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Educational information only — not medical advice. TRT requires a licensed prescriber and lab testing. How to start safely

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How to start TRT the right way

If you’re going to do this, do it properly: the correct labs, a real evaluation, and a clinic that monitors you — not one that prescribes off a quiz.
Medically reviewed by Alan Reyes, MD, FACEBoard-certified endocrinologist · 18 years in hormone healthLast reviewed Sep 1, 2026 · AI-assisted draft, physician-verified

The path, step by step

1

See a clinician about your symptoms

Primary care, a urologist, or an endocrinologist. Describe your symptoms honestly. Many symptoms of “low T” have other causes — sleep apnea, thyroid issues, depression, medication side effects — that should be ruled out.

2

Get the right blood tests

Total testosterone drawn in the morning (7–10 a.m.), on two separate days. Plus free testosterone, LH, FSH, estradiol, hematocrit (CBC), and PSA. These confirm deficiency, find its cause, and check for contraindications.1

3

Confirm the diagnosis

Two morning readings below your lab’s threshold (often ~300 ng/dL), plus symptoms. One low reading isn’t enough — levels fluctuate.1

4

Discuss fertility before starting

If there’s any chance you’ll want biological children, raise it now. TRT suppresses sperm production. Alternatives (clomiphene, hCG) exist that raise testosterone while preserving fertility.2

5

Choose a method and start low

Injections, gel, pellets, patch, or nasal — chosen for your lifestyle and budget. Reputable clinics start conservatively and titrate to the lower end of the normal range, not the top.

6

Monitor — forever

Recheck testosterone, hematocrit, PSA, and estradiol at 3, 6, and 12 months, then annually. TRT is typically lifelong; monitoring is not optional.1

The six labs a good clinic runs

1

Total testosterone

The headline number. Morning draw, twice.

2

Free testosterone

The biologically active fraction.

3

LH & FSH

Distinguish primary (testicular) from secondary (pituitary) causes.

4

Estradiol

Testosterone converts to estrogen; too much causes side effects.

5

Hematocrit (CBC)

TRT thickens blood; baseline and monitoring are essential.

6

PSA

Prostate baseline before and during therapy.

Questions to ask any prescriber

  • Will you require two morning blood tests before prescribing?
  • Which labs do you run beyond total testosterone?
  • How and how often will you monitor me?
  • How does this affect my fertility, and what are my options?
  • What’s your target range, and why?
  • What are the signs I should stop or adjust?
Red flags: prescribing from a symptom quiz with no labs · “instant” or same-day scripts · pushing maximum doses · no mention of fertility or monitoring · bundling testosterone with unproven “stacks.” If you see these, walk away.
We don’t prescribe or refer for commission on this page. trtusa.info is educational. Bring this checklist to a licensed clinician of your choosing — your primary-care doctor, a urologist, or an endocrinologist.

References

  1. Bhasin S, et al. Endocrine Society Clinical Practice Guideline. academic.oup.com. 2018.
  2. Patel AS, et al. Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. pubmed.ncbi.nlm.nih.gov. 2019.