Testosterone is a naturally occurring hormone that plays a broad role in the human body. This steroid hormone is responsible for the development of secondary sexual characteristics, and it influences bone density, muscle mass, fat distribution, and red blood cell production. When testosterone levels are consistently low, they can negatively impact energy, mood, and overall well-being. Initiating testosterone therapy requires careful evaluation and ongoing professional oversight to ensure safety and effectiveness.
Determining Eligibility and Need
The decision to begin testosterone therapy is medically complex and based on two distinct pathways: treating a diagnosed deficiency or pursuing gender-affirming care. Testosterone Replacement Therapy (TRT) is prescribed for hypogonadism, a condition where the body does not produce enough of the hormone. Symptoms of hypogonadism are non-specific and can include decreased libido, chronic fatigue, depressed mood, and reduced lean muscle mass.
To confirm the diagnosis, a physician requires multiple blood tests, specifically two morning measurements of total testosterone, since levels naturally peak in the early hours. A total testosterone level below 300 nanograms per deciliter (ng/dL) combined with clinical symptoms is often the threshold for diagnosis. Further blood work, including Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH), determines if the cause is a primary testicular issue or a secondary problem stemming from the pituitary or hypothalamus.
The second pathway is gender-affirming hormone therapy (GAHT), guided by established clinical protocols focused on the individual’s goals. These protocols emphasize informed consent, ensuring the patient understands the expected physical changes and potential risks of masculinizing hormone therapy. While a psychological evaluation may be part of the assessment, the focus is on the patient’s capacity to consent and readiness for the treatment’s effects.
The Initial Steps to Obtaining a Prescription
The first practical step is securing a qualified healthcare provider, such as an endocrinologist, a urologist, or a primary care physician specializing in hormone management. During the initial consultation, the provider will conduct a thorough medical history and physical examination, which often includes a digital rectal exam for older patients.
Before a prescription is issued, baseline laboratory tests beyond the hormone panel are required to check for pre-existing conditions. A Complete Blood Count (CBC) is necessary to measure hematocrit and hemoglobin, as testosterone can increase red blood cell production, potentially raising the risk of clotting. A lipid panel and a comprehensive metabolic panel are also checked to evaluate cardiovascular health, liver, and kidney function. For men over 40, a Prostate-Specific Antigen (PSA) test is included in the baseline labs to screen for prostate issues before beginning therapy.
The informed consent process then follows, which is a formal discussion where the provider reviews all potential benefits, risks, and side effects of treatment.
Understanding Treatment Options
Testosterone therapy is available in several formulations, each with a unique administration method that impacts the patient’s experience and dosing schedule. Injections, administered either intramuscularly or subcutaneously, are a common and cost-effective option. These are typically given every one to four weeks, but the periodic dosing can lead to fluctuations in hormone levels, resulting in peaks shortly after the injection and troughs before the next dose.
Topical gels and creams are applied daily to the skin, offering a convenient, non-invasive option that generally provides more stable hormone levels throughout the day. A significant consideration with gels is the risk of transference, where the testosterone can accidentally pass to other people through skin-to-skin contact or shared fabrics. Patients must take precautions, such as covering the application site and washing their hands thoroughly.
Transdermal patches are another daily option, adhering to the skin and releasing the hormone slowly, but they can sometimes cause localized skin irritation at the application site. For patients who prefer minimal self-administration, testosterone pellets can be implanted under the skin, usually in the hip or buttocks area, during a minor in-office procedure. These pellets dissolve slowly, providing a consistent release of the hormone for three to six months, though dose adjustments are less flexible once implanted.
Monitoring and Adjusting Therapy
Testosterone therapy requires regular medical monitoring to ensure safety and optimize the dosage. After starting treatment, follow-up lab work is typically scheduled for two to three months, and again after any dose change, to confirm the testosterone level is within the therapeutic range. Once levels are stable and symptoms are managed, the monitoring frequency usually shifts to every six to twelve months.
Ongoing laboratory testing focuses on long-term safety, with a close watch on hematocrit and hemoglobin levels. If the hematocrit (the proportion of red blood cells in the blood) rises above 54 percent, it indicates polycythemia, which increases the risk of blood clots. In such cases, the dosage may need to be reduced or the patient may be advised to donate blood.
The provider will also regularly monitor the Prostate-Specific Antigen (PSA) level in older men to track prostate health, as testosterone can affect prostate tissue. Dosage adjustments are made based on a combination of laboratory results and the patient’s reported symptoms, such as changes in energy, mood, or libido.