 months
Ongoing
For as long as you are on it.
What we check
- Testosterone
- Hematocrit
- PSA by age
- Blood pressure
What we decide
Refills stay tied to current labs. A reminder goes out two weeks before each draw.
What it costs · TRT monthly care
$139 to $199 per month
Included
- Clinician visits: three in the first six months, then two a year
- All monitoring labs on the schedule above
- Dose changes and refill approvals
- Secure messages, answered within one business day
- In-clinic injection visits if you prefer them
Not included
- The medication itself, filled at the pharmacy you choose. Generic testosterone often runs $25 to $80 a month with a discount card, and some insurance plans cover it
- Extra labs you ask for outside the schedule
- The first labs and consult ($189 to $249, billed once)
Common questions.
All questionsCan I just get a prescription if I already know my levels are low?
We need to see your own labs. If you had two morning tests in the last 3 months from another lab, bring them and we may not need to repeat them. A single test, a home finger-prick kit or an afternoon draw is not enough to diagnose low testosterone.
How soon would I notice a difference?
It varies a lot. Some men notice changes in energy or mood within a few weeks, others in a few months, and some notice little. We will not promise a result. If treatment is not helping after a fair trial, we say so and talk about stopping.
Do I have to stay on it forever?
No. Some men stay on it for years, some stop after weight loss or sleep treatment brings their own levels up. Stopping takes planning, because your own production can take months to recover.
Is testosterone a controlled substance?
Yes. It is a Schedule III medication, which is why we need an in-person exam, current labs and regular follow-ups to keep prescribing it.
Other programs
Labs + consult · $189 to $249
Start with a number, not a guess.
Book two morning draws and a 40-minute results visit with a clinician. If treatment does not fit, we say so, and you leave with your results and a plan.
Rather talk first? (918) 555-0143, weekdays 7 a.m. to 5:30 p.m.
Important safety information
Every treatment here is prescribed only after a licensed clinician reviews your history and labs. This is a summary, not medical advice. Questions
- Testosterone therapy
- Not for men with normal testosterone, prostate or breast cancer, or a high hematocrit. Can cause infertility that does not always reverse, raise red blood cell counts and PSA, and worsen sleep apnea. Requires blood work at 6 to 8 weeks, 3 to 6 months, 12 months and every 6 to 12 months after. Gel can transfer to others by skin contact. Testosterone is a Schedule III controlled substance.
- ED medication
- Never take with nitrates or poppers: blood pressure can drop dangerously. Get emergency care for sudden vision or hearing loss, or an erection lasting more than 4 hours. Common side effects are headache, flushing and a stuffy nose.
- GLP-1 medicines
- Not used with a personal or family history of medullary thyroid cancer or MEN2. Nausea and constipation are common early. Severe belly pain can signal pancreatitis or gallbladder problems and needs urgent care.
- Finasteride and minoxidil
- Finasteride can cause sexual side effects and mood changes, and it halves PSA readings. Minoxidil can cause shedding at first, scalp irritation and, as a tablet, dizziness or fluid retention. Benefits fade after stopping.