Getting prescribed testosterone replacement therapy requires a confirmed diagnosis of low testosterone, which means blood work showing levels below 300 ng/dL on two separate morning tests, combined with symptoms. You can’t walk into a doctor’s office, ask for TRT, and leave with a prescription the same day. The process involves at least two visits, lab work, and a clinical evaluation before any treatment starts.
What Doctors Look For
A doctor won’t prescribe TRT based on symptoms alone or lab numbers alone. You need both. The American Urological Association defines testosterone deficiency as total testosterone below 300 ng/dL confirmed on two separate early morning blood draws, paired with signs or symptoms of low testosterone. Morning testing matters because testosterone peaks in the early hours and drops throughout the day. A late afternoon test could show artificially low numbers.
The symptoms that support a diagnosis include reduced sex drive, weaker erections, low energy, decreased strength or endurance, loss of height, depressed mood, declining work performance, and falling asleep after dinner. A screening tool called the ADAM questionnaire captures these in 10 yes-or-no questions. If you answer yes to the question about sex drive or erection quality, or yes to any three other questions, it suggests low testosterone is worth investigating. The questionnaire correctly identifies low testosterone about 88% of the time.
How to Prepare for Your Appointment
Before your visit, track your symptoms so you can describe them clearly. Vague complaints like “I feel tired” carry less weight than specifics: how long the symptoms have lasted, how they’ve changed, and how they affect your daily life. If your sex drive has dropped noticeably, your erections are weaker, you’ve lost muscle despite regular training, or your mood has shifted without an obvious cause, say so directly.
Your doctor will order a total testosterone blood test first. This measures all testosterone in your blood, both the free-floating kind your body can use and the portion bound to proteins. If total testosterone comes back low or borderline, your doctor may also check your sex hormone-binding globulin (SHBG) level. SHBG binds to testosterone and makes it unavailable, so even if your total number looks acceptable, high SHBG could mean very little testosterone is actually free for your body to use.
Additional blood work typically includes luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These help your doctor figure out where the problem originates. If LH and FSH are high, your brain is signaling your testes to produce testosterone but they aren’t responding, pointing to a testicular issue. If LH and FSH are low, the signal itself is weak, which suggests a problem in the pituitary gland or hypothalamus. This distinction matters because it shapes the treatment approach.
Which Doctor to See
Your primary care doctor can order the initial blood work and may even prescribe TRT if the diagnosis is straightforward. For more complex cases, you’ll likely be referred to a specialist. Endocrinologists and urologists both treat low testosterone, but their approaches can differ. Endocrinologists focus on the hormonal system as a whole and tend to evaluate free testosterone, SHBG, and the full hormonal picture. Urologists often concentrate on total testosterone and reproductive function.
Some men find that urologists are less interested in borderline cases, particularly when total testosterone is low-normal but free testosterone is the real problem. If you feel your concerns aren’t being addressed by one type of specialist, requesting a referral to the other is reasonable. Men’s health clinics and telehealth TRT providers have also become common options, though insurance coverage through these routes varies.
What Happens After Diagnosis
Once two morning blood tests confirm testosterone below 300 ng/dL and your symptoms match, your doctor will discuss treatment options. The most common delivery methods are:
- Injections: Typically given every one to two weeks, either at home or in a clinic. Injections are the most affordable option and provide reliable absorption, but testosterone levels rise and fall between doses, which some men notice as energy or mood fluctuations.
- Topical gel: Applied once daily to the skin, usually on the shoulders or upper arms. Gels maintain steadier testosterone levels throughout the day but carry a risk of transferring the hormone to others through skin contact.
- Skin patch: Worn on the arm or upper body, applied once daily in the evening. You rotate the application site and wait seven days before reusing the same spot.
- Oral tablets: Newer formulations bypass the liver (older versions caused liver problems). Taken twice daily with food. These tend to be expensive and insurers often require you to try other methods first.
Your doctor will recommend a method based on your lifestyle, insurance coverage, and preferences. Injections remain the most widely prescribed because of their cost and effectiveness.
Fertility Is a Serious Consideration
If you’re planning to have children, bring this up before starting treatment. TRT suppresses your body’s natural testosterone production, which in turn shuts down sperm production. About 65% of men on TRT become azoospermic, meaning they produce no detectable sperm.
Doctors can prescribe a hormone called HCG alongside TRT to maintain sperm production. In one study, men who took HCG every other day while on TRT maintained their sperm counts near baseline levels, and none became azoospermic. Among those actively trying to conceive during treatment, 9 out of 12 achieved pregnancy. If fertility matters to you now or in the future, this combination protocol is worth discussing before your first dose.
Insurance and Prior Authorization
Most insurance plans cover TRT, but nearly all require prior authorization. This means your doctor submits documentation proving you meet the diagnostic criteria before the insurer approves payment. The typical requirements mirror clinical guidelines: two morning blood tests showing total testosterone below 300 ng/dL, plus documentation of a qualifying diagnosis.
Injectable testosterone cypionate is generally the cheapest option, often costing under $50 per month even without insurance. Gels and patches run significantly higher. Oral formulations are the most expensive, and many insurers won’t cover them unless you’ve tried and failed other methods or experienced side effects. If prior authorization is denied, your doctor’s office can usually appeal with additional clinical documentation.
Ongoing Monitoring Once You Start
TRT isn’t a one-time prescription. Once you begin treatment, your doctor will monitor your blood work regularly to ensure the therapy is working safely. The key markers include:
- Testosterone levels: Checked to confirm you’re reaching the target range and to adjust dosing.
- Hematocrit: Measured every 6 to 12 months. TRT stimulates red blood cell production, and hematocrit levels above 54% increase the risk of blood clots. If yours climbs too high, your doctor may reduce the dose or recommend blood donation.
- PSA (prostate-specific antigen): Monitored as part of prostate health screening. TRT doesn’t cause prostate cancer, but it can accelerate the growth of existing prostate tissue, so tracking PSA over time is standard.
- Estradiol: Checked if you develop breast tenderness or tissue swelling. Testosterone converts to estrogen in the body, and some men produce too much during treatment.
Expect blood work at roughly 3 months after starting, then every 6 to 12 months once your levels stabilize. Your doctor will adjust your dose based on both your lab results and how you feel. Some men respond well to a standard dose while others need fine-tuning over several months to find the right level.