Testosterone Replacement Therapy (TRT)

What Is Testosterone Replacement Therapy (TRT)?

Testosterone Replacement Therapy (TRT) is medical treatment that supplements or replaces testosterone in men who have clinically low levels (hypogonadism). TRT aims to restore testosterone to normal physiological levels, alleviating symptoms of low T and improving quality of life.

TRT is NOT: TRT is not steroid abuse or “juicing.” It’s not performance enhancement for athletes or an anti-aging miracle cure. TRT is also not appropriate for men with normal testosterone levels.

TRT IS: TRT is legitimate medical treatment for diagnosed low testosterone. It’s prescribed and monitored by licensed physicians, designed to restore normal hormone levels, and is an evidence-based therapy with proven benefits and known risks.

What Is Testosterone and Why Does It Matter?

Testosterone is the primary male sex hormone (androgen) responsible for numerous bodily functions.

Physical Characteristics: Testosterone drives muscle mass and strength, bone density, fat distribution, and red blood cell production. It also controls body and facial hair growth and contributes to a deep voice.

Sexual Function: Testosterone regulates libido (sex drive), erectile function, sperm production, and overall fertility.

Mental & Cognitive: Testosterone influences mood and sense of well-being, energy levels and motivation, as well as cognitive function and memory.

Metabolic: Testosterone affects insulin sensitivity and metabolic rate.

Normal testosterone levels: Normal total testosterone ranges from 300-1,000 ng/dL (though this varies by lab), while free testosterone typically falls between 5-21 ng/dL. Testosterone levels naturally decline by approximately 1-2% per year after age 30.

Symptoms of Low Testosterone (Hypogonadism)

Physical Symptoms

Physical symptoms of low testosterone include decreased muscle mass and strength, increased body fat (especially around the midsection), and reduced bone density (which increases osteoporosis risk). Many men experience fatigue and low energy, reduced endurance and stamina, gynecomastia (breast tissue development), and hair loss on the body and face.

Sexual Symptoms

Sexual symptoms include reduced libido (low sex drive), erectile dysfunction, and fewer spontaneous erections (including morning erections). Men may also experience reduced fertility and sperm count, as well as shrinking testicles.

Psychological Symptoms

Psychological symptoms of low testosterone include depression or low mood, anxiety, and irritability. Many men report brain fog and difficulty concentrating, memory problems, lack of motivation, and a reduced sense of well-being.

Other Signs

Other signs of low testosterone include hot flashes or night sweats, sleep disturbances, and reduced competitiveness or assertiveness.

Important: These symptoms are non-specific and can be caused by many conditions. Blood testing is required to diagnose low testosterone.

Who Needs TRT? Diagnosing Low Testosterone

Criteria for TRT

You need BOTH:

1. Symptoms of low testosterone (listed above)
2. Lab-confirmed low testosterone levels on two separate morning blood tests

The Testing Process

Step 1: Initial Blood Test The first step is a fasting morning blood draw (8-10 AM when T is highest). Your doctor will order a comprehensive panel of tests including total testosterone, free testosterone (or calculated), sex hormone binding globulin (SHBG), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), estradiol, prolactin, complete blood count (CBC), and comprehensive metabolic panel.

Step 2: Confirmatory Test If the first test shows low T, your doctor will repeat the test on a separate day to ensure the results aren’t just a temporary fluctuation. The timing remains the same—a morning blood draw.

Step 3: Diagnosis Based on your test results, your doctor will determine the type of hypogonadism. Primary hypogonadism means your testicles don’t produce enough testosterone (characterized by low T with high LH/FSH). Secondary hypogonadism means your brain doesn’t signal your testicles properly (characterized by low T with low or normal LH/FSH). Age-related decline refers to the gradual testosterone decline associated with aging.

When TRT Is NOT Appropriate

Contraindications: TRT is not appropriate for men with normal testosterone levels, untreated prostate cancer, untreated breast cancer (in men), severe heart failure, uncontrolled sleep apnea, or polycythemia (high red blood cell count). Men who are trying to conceive should also avoid TRT, as it suppresses sperm production.

TRT Treatment Options

1. Testosterone Injections (Most Common)

Types: The three main types of injectable testosterone are testosterone cypionate (most common in the US), testosterone enanthate (similar to cypionate), and testosterone propionate (shorter-acting).

Administration: Testosterone injections are given intramuscularly (into the thigh or glute) and can be self-administered at home after proper training. The typical frequency is once every 1-2 weeks, or smaller doses administered twice weekly for more stable levels.

Dosage: Typical dosing ranges from 50-200mg every 1-2 weeks, adjusted based on your blood levels and response to treatment.

Pros: Injections are the most cost-effective TRT method with reliable absorption, flexible dosing, and the convenience of home administration.

Cons: The downsides include the requirement for needles, peaks and troughs in testosterone levels (creating a rollercoaster effect), injection site soreness, and a learning curve for self-injection.

Cost: $30-100/month

2. Testosterone Gels/Creams

Brands: AndroGel, Testim, Vogelxo, compounded creams

Administration: Testosterone gels and creams are applied daily to the skin (shoulders, upper arms, or abdomen) where they’re absorbed through the skin. The gel must dry completely before contact with others to prevent transfer.

Dosage: Typical dosing is 5-10g of gel daily (containing 50-100mg of testosterone), adjusted based on your blood levels.

Pros: Gels offer several advantages: no needles required, daily application maintains steady testosterone levels, the dose is easy to adjust, and you can apply them at home.

Cons: The downsides include higher cost compared to injections, transfer risk to partners or children (requiring caution), messiness, possible skin irritation, and variable absorption between individuals.

Cost: $200-500/month (without insurance)

3. Testosterone Pellets

Brand: Testopel

Administration: Testosterone pellets are implanted under the skin (usually in the buttocks) by a doctor in a minor surgical procedure using local anesthetic. The pellets last 3-6 months before requiring replacement.

Dosage: Typically 6-10 pellets (75mg each) are implanted at once. They slowly release testosterone over time for sustained levels.

Pros: Pellets are the most convenient option, requiring only 2-4 procedures per year. They provide steady hormone levels without any daily administration.

Cons: The downsides include requiring office procedures, being the most expensive option, inability to easily adjust the dose once implanted, risk of pellet extrusion or infection (though rare), and difficulty stopping quickly if issues arise.

Cost: $700-1,500 per procedure (every 3-6 months)

4. Testosterone Patches

Less common, largely replaced by gels

Administration: Patches are applied daily to the skin and changed every 24 hours.

Pros: Patches are non-invasive and provide steady testosterone levels.

Cons: The significant downsides include very common skin irritation, patches that often fall off, and less effective absorption compared to other methods.

5. Oral Testosterone

Not widely used in US Oral testosterone is not widely used in the United States due to several drawbacks: it can stress the liver, has poor absorption, and is expensive.

Exception: Jatenzo (a new oral formulation) and compounded sublingual troches may work for some men as alternatives to traditional oral testosterone.

Comparison of TRT Methods

Method	Cost/Month	Convenience	Steady Levels	Pros	Cons
Injections	$30-100	Moderate	Fluctuating	Affordable, effective	Needles, peaks/valleys
Gels/Creams	$200-500	High	Very steady	Easy, no needles	Expensive, transfer risk
Pellets	$200-500	Highest	Very steady	Convenient, steady	Procedures, can’t adjust
Patches	$300+	Moderate	Steady	Non-invasive	Skin irritation

Most popular: Injections (affordable, effective) and gels (convenient, steady)

Starting TRT: What to Expect

Initial Consultation

During your initial consultation, your doctor will review your symptoms and medical history, perform a physical examination, and order comprehensive blood work. You’ll discuss treatment options and expectations together, and review the risks and benefits of TRT.

First Month

You’ll start treatment with your chosen method during the first month. While you may feel better within days to weeks, don’t expect instant results—full benefits take 3-6 months to appear. Possible initial side effects include acne, oily skin, and water retention.

Months 2-3

Your doctor will recheck your blood work at 6-8 weeks after starting treatment. The target levels are total testosterone of 500-900 ng/dL and free testosterone in the upper-normal range. Your dose will be adjusted if needed based on these results, and your symptoms should be beginning to improve.

Months 3-6

The full benefits of TRT emerge during months 3-6. You’ll experience increased energy and motivation, improved libido, increased muscle mass, decreased body fat, stabilized mood, and sharper cognitive function.

Ongoing Monitoring

Regular monitoring is essential for safe TRT. You’ll need blood work every 3-6 months to check testosterone levels, hematocrit (red blood cell count), PSA (prostate health), estradiol, and lipids. Your doctor will adjust treatment as needed based on these results. Men over 40 should have an annual prostate exam.

Benefits of TRT (When Properly Administered)

Sexual Health

TRT significantly improves sexual function in men with low testosterone. You can expect increased libido, improved erectile function, more frequent morning erections, and enhanced sexual satisfaction overall.

Physical Health

The physical benefits of TRT are substantial. You’ll gain muscle mass and strength while reducing body fat, especially visceral fat around your midsection. Your bone density will improve, reducing osteoporosis risk. You’ll also notice better exercise capacity and faster recovery after workouts.

Mental & Cognitive

TRT profoundly affects mental health and cognitive function. Most men experience improved mood and a better sense of well-being. Depression and anxiety often decrease significantly. Your focus and concentration sharpen, memory improves, and motivation and drive increase noticeably.

Metabolic

TRT improves metabolic health by enhancing insulin sensitivity and glucose control. These favorable changes in body composition contribute to better overall metabolic function.

Quality of Life

The cumulative effect of TRT is dramatically improved quality of life. You’ll experience increased energy and vitality, better sleep quality, enhanced physical performance, and an overall improved sense of well-being.

Timeline for Benefits: Different benefits appear at different times. Libido and mood improvements show up within 3-6 weeks. Muscle gain and fat loss become noticeable at 12-16 weeks. Bone density improvements take longer, typically 6-12 months to fully manifest.

Risks and Side Effects of TRT

Common Side Effects

Most men experience some minor side effects, especially initially. Acne and oily skin are common when starting TRT. Fluid retention and swelling can occur but usually resolve. Testicular shrinkage happens as natural sperm production decreases. Breast tenderness may develop if estradiol levels rise. Sleep apnea can worsen in men who already have this condition.

Serious Risks (Require Monitoring)

Several serious risks require ongoing monitoring. Polycythemia (elevated red blood cell count) is the most common concern—it increases blood thickness and may increase cardiovascular risk. This requires monitoring and may need dose adjustment or blood donation to manage. Cardiovascular effects remain controversial with conflicting evidence, making heart health monitoring essential. Prostate concerns are important to understand: TRT may stimulate existing prostate cancer (though it doesn’t cause it). Regular PSA monitoring is required, and benign prostatic hyperplasia (BPH) may worsen in some men. Liver stress can occur, mainly with oral forms of testosterone.

Fertility Impact

TRT suppresses sperm production in most men, which can lead to infertility while on treatment. If fertility is a concern, you have several options. You can use HCG alongside TRT to maintain sperm production. Alternatively, consider clomiphene or enclomiphene instead of TRT, as these preserve fertility. Always discuss fertility concerns with your doctor before starting TRT.

Long-Term Unknowns

The effects of lifelong TRT aren’t fully understood yet. Cardiovascular risk remains debated in the medical community. The relationship between TRT and prostate cancer is still unclear, though current evidence suggests TRT doesn’t cause prostate cancer.

TRT and Fertility: Important Information

Critical fact: TRT typically shuts down natural testosterone and sperm production.

If You Want to Have Children

If you’re planning to have children, you have several options to consider. The simplest approach is to delay TRT until after having children. If you want to start TRT now, you can use HCG (human chorionic gonadotropin) alongside TRT—it mimics LH hormone, maintains testicular function and sperm production, but must be added from the start or before fertility is needed. Alternatively, consider clomiphene or enclomiphene instead of TRT, as these stimulate natural testosterone production while preserving fertility, making them a good alternative for younger men wanting children. Finally, you can bank sperm before starting TRT as a backup plan.

Recovering Fertility After TRT

If you stop TRT, natural testosterone and sperm production may resume in 3-12 months. However, some men don’t fully recover their previous fertility levels. The longer you’re on TRT, the harder recovery may be. HCG and SERMs (selective estrogen receptor modulators) can help restart natural production, though success isn’t guaranteed.

Cost of TRT

Treatment Costs

The cost of TRT varies significantly by method. Injections are the most affordable option—generic testosterone costs $30-100 per month, with syringes and supplies included or adding minimal cost. Gels and creams are more expensive: brand-name products run $300-600 per month, while generic or compounded versions cost $100-300 per month. Pellets require the largest upfront payment at $700-1,500 per procedure (every 3-6 months), which averages to $175-500 per month.

Beyond the medication itself, you’ll have additional costs. Initial blood work runs $100-300. Follow-up blood work (done quarterly) costs $100-200 each time. Doctor visits add $100-300 per visit. Overall, expect to spend approximately $1,000-5,000 annually depending on your chosen method.

Insurance Coverage

Many insurance plans cover TRT if it’s medically necessary. Coverage requires documented low testosterone with symptoms affecting your quality of life. You may still have copays for medications and visits. Note that telehealth services are usually not covered by insurance, though they may still be cost-competitive with traditional in-person care due to bundled pricing.

Telehealth TRT Services

Best for Most Men: Hone Health offers comprehensive TRT programs ($129-599/month all-inclusive) with at-home blood testing, physician consultations, multiple medication options (injections, creams, troches), and ongoing monitoring. Great for convenient, structured testosterone therapy.

Best Concierge Experience: Vault Health delivers premium TRT care ($129-599/month) with weekly physician video calls, comprehensive health optimization, and white-glove service. Ideal if you want maximum medical support and personalized attention.

Best for Existing Customers: Hims and Ro offer TRT through partnerships with their existing men’s health platforms. Good if you already use them for other treatments (ED, hair loss, etc.).

Compare all testosterone services to find the best option for your needs and budget.

What’s included in telehealth TRT: Telehealth TRT services provide comprehensive care in one package. You’ll receive at-home blood testing kits, licensed physician consultations, prescription testosterone medication, ongoing monitoring and dose adjustments, and support for managing side effects.

Pros and Cons: The advantages include convenient all-in-one care, dedicated hormone specialists, and no in-person visits required. The downsides are that insurance typically doesn’t cover these services, and monthly costs may be higher than a DIY approach where you manage everything separately.

TRT vs. Alternatives

For Men Who Want to Avoid TRT

Lifestyle modifications can boost testosterone naturally, though they won’t fix true hypogonadism. Weight loss (if overweight), strength training, adequate sleep (7-9 hours nightly), stress management, proper nutrition (adequate healthy fats, zinc, vitamin D), and limiting alcohol can raise testosterone by 100-200 ng/dL. While helpful, these changes won’t correct true hypogonadism.

Medications that stimulate natural testosterone production offer another alternative. Clomiphene citrate (Clomid) raises testosterone by stimulating your natural production while preserving fertility. Enclomiphene is a newer option that works similarly to clomiphene. HCG monotherapy mimics LH hormone to stimulate testosterone production. These alternatives work best for younger men, those wanting to preserve fertility, and men with secondary hypogonadism.

”Natural” Testosterone Boosters

Over-the-counter testosterone supplements are heavily marketed but largely ineffective. Most have little to no scientific evidence supporting their effectiveness. They may help if you have specific nutritional deficiencies (vitamin D, zinc), but they won’t significantly raise testosterone if you’re truly low. Common examples include D-aspartic acid, fenugreek, ashwagandha, and Tribulus terrestris.

Don’t rely on supplements to treat clinical low testosterone. If you have confirmed hypogonadism, you need real medical treatment.

Summary

TRT is right for you if you meet all these criteria: You have confirmed low testosterone on two separate blood tests. You experience significant symptoms that affect your quality of life. You understand both the risks and benefits of treatment. You’re committed to lifelong treatment (or at least long-term use). You’re not trying to conceive children (or you’re willing to use HCG to preserve fertility). You accept the need for ongoing monitoring with regular blood work.

Benefits when done correctly: When properly administered and monitored, TRT delivers substantial benefits. You’ll experience improved energy, mood, and libido. Your body composition will improve with increased muscle and reduced fat. Overall quality of life improves dramatically for most men with true hypogonadism.

Risks to monitor: Several risks require ongoing monitoring. Red blood cell elevation (polycythemia) is the most common concern. Cardiovascular health needs monitoring, though the evidence on risk remains mixed. Prostate health requires regular PSA testing. Fertility will be impacted unless you take preventive measures.

Talk to a qualified physician specializing in hormone optimization to determine if TRT is appropriate for you. Proper diagnosis, treatment selection, and ongoing monitoring are essential for safe, effective TRT.

Related Resources

Testosterone Guides:

• How to Get Testosterone Tested
• TRT Cost Breakdown Complete Guide
• TRT Side Effects Complete Guide
• Low Testosterone Symptoms Checklist

Service Reviews:

• Hone Health Review - Best overall TRT program
• Vault Health Review - Premium concierge care
• Hims Review - Multi-service platform with TRT

Popular Comparisons:

• Hone Health vs Vault Health

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This guide is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting TRT.