Getting testosterone replacement therapy (TRT) requires a confirmed diagnosis of low testosterone, which means blood work showing levels below 300 ng/dL on two separate mornings combined with symptoms like fatigue, low sex drive, or loss of muscle mass. You can’t walk into a pharmacy and pick it up. Testosterone is a Schedule III controlled substance, so every prescription goes through a regulated medical process.
Symptoms That Qualify You
Low testosterone isn’t diagnosed by a blood test alone. You need both low levels on lab work and symptoms that match. The American Urological Association groups these into three categories:
- Sexual symptoms: reduced sex drive, erectile problems, difficulty conceiving
- Physical symptoms: fatigue, reduced energy and endurance, loss of body hair, reduced beard growth, loss of lean muscle mass, weight gain
- Cognitive symptoms: depressive symptoms, poor concentration, poor memory, irritability, reduced motivation
Less common signs include breast tissue growth and diminished work or physical performance. None of these symptoms on their own prove low testosterone, since they overlap with dozens of other conditions. That’s why the blood test is essential.
The Blood Tests You’ll Need
The diagnostic standard is two total testosterone measurements taken on separate days, both drawn in the early morning when levels peak. The AUA uses 300 ng/dL as the cutoff: if both results come back below that number and you have symptoms, you meet the criteria. Insurance companies follow this same standard. Aetna, for example, requires at least two confirmed low morning results before covering treatment.
Beyond testosterone levels, your provider will typically order several other blood tests before starting you on therapy. These include hemoglobin and hematocrit (to check red blood cell levels), liver function tests, a PSA test (a prostate screening marker), prolactin levels, and luteinizing hormone. The luteinizing hormone test helps determine whether the problem originates in your testes or in the pituitary gland, which changes the underlying diagnosis and may affect treatment options.
You’ll also get a physical exam. Providers look at body composition, body hair patterns, breast tissue, testicular size and consistency, and BMI or waist circumference. All of this builds a clinical picture that either supports or weakens the case for TRT.
Where to Get a Prescription
Several types of providers can prescribe TRT, and the experience varies significantly between them.
Your primary care doctor is often the simplest starting point. Many PCPs are comfortable diagnosing low testosterone and writing a prescription, especially for straightforward cases. If your situation is more complex, they’ll refer you out.
Endocrinologists specialize in hormonal conditions and are generally considered the most thorough option. They’re more likely to investigate the root cause of your low levels, not just treat the number. The tradeoff is longer wait times for appointments and the need for a referral in many insurance plans.
Urologists also treat low testosterone, though their focus tends to lean toward reproductive and sexual health. Patient experiences vary widely. Some urologists are very proactive about TRT, while others focus primarily on total testosterone and may be less interested in borderline cases.
Specialty TRT clinics have grown rapidly in recent years, both in-person and online. These clinics typically streamline the process: you get labs, a consultation, and a prescription in a compressed timeline. Some use compounded formulations or pellet implants that traditional providers may not offer. The downside is that many operate outside insurance networks, so you’ll pay out of pocket.
Getting TRT Through Telehealth
Online TRT clinics are a legitimate option under current federal rules. The DEA and HHS have extended telemedicine prescribing flexibilities through December 31, 2026, allowing providers to prescribe Schedule II through V controlled substances (including testosterone) without an in-person visit, as long as certain conditions are met. In practice, this means a licensed provider can evaluate your symptoms over video, review your lab results, and write a prescription without you ever visiting an office.
You’ll still need blood work. Most telehealth TRT providers either send you to a local lab or ship an at-home testing kit. The diagnostic requirements don’t change just because the visit is virtual: two low morning testosterone results plus symptoms.
Choosing a Delivery Method
Once you have a prescription, you and your provider will choose from several delivery options. Each has different routines, costs, and convenience tradeoffs.
- Injections are the most common form. Testosterone cypionate and enanthate are injected into muscle or under the skin every one to two weeks. Many patients learn to self-inject at home. Injections tend to be the cheapest option and are widely covered by insurance.
- Gels and creams are applied daily to the shoulders, arms, or thighs. They deliver a steady dose but require care to avoid skin-to-skin transfer to partners, children, or pets. Insurance often covers gels, though some plans steer patients toward injections first.
- Patches are applied nightly and release testosterone steadily over 24 hours. Some people experience skin irritation at the application site.
- Pellets are implanted under the skin near the hip in a minor office procedure. They release testosterone slowly over two to three months, which means fewer visits but a small incision each time.
- Oral tablets are a newer option. Testosterone undecanoate is taken twice daily with food. Earlier oral forms of testosterone were hard on the liver, but the current formulation uses a different absorption pathway.
What Insurance Typically Covers
Most major insurers cover TRT when the diagnosis meets their criteria, which generally mirrors the clinical guidelines: two confirmed low morning testosterone results plus documented symptoms. Generic testosterone cypionate injections are the form most consistently covered and also the least expensive, sometimes costing under $30 per month even without insurance.
Gels, patches, and brand-name formulations cost more and may require prior authorization. Pellet implants and compounded creams from specialty clinics are rarely covered. If you go through a telehealth TRT clinic that operates outside your insurance network, expect to pay $100 to $250 per month for the medication, lab work, and provider consultations combined, depending on the company.
Ongoing Monitoring After You Start
TRT isn’t a one-time prescription. Once you start, you’ll need regular blood work to make sure the therapy is working and not causing problems. The AUA recommends checking testosterone levels and hematocrit every 6 to 12 months once you’re stable. Hematocrit is especially important because testosterone stimulates red blood cell production, and levels above 54% increase the risk of blood clots.
PSA testing follows a shared decision-making approach, meaning you and your provider discuss the frequency based on your age and risk factors. If you develop breast tenderness or swelling, your provider will check estradiol levels, since testosterone partially converts to estrogen in the body. Prolactin monitoring is only needed if you were treated for elevated prolactin before starting TRT.
Early follow-up visits are typically more frequent, often at 3 and 6 months, to adjust your dose and catch any issues. After that, most men settle into a routine of visits once or twice a year. The goal is to bring your testosterone into the normal range while keeping side effect markers in check.