Considering Testosterone Therapy? We Break Down the Entire Process From Diagnosis to Monitoring

If you pay even a little attention to the health and wellness space, you've probably noticed that testosterone is everywhere. It's marketed as the answer to just about everything, from low energy and poor sleep to stubborn weight gain and fading libido. Scroll long enough, and it starts to feel like the modern fountain of youth. Click on one clinic promising to “optimize” your hormones, and you can expect months of ads pushing TRT across every screen you own.

The conversation about how to get TRT has gone fully mainstream. Influential voices in health and neuroscience talk about testosterone openly, and celebrities have shared their own experiences without hesitation. Access to treatments that help men feel stronger, sharper, and more engaged as they age is, in many ways, a positive step. At the same time, some experts are beginning to question the culture forming around TRT, particularly how it has drifted from a medical intervention into a lifestyle product.

What's missing, though, is a clear picture of what it actually means to start testosterone therapy, what the process looks like, and what can happen when it is prescribed without a true medical need. The upside is often highlighted. The trade-offs rarely are.

To make sense of all the noise, it helps to step away from the marketing and look at how testosterone therapy actually works when practiced responsibly. That means understanding how doctors diagnose low testosterone, what happens before a prescription is written, and what ongoing care really involves. Below, experts break down the step-by-step process of "hopping on."

This feature appears in the Men’s Journal Fitness Special, on newsstands now. Order your copy today!

Related: The Testosterone Boom Is Here to Stay. What Does It Mean for Masculinity?

What Is Testosterone Replacement Therapy?

Testosterone replacement therapy, often called TRT, is a medical treatment prescribed when men experience symptoms commonly tied to low testosterone, such as loss of muscle mass, persistent fatigue, low libido, and mood changes. Rather than chasing a single lab number, clinicians look at how someone feels and functions alongside blood work. TRT works by supplementing the body with manufactured testosterone through methods like injections, topical gels or patches, under-the-skin pellets, pills, or nasal sprays, all with the aim of restoring hormonal balance and improving quality of life.

What Starting TRT Actually Looks Like

Diagnosis

"The first step is a comprehensive intake," says Dr. Pete Stahl, M.D., Head of Men’s Health at Hims. "A clinician gathers detailed information about symptoms, medical history, and overall health to determine whether testosterone therapy would be safe and effective. If there are no clear contraindications, the next steps include educating the patient on available treatments and assessing hormone levels through lab testing."

Two morning blood draws confirm low testosterone. Urologist Jason B. Carter, M.D., orders total testosterone (how much you have in your blood) and free testosterone (how much you can actively use), then baseline estradiol, hemoglobin and hematocrit, LH, prolactin, and PSA. If prolactin is high, he adds a pituitary MRI to rule out prolactinoma, a non-cancerous tumor of the gland.

Onboarding and Timing

Male reproductive medicine specialist Justin Houman, M.D., delivers a symptom questionnaire, in addition to intake forms, "covering things like energy, mood, sleep, and libido," he says, as well as a comprehensive hormone panel, ideally on two separate mornings. Results are reviewed alongside goals and fertility plans before a prescription goes out.

"Once results are in, a licensed provider reviews everything holistically, including symptoms, medical history, and lab data together," Stahl says. "Testosterone should never be prescribed based on numbers alone. If treatment is appropriate, the provider writes a prescription and starts therapy, often paired with personalized guidance on managing medical conditions or lifestyle factors that may be contributing to low testosterone."

Cost

Carter ballparks consultation costs around $150 to $250, with an average of $150 to $300 for baseline labs and medication ranges, depending on where you live. Injectable testosterone cypionate can cost about $30 to $60 with a discount card; gels, which are applied daily, often run higher; pellets, which are implanted under the skin every three to six months, are typically not covered by insurance. Greg Novacheck says his telehealth clinic’s "basic TRT program starts at around $20 a week," with most patients paying $70 to $700 monthly, depending on the plan.

Monitoring

Carter rechecks symptoms, estradiol, hematocrit, PSA, and total T at 12 weeks, while Houman repeats labs at six to 12 weeks and pauses TRT if hematocrit hits 54 percent or higher. High hematocrit increases blood viscosity and clot risk, so a therapeutic phlebotomy or blood donation is done to quickly lower red‑cell mass and reduce short‑term cardiovascular risk.

"Patients typically repeat labs and follow up about three months after starting therapy to reassess hormone levels, symptoms, and identify side effects," Stahl says. "Ongoing monitoring is individualized—some patients need closer follow-up, while others can check in less frequently. Once treatment is stable and symptoms are well managed, annual visits and lab testing are usually sufficient, with providers reassessing the full clinical picture each time to keep care safe and effective."

Related: The 8 Dietitian-Approved Foods That Can Naturally Boost Testosterone

Potential Risks of Testosterone Therapy

"The potential risks of testosterone therapy depend on the treatment plan and the individual’s health profile," says Stahl. "One of the biggest challenges in diagnosis is symptom overlap. Many middle-aged men experience fatigue, mood changes, low libido, or reduced motivation—symptoms that could stem from low testosterone, but also from poor sleep, depression, stress, or inactivity. That’s why careful clinical evaluation is so important before starting treatment."

Stahl adds that he advocates for interpreting testosterone levels in context. This means looking at both the number and the patient’s specific symptoms. Vague issues like fatigue are often lumped into symptoms such as low libido or erectile dysfunction, which are more directly linked to testosterone deficiency.

Testosterone replacement therapy is an FDA-approved medical treatment when prescribed appropriately for men with clinically low testosterone. Like any hormone therapy, it is not without trade-offs. Research is still evolving, and while most men tolerate treatment well, some experience side effects early on. These can include acne, fluid retention that shows up as ankle swelling, breast tenderness, or worsened sleep apnea in those already prone to it. None of this means TRT is inherently dangerous, but it does underscore why proper screening, dosing, and ongoing monitoring matter far more than the hype would suggest.

Ultimately, excellent care means ensuring patients fully understand the potential benefits and risks, then helping them make informed, personalized decisions. The balance between benefit and risk isn’t one-size-fits-all. It’s a thoughtful, collaborative process between provider and patient, grounded in science, safety, and individual goals.