Testosterone Replacement Therapy (TRT) is a medical treatment for men with clinically confirmed low testosterone (hypogonadism). TRT aims to restore hormone levels to alleviate symptoms like persistent fatigue, low libido, reduced muscle mass, and mood changes. Finding a qualified healthcare provider is fundamental for safe and effective treatment. The doctor must manage the diagnosis, prescribe medication, monitor potential side effects, and ensure the therapy aligns with your overall health profile.
Traditional Medical Specialists and Primary Care
TRT management often begins with a Primary Care Physician (PCP), who may be an internal medicine or family medicine doctor. The PCP serves as the initial point of contact for men experiencing low testosterone symptoms. They can order preliminary blood tests, conduct the initial physical examination, and manage straightforward cases of hypogonadism.
For complex diagnoses or unclear causes of low testosterone, a referral to a specialist is common. Endocrinologists are hormone specialists with expertise in the endocrine system. These specialists are best suited to diagnose and manage hypogonadism caused by pituitary or hypothalamic issues, often referred to as secondary causes.
Urologists are also frequently involved in TRT, focusing on the male reproductive and urinary systems. Their expertise is relevant when low testosterone is accompanied by related male health issues, such as erectile dysfunction or prostate concerns. Urologists are highly trained in interpreting blood levels and monitoring for potential side effects affecting the male genitourinary tract.
Dedicated Men’s Health and Wellness Clinics
Dedicated men’s health and wellness clinics, sometimes called “T clinics,” are an alternative option focusing exclusively on hormone replacement. These clinics offer a streamlined, cash-based model of care known for its convenience and specific focus. Staff may include physicians (MDs or DOs) or advanced practice providers like Physician Assistants (PAs) and Nurse Practitioners (NPs).
These clinics often provide focused expertise, in-house lab work, and customized treatment plans. They emphasize a holistic approach, often extending beyond TRT to include services like medical weight loss and sexual health treatments. Patients should verify the medical credentials of the staff, as this model contrasts with traditional settings where a PCP manages TRT or refers to specialists.
The Required Initial Evaluation and Monitoring
Initial Diagnosis and Baseline Testing
A rigorous medical evaluation is required before initiating TRT to confirm the diagnosis and ensure patient safety. Diagnosis must combine clinical symptoms and laboratory evidence. This evidence requires at least two separate measurements of total serum testosterone, taken on different mornings, ideally before 10:00 AM, with levels typically below 300 nanograms per deciliter (ng/dL).
Additional baseline testing is necessary to determine the cause of the deficiency. This includes tests for Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH), which distinguish between primary and secondary hypogonadism. Baseline testing also requires a Complete Blood Count (CBC) and Prostate-Specific Antigen (PSA) levels, especially for men over 40. The provider must also rule out other potential causes for symptoms, such as thyroid issues or pituitary tumors.
Ongoing Monitoring
Once therapy is started, ongoing monitoring is required to optimize the dosage and minimize side effects. Follow-up blood tests are typically scheduled frequently in the first year (e.g., at 3 to 6 months), and then annually once levels are stable.
A major focus of monitoring is the hematocrit, a measure of red blood cell concentration, which can increase with TRT and raise the risk of blood clots. If hematocrit rises above 54%, the dose may need to be reduced or the therapy temporarily stopped. Regular PSA monitoring and a digital rectal examination are also standard, as testosterone can affect the prostate.