Getting on testosterone replacement therapy (TRT) requires a clinical diagnosis of low testosterone, which means blood work showing levels below 300 ng/dL combined with symptoms like fatigue, low libido, or loss of muscle mass. You can’t walk in and request a prescription. The process involves specific lab tests, a physical exam, and at least two separate blood draws before any treatment begins.
Symptoms That Qualify You
Low testosterone is only diagnosed when lab results and symptoms appear together. A blood level below 300 ng/dL on its own isn’t enough, and neither are symptoms alone. The combination is what qualifies you for treatment.
Common symptoms include reduced sex drive, erectile difficulty, fatigue that doesn’t improve with sleep, loss of muscle mass or strength, increased body fat (especially around the midsection), depressed mood, and difficulty concentrating. Some men also notice breast tissue growth or a decrease in body hair. Your provider will do a physical exam looking at body composition, hair patterns, breast tissue, and testicular size to see if your body shows signs consistent with testosterone deficiency.
The Blood Work You’ll Need
The cornerstone of diagnosis is two separate morning blood draws, taken on different days, both before 10 a.m. Testosterone levels peak in the early morning and drop throughout the day, so late-afternoon draws can give misleadingly low results. These draws should be fasting and ideally processed at the same lab for consistency. Insurance companies, including Medicare, specifically require this two-draw protocol before they’ll consider covering treatment.
Beyond total testosterone, your provider will check several other markers. Luteinizing hormone (LH) helps determine whether the problem originates in the testes or the brain’s signaling system. If LH comes back low or borderline, a prolactin test may follow to rule out a pituitary issue. You’ll also get a complete blood count to check your red blood cell concentration (hematocrit), since testosterone therapy raises red blood cell production and starting with already-elevated levels can be dangerous. Men over 40 will have a PSA test to screen for prostate cancer before starting treatment. Free testosterone and a protein called SHBG (which binds to testosterone and makes it inactive) may also be measured to get a fuller picture.
Who to See
Several types of providers can diagnose and prescribe TRT. Urologists are the most common specialists for this, particularly those at men’s health centers. Endocrinologists handle hormonal disorders broadly and are a good fit if your case is complex or involves pituitary concerns. Many primary care physicians also prescribe TRT, especially for straightforward cases.
Telehealth clinics have become a popular option. Through the end of 2026, federal regulations allow practitioners to prescribe controlled substances like testosterone via telemedicine without requiring an in-person visit first, thanks to extended pandemic-era flexibilities from the DEA and HHS. This means you can complete consultations, get lab orders, and receive prescriptions entirely online through licensed telehealth platforms, though you’ll still need to visit a local lab for blood draws.
Conditions That Can Disqualify You
Certain conditions rule out TRT entirely. Active prostate cancer, breast cancer, a PSA level above 4 ng/mL, or a red blood cell concentration (hematocrit) above 54% are absolute contraindications. If your provider finds nodules or hardening during a prostate exam, that also needs to be investigated before testosterone is on the table.
Some conditions don’t automatically disqualify you but require careful consideration. A baseline hematocrit above 50%, untreated sleep apnea, uncontrolled heart failure, or severe urinary symptoms all fall into this category. If you’ve had a heart attack, stroke, or other cardiovascular event, guidelines recommend waiting three to six months before starting therapy. And if you’re planning to have children in the near future, TRT is generally not recommended because it can suppress sperm production significantly, sometimes to zero.
How Testosterone Is Administered
Once you’re approved, you and your provider will choose a delivery method. The FDA has approved several options: injections, topical gels, transdermal patches, and a buccal system that adheres to the upper gum. Subcutaneous pellets implanted under the skin are another option offered at many clinics.
Injections are the most widely used form. They’re typically self-administered at home and are the least expensive option, which matters if insurance coverage is limited. Gels are applied daily to the shoulders or upper arms and absorb through the skin, providing a steady hormone level but requiring care to avoid skin-to-skin transfer to partners or children. Patches work similarly but can cause skin irritation at the application site. Pellets are implanted every few months in a quick office procedure, which eliminates the need for daily or weekly dosing. Each method has trade-offs in convenience, cost, and how stable your testosterone levels stay between doses.
What Happens After You Start
TRT isn’t a set-it-and-forget-it treatment. Your provider will order follow-up blood work roughly 10 to 12 weeks after you begin to check whether your levels have reached the target range. The goal is to land in the middle of the normal range, around 450 to 600 ng/dL. If you’re on pellets, you’ll have an earlier check at two to four weeks after implantation, then again at 10 to 12 weeks.
Once your dose is dialed in, expect blood tests every 6 to 12 months to confirm your levels are holding steady and to monitor red blood cell counts. Rising hematocrit is the most common side effect that requires intervention.
Here’s something many men don’t expect: if your testosterone levels normalize but your symptoms don’t improve within three to six months, your provider should discuss stopping treatment. Persistent symptoms despite normal levels suggest something other than testosterone deficiency is the cause, and continuing therapy in that scenario adds risk without benefit.
Getting Insurance to Cover It
Most insurance plans cover TRT when it’s medically necessary, but they enforce specific documentation requirements. The two fasting morning blood draws from the same lab, both showing levels below 300 ng/dL, are typically non-negotiable for coverage approval. Your provider will also need to document your symptoms and physical exam findings. Without this paper trail, expect a denial.
If your levels are borderline (just above or just below 300 ng/dL), coverage can become less predictable. Some plans use stricter thresholds or require additional documentation of symptoms. Telehealth TRT clinics often operate on a cash-pay model, which bypasses insurance requirements but can cost $100 to $250 per month depending on the provider and delivery method. If cost is a concern, starting with your primary care physician or a urologist within your insurance network is the most affordable path.