Testosterone Replacement Therapy (TRT) supplements the body’s natural testosterone production. It is considered for individuals experiencing symptoms of low testosterone levels, a condition known as hypogonadism. This article outlines the process and criteria for qualifying for TRT. This content is for informational purposes only and does not constitute medical advice.
Recognizing Potential Symptoms
Individuals should seek medical evaluation if they notice changes in their physical, emotional, or sexual well-being that suggest low testosterone. Common symptoms include decreased sexual desire and erectile function. Persistent fatigue or reduced energy levels are also common, making daily activities more challenging.
Changes in body composition can include reduced lean muscle mass despite exercise, and increased body fat, particularly around the abdomen. Emotional shifts, such as irritability, mood changes, or symptoms of depression, may also occur. These symptoms warrant discussion with a healthcare professional, as they are not definitive diagnoses of low testosterone.
The Diagnostic Process
Diagnosing low testosterone begins with a consultation with a healthcare provider, including a medical history review and physical examination. The next step involves blood tests to measure testosterone levels. These tests include total testosterone, and sometimes free testosterone and Sex Hormone Binding Globulin (SHBG).
For accurate results, blood samples are collected in the early morning, ideally between 7 AM and 10 AM, when testosterone levels are highest and most stable. Fasting for several hours before the test may be advised, as food intake can influence levels. Because testosterone levels fluctuate, healthcare providers require repeated morning blood tests over weeks or months to confirm persistently low levels before diagnosis.
Medical Criteria for Treatment
Qualification for Testosterone Replacement Therapy relies on persistent symptoms and confirmed low testosterone levels through blood tests. Medical guidelines define low total testosterone as levels below 300 nanograms per deciliter (ng/dL). However, these are guidelines, and diagnosis is not solely based on a number.
The Endocrine Society states that a diagnosis of hypogonadism requires both symptoms consistent with testosterone deficiency and consistently low testosterone levels. If total testosterone levels are near the lower end of the normal range, or if conditions that alter SHBG are suspected, free testosterone levels may be measured. The aim of treatment is to restore testosterone levels to a mid-normal range, typically between 300-1000 ng/dL.
Factors Influencing Eligibility
Even when a person meets the criteria for low testosterone, a healthcare provider will assess other health considerations before prescribing TRT. A comprehensive health assessment is performed to ensure TRT is safe and appropriate. This includes evaluating for conditions that could be worsened by testosterone therapy or that might mimic low testosterone symptoms.
One important consideration is prostate health, which involves checking Prostate-Specific Antigen (PSA) levels and conducting a digital rectal exam (DRE) to assess prostate cancer risk. TRT is generally contraindicated in men with known prostate or breast cancer. Other factors include untreated severe obstructive sleep apnea, uncontrolled heart failure, or a recent heart attack or stroke. TRT may exacerbate existing sleep apnea in some patients.
Providers monitor for polycythemia, a condition characterized by an elevated red blood cell count, as testosterone can stimulate red blood cell production. A hematocrit level above 52% or 54% is a common threshold for concern and may require dose adjustment or temporary cessation of TRT. Patients actively seeking fertility are typically not candidates for TRT, as it can suppress natural hormone production and sperm count.