Getting on testosterone requires a prescription, since testosterone is a Schedule III controlled substance in the United States. The process typically starts with your doctor, involves blood work to confirm low levels, and leads to a treatment plan if you qualify. Most people can move from that first appointment to a prescription within a few weeks, depending on how quickly lab results come back and whether follow-up testing is needed.
Step 1: Talk to the Right Doctor
Your primary care doctor can order the initial blood work and, in many cases, prescribe testosterone directly. If your situation is more complex or your doctor isn’t comfortable managing hormone therapy, you’ll likely be referred to a specialist. Endocrinologists are the go-to experts for hormonal conditions, including low testosterone. Urologists also treat low testosterone, though their focus tends to skew toward reproductive and urinary issues, and some are less interested in fine-tuning hormone levels.
Men’s health clinics and telehealth TRT (testosterone replacement therapy) clinics have become increasingly common. These clinics specialize in testosterone therapy and often streamline the process, but quality varies. Some are thorough with diagnostics and monitoring; others are more willing to prescribe without rigorous evaluation. If you go the clinic route, make sure they require blood work before prescribing and schedule regular follow-ups.
Step 2: Get Your Blood Tested
No responsible provider will prescribe testosterone without blood work first. The key number is your total testosterone level. The American Urological Association defines low testosterone as below 300 ng/dL for adult males without obesity, though some labs report levels as low as 264 ng/dL as still within normal range. A healthy range generally falls between 450 and 600 ng/dL.
A comprehensive testosterone panel typically measures:
- Total testosterone: the combined amount of testosterone in your blood, both protein-bound and unbound
- Free testosterone: the portion that’s unbound and actively available for your body to use
- Sex hormone-binding globulin (SHBG): a protein that binds to testosterone, which helps calculate your free testosterone accurately
- Albumin: another protein factor used in the free testosterone calculation
Your doctor will also likely check LH and FSH, two hormones produced by the pituitary gland. These help determine whether the problem originates in the testes themselves (primary hypogonadism, where LH and FSH are elevated because the brain is trying harder to signal the testes) or in the brain’s signaling system (secondary hypogonadism, where LH and FSH are low or normal). This distinction matters because secondary hypogonadism sometimes has a treatable underlying cause, like a pituitary issue or a medication side effect.
Blood draws for testosterone need to happen in the morning, usually between 7 and 10 a.m., when levels are at their peak. Most guidelines require at least two separate low readings on different days before a diagnosis is made. Expect the testing phase to take a couple of weeks.
What Symptoms Qualify You
Low blood levels alone aren’t always enough. Doctors look for a combination of low numbers and symptoms. Common signs of low testosterone include persistent fatigue that doesn’t improve with sleep, reduced sex drive, difficulty getting or maintaining erections, loss of muscle mass or strength, increased body fat (especially around the midsection), depressed mood or irritability, and difficulty concentrating.
Some of these symptoms overlap with other conditions like depression, thyroid disorders, or sleep apnea, which is part of why the diagnostic process involves blood work rather than symptoms alone. If your testosterone comes back normal but you still have these symptoms, your doctor will investigate other causes.
Who Can’t Take Testosterone
Certain conditions rule out testosterone therapy entirely. According to guidelines from the American Academy of Family Physicians, absolute contraindications include breast cancer, prostate cancer, and a condition called polycythemia where your blood is already too thick (hematocrit above 54%). An elevated PSA level above 4 ng/mL or abnormal findings on a prostate exam also disqualify you until further evaluation.
If you’re trying to have children, testosterone therapy is generally not recommended. It suppresses sperm production, sometimes severely, and the effects can take months to reverse after stopping. Untreated sleep apnea and uncontrolled heart failure are also reasons your doctor may hold off on prescribing until those conditions are managed first.
Choosing a Delivery Method
Once you qualify, you and your doctor will choose how to take testosterone. Each method has trade-offs in terms of convenience, consistency, and cost.
Injections are the most common and generally the least expensive option. A typical long-acting injectable is given at the start of treatment, again at 4 weeks, and then every 10 weeks after that. Shorter-acting versions, like testosterone cypionate, are often dosed weekly. Many people learn to self-inject at home, which cuts down on office visits. The downside is that hormone levels can fluctuate between doses, sometimes creating an energy roller coaster in the days before your next shot.
Topical gels are applied daily, usually in the morning, to the shoulders, upper arms, or abdomen. Starting doses are typically around 50 mg per day, with adjustments based on follow-up blood work. Gels provide more stable day-to-day hormone levels than injections, but they come with the risk of transferring testosterone to partners, children, or pets through skin contact. You need to wash your hands thoroughly after application and keep the area covered.
Patches are worn on the skin and deliver a steady dose over 24 hours. They’re available in 2 mg and 4 mg strengths. Skin irritation at the application site is the most common complaint.
Implantable pellets are inserted under the skin (usually in the hip area) during a brief in-office procedure. They release testosterone slowly over 3 to 4 months. A common starting dose is around 10 pellets, with a range of 6 to 12 pellets depending on your needs. Pellets are the most “set it and forget it” option, but the insertion procedure carries a small risk of infection or pellet extrusion.
What Happens After You Start
Starting testosterone isn’t a one-and-done event. Your doctor will recheck your blood levels within the first few months to make sure your dose is putting you in the right range. Adjustments are common early on. Besides testosterone levels, follow-up blood work monitors your red blood cell concentration (hematocrit), since testosterone stimulates red blood cell production and levels that climb too high increase the risk of blood clots. PSA levels are also tracked to watch for prostate changes.
Most people notice improvements in energy and mood within the first few weeks, though the full effects on body composition, sexual function, and strength can take 3 to 6 months to fully develop. Testosterone therapy is generally a long-term commitment. Stopping abruptly can leave you feeling worse than before as your body readjusts, so any decision to discontinue should be done gradually and with medical guidance.
For Transgender Men and Nonbinary Individuals
If you’re seeking testosterone as part of gender-affirming care, the pathway is similar in terms of blood work and prescriptions, but the clinical context is different. Rather than diagnosing a deficiency, the goal is to bring your testosterone levels into the typical male range to align your body with your gender identity. Many informed consent clinics allow you to start testosterone after a single visit where you discuss the effects, risks, and timeline, without requiring a letter from a therapist. Planned Parenthood locations in many states offer this service, as do a growing number of telehealth platforms specializing in gender-affirming hormone therapy. The delivery methods and monitoring schedule are largely the same as those described above.