Testosterone Replacement

Our approach follows the American Urological Association (AUA) and Endocrine Society guidelines listed under Sources below:

• Two early-morning tests on different days. Testosterone is highest in the morning and varies from day to day, so one low result isn't enough. The AUA uses a total testosterone below 300 ng/dL as a reasonable cut-off, together with symptoms.
• Looking for the cause. If your level is low, we check luteinizing hormone (LH), and prolactin when LH is low or normal, to see whether the problem starts in the testes or the pituitary gland.
• Safety tests before treatment. A blood count (hemoglobin and hematocrit) for everyone, and a PSA test for men over 40.
• Your whole health. Your provider reviews your medicines, sleep, weight and other conditions that can lower testosterone. Sometimes treating those comes first.

If your tests confirm low testosterone and your symptoms fit, your provider will go over the options, the likely benefits and the risks before you decide. Our main treatment is testosterone cypionate injections, given at the clinic or at home once we've shown you how. Ask whether another form, such as a gel, suits you better.

Monitoring is part of the treatment:

• Testosterone level — checked after you start to make sure you've reached the target range, then every 6 to 12 months.
• Blood count — testosterone can raise your red blood cell count, so your hematocrit is checked during treatment; a high result means adjusting or pausing the dose.
• Prostate — PSA and urinary symptoms are followed during treatment for men in the screening age range.
• Whether it's working — if your level is normal after 3 to 6 months but your symptoms haven't improved, the AUA advises talking about stopping.

For men with confirmed low testosterone, the AUA guideline says treatment may improve:

• Sex drive and erectile function
• Mood and depressive symptoms
• Anemia
• Bone density
• Lean muscle mass

The evidence is mixed on whether it improves energy, thinking, blood sugar, cholesterol or overall quality of life — be wary of anyone who promises those.

Possible side effects and risks include:

• A high red blood cell count (polycythemia), which raises the risk of blood clots
• Lower sperm production and infertility, and smaller testicles
• Acne, breast tenderness or swelling, and fluid retention
• Worse sleep apnea

In the TRAVERSE trial (2023), men with low testosterone and heart disease or heart risk who used testosterone had no more heart attacks or strokes than men on placebo, but atrial fibrillation, acute kidney injury and blood clots in the lungs were more common.

The Endocrine Society guideline advises against starting testosterone if you:

• Plan to father a child soon
• Have breast or prostate cancer
• Have a prostate lump, or a raised PSA that a urologist hasn't checked
• Have a high hematocrit
• Have untreated severe sleep apnea
• Have severe urinary symptoms from an enlarged prostate
• Have uncontrolled heart failure
• Had a heart attack or stroke in the last 6 months
• Have a blood-clotting disorder (thrombophilia)

Testosterone therapy is for men with diagnosed testosterone deficiency. It is not a bodybuilding or performance program.

Many insurance plans cover testosterone therapy when low testosterone is confirmed by lab tests and documented symptoms, and we can check your benefits before you start. If you're paying yourself, ask for the self-pay price of the visit, lab work and medication before you start. If you're uninsured or not using insurance, you can also ask for a good faith estimate.