Getting testosterone requires a prescription in the United States, and that prescription requires blood work showing your levels are low. The clinical threshold is 300 nanograms per deciliter (ng/dL). If your levels fall below that number and you have symptoms, a doctor can diagnose you with low testosterone (hypogonadism) and prescribe treatment. The process involves specific steps, and there are also meaningful ways to raise your levels without medication.
How Low Testosterone Is Diagnosed
A doctor won’t prescribe testosterone based on symptoms alone. You need at least two blood draws showing low levels, and those draws need to happen in the morning, ideally before 10 a.m. or within three hours of waking up, preferably fasting. Testosterone peaks early in the day, so morning samples give the most accurate reading.
Two samples are required because testosterone naturally fluctuates by 10 to 15 percent from day to day. A single low reading could be a fluke. If both results come back below 300 ng/dL and you have symptoms, that’s when a diagnosis is made.
The most telling symptoms are sexual: low sex drive, fewer morning erections, and difficulty getting or maintaining erections. Other strong indicators include loss of body hair, shrinking testicles, hot flashes, and very low sperm counts. Less specific symptoms like fatigue, depressed mood, increased body fat, reduced muscle mass, and trouble concentrating can also point toward low testosterone, but they overlap with many other conditions.
Who Can Prescribe It
You don’t necessarily need a specialist. Many primary care doctors prescribe testosterone replacement therapy (TRT) and manage it long term. If your case is more complex, or if your doctor prefers to refer you, the two main specialists are endocrinologists (hormone specialists) and urologists. Endocrinologists who focus on testicular and hormonal issues tend to be the most experienced with TRT management. Some men also go through specialty hormone clinics, which handle everything from blood work to treatment in one place.
Regardless of which provider you see, the process follows the same pattern: symptom evaluation, blood work confirming low levels, a discussion of treatment options, and then a prescription if you qualify. Some providers also check additional markers like thyroid hormones or prolactin to rule out other causes of your symptoms before starting treatment.
Types of Testosterone Replacement
Once you have a prescription, there are several delivery methods. Each has trade-offs in convenience, consistency, and cost.
- Injections are the most common and typically the least expensive option. Testosterone cypionate is injected into the muscle every two to four weeks, with doses ranging from 50 mg to 400 mg depending on your needs. Many men learn to self-inject at home. The main downside is that hormone levels rise sharply after injection and gradually fall before the next one, which can cause mood or energy fluctuations.
- Topical gels are applied daily to the shoulders, upper arms, or abdomen. You apply the gel in the morning to clean, dry skin and let it air-dry before putting on a shirt. Gels provide more stable day-to-day levels than injections, but you need to avoid skin contact with others (especially women and children) until the gel is fully absorbed, since testosterone can transfer through touch.
- Pellets are small implants placed under the skin during a brief in-office procedure. They dissolve slowly over three to six months, providing steady testosterone levels without daily or weekly effort. Some men prefer this approach because of the low maintenance, though each insertion requires a minor procedure.
- Oral capsules are taken once or twice daily with food. They’re the newest option and the most convenient, but they tend to be more expensive and may not be covered by all insurance plans.
Your doctor will help choose a method based on your lifestyle, how your body responds, and your insurance coverage. It’s common to try one form and switch if it doesn’t work well for you.
What Monitoring Looks Like
Starting TRT isn’t a one-and-done event. You’ll need follow-up blood work two to four weeks after beginning treatment to see how your body is responding, and then every 6 to 12 months once your dose is stable.
The key things your doctor will track include your testosterone levels (to confirm they’ve reached a healthy range), your hematocrit (a measure of red blood cell concentration), and potentially your PSA levels if prostate screening is appropriate for your age. Testosterone stimulates red blood cell production, which is beneficial in moderation but can become dangerous if levels climb too high. A hematocrit above 54 percent raises the risk of blood clots, stroke, and heart attack, so this number gets watched closely.
Risks Worth Understanding
Testosterone therapy is generally safe when monitored properly, but it carries real trade-offs. The most important one for younger men: exogenous testosterone suppresses your body’s own hormone production, which typically shuts down sperm production. If you’re planning to have children, this is a critical conversation to have with your doctor before starting. There are alternative treatments that can raise testosterone without the same impact on fertility.
The red blood cell issue mentioned above is the other main risk. Depending on the delivery method, some forms of testosterone cause more pronounced increases in red blood cell counts than others. Injections, which create higher peak levels, tend to have a larger effect on hematocrit than gels or pellets. Regular blood work catches this early, and dose adjustments or periodic blood donation can manage it.
Other potential side effects include acne, oily skin, breast tissue enlargement, and sleep apnea. Most of these are dose-dependent and resolve with adjustments.
Raising Testosterone Without Medication
If your levels are borderline or you want to optimize before considering TRT, lifestyle changes can make a meaningful difference. They won’t double your testosterone, but they can move the needle enough to improve how you feel.
Sleep is the single most impactful factor. Getting only five hours of sleep per night reduces testosterone by 10 to 15 percent in healthy young men. That’s a significant drop from one variable alone. Consistently sleeping seven to nine hours is the most effective natural intervention available.
Resistance training, particularly compound lifts like squats and deadlifts, reliably raises testosterone levels. The effect is most pronounced with heavier loads and larger muscle groups. Losing excess body fat also helps, since fat tissue converts testosterone into estrogen. For overweight men, even modest weight loss can produce noticeable improvements in hormone levels.
Chronic stress, excessive alcohol, and nutritional deficiencies in zinc, vitamin D, and magnesium can all suppress testosterone production. Addressing these won’t produce dramatic changes individually, but together they create the hormonal environment your body needs to produce testosterone at its full capacity.