Testosterone therapy for men with confirmed low T

How low testosterone is diagnosed

Testosterone deficiency is a combination of symptoms and lab results, not a number alone. Typical symptoms include low sex drive, fewer morning erections, fatigue, reduced muscle mass and strength, and low mood. Because testosterone varies through the day and from day to day, guidelines call for at least two early-morning total testosterone measurements on separate days.

The American Urological Association uses a total testosterone below 300 ng/dL as a reasonable cut-off. There is no level that automatically qualifies you for treatment, and your clinician will consider free testosterone and other results when total testosterone is borderline.

What we measure first

• Total testosterone, measured in the morning, repeated to confirm.
• Free testosterone or SHBG when needed.
• LH and FSH, to tell whether the problem starts in the testes or the pituitary.
• Hematocrit and a complete blood count.
• PSA for men over 40.
• Estradiol, prolactin, thyroid, lipids and glucose markers as indicated.

Two paths: replacement or stimulating your own production

Testosterone replacement supplies testosterone directly. It is effective for symptoms of true deficiency, but it signals the brain to stop sending LH and FSH, which shuts down your own production and usually lowers sperm counts, sometimes to zero.

Enclomiphene works differently. It blocks estrogen feedback at the brain, prompting more LH and FSH so the testes make more testosterone and continue producing sperm. It only helps when the testes can respond, typically in secondary hypogonadism. Our Enclomiphene / DHEA / Boron / Pregnenolone ODT (from $129/month) is compounded and not FDA-approved; no enclomiphene product is FDA-approved.

Fertility comes first if you want children

Men who are trying to conceive now or soon should not use testosterone therapy. If future fertility matters to you, say so at the start. Your clinician may suggest a semen analysis before treatment, and our Male Fertility Test ($299) is available for this purpose.

Safety and monitoring

Testosterone therapy can raise red blood cell counts, so hematocrit is checked before and during treatment, and the dose may be reduced or paused if it rises too high. In 2025 the FDA added blood pressure warnings to all testosterone product labels and added results from the TRAVERSE trial, which did not show an increase in major cardiovascular events in men with hypogonadism.

PSA is checked before starting in men over 40 and during the first year, with referral to urology if it rises sharply or exceeds guideline thresholds. Other possible effects include acne, fluid retention, breast tenderness, worsened sleep apnea and testicular shrinkage. Testosterone is a federally controlled substance, which adds prescribing requirements.

Who should not use testosterone therapy

• Men trying to conceive now or in the near future.
• Men with prostate or breast cancer, or a prostate nodule or PSA elevation that has not been evaluated.
• Men with an elevated hematocrit.
• Men with untreated severe obstructive sleep apnea or uncontrolled heart failure.
• Men who have had a heart attack or stroke in the past six months.

When it is not low T

Symptoms that feel like low testosterone often come from poor sleep, sleep apnea, depression, excess alcohol, thyroid disease, medications such as opioids, or weight gain. Excess body fat itself can lower testosterone. Your clinician will look at these, and treating them sometimes improves testosterone without replacement.

What ongoing care looks like

Expect more frequent check-ins and labs in the first few months while your dose is set, then periodic monitoring. Your clinician reviews symptoms, testosterone level, hematocrit, PSA and blood pressure and adjusts as needed. If treatment is not improving symptoms after a reasonable trial, it should be reconsidered.