Primary care physicians write the majority of testosterone prescriptions in the United States, accounting for roughly 60% of all prescriptions. You don’t necessarily need a specialist, though endocrinologists and urologists also prescribe testosterone and may be better suited for complex cases. The type of provider you see depends on your situation, whether that’s symptoms of low testosterone, a known hormonal condition, or gender-affirming care.
Primary Care Physicians
Your regular doctor is the most common starting point. In the U.S., primary care physicians handle the bulk of testosterone therapy management, and in Canada that number is even higher, with PCPs writing an estimated 92% of prescriptions in some regions. A primary care doctor can order the necessary blood work, interpret results, write the prescription, and monitor you over time.
PCPs are well-positioned to manage straightforward cases of low testosterone because they already know your medical history, current medications, and overall health picture. They’ll typically refer you to a specialist if something more complex turns up during testing, like an underlying pituitary issue, fertility concerns, or an abnormal finding that needs further investigation.
Endocrinologists
Endocrinologists specialize in the hormonal system and are often considered the go-to experts for testosterone therapy, especially for complicated cases. If your low testosterone stems from a problem with the pituitary gland, thyroid dysfunction, or another hormonal disorder, an endocrinologist can untangle those overlapping systems in a way a generalist may not.
Outside the United States, testosterone therapy is still primarily managed by endocrinologists, andrologists, and urologists rather than primary care doctors. Even within the U.S., some patients find that endocrinologists take a more detailed approach to hormone levels, including free testosterone (the portion actually available for your body to use) rather than just total testosterone. If your PCP seems uncertain about your results or you’re not improving on treatment, requesting a referral to an endocrinologist is a reasonable next step.
Urologists
Urologists focus on the male reproductive and urinary systems, which makes them a natural fit when low testosterone overlaps with sexual health concerns like erectile dysfunction or reduced libido. They’re also the right choice if fertility preservation is part of the conversation, since standard testosterone therapy can suppress sperm production.
That said, not every urology practice actively manages testosterone replacement. Some urology offices have shifted away from ongoing hormone management and focus instead on surgical or procedural care. If you’re referred to a urologist specifically for testosterone therapy, it’s worth confirming ahead of time that the practice handles it.
Gender-Affirming Hormone Therapy
Transgender and gender-diverse individuals seeking testosterone as part of masculinizing hormone therapy can receive prescriptions from many of the same provider types: primary care physicians, endocrinologists, and in some cases OB-GYNs or family medicine doctors with training in gender-affirming care. Informed consent clinics, which operate in many U.S. cities, allow patients to begin hormone therapy after a thorough discussion of risks and benefits without requiring a mental health referral first. Availability varies significantly by state and region.
Telehealth Providers
Testosterone is classified as a Schedule III controlled substance under federal law, which normally requires an in-person visit before a provider can prescribe it through telehealth. However, the DEA and the Department of Health and Human Services have extended pandemic-era telemedicine flexibilities through December 31, 2026. Under these temporary rules, a DEA-registered practitioner can prescribe testosterone via video visit without a prior in-person exam, as long as certain conditions are met.
Several online men’s health clinics and hormone therapy platforms operate under these rules. They typically have you complete blood work at a local lab, then schedule a video consultation with a licensed provider. The convenience is real, but it’s worth making sure any telehealth platform you use employs providers who are licensed in your state and follow standard diagnostic protocols rather than prescribing based on symptoms alone.
What Happens Before You Get a Prescription
No matter which provider you see, the diagnostic process follows a similar path. A blood test measuring total testosterone is the starting point, and the American Urological Association uses a level below 300 ng/dL as the threshold supporting a diagnosis of low testosterone.
Timing matters for the blood draw, but how much depends on your age. Men younger than 45 should have their blood drawn in the early morning, ideally before 9 a.m., because testosterone levels peak overnight and decline through the day. For men 45 and older, that daily fluctuation flattens out, and a sample drawn anytime before 2 p.m. is considered acceptable.
One low reading isn’t enough. Up to 30% of men who test low on the first draw will have a normal result when tested again. Guidelines call for at least two separate low readings before confirming the diagnosis. Your provider will also want to rule out other causes: thyroid problems, medication side effects, obesity, sleep apnea, or pituitary disorders can all drive testosterone down, and treating the root cause sometimes resolves the issue without hormone therapy.
Conditions That Prevent a Prescription
Certain health conditions will stop a provider from prescribing testosterone regardless of how low your levels are. The absolute contraindications include:
- Locally advanced or metastatic prostate cancer
- Male breast cancer
- A baseline hematocrit of 54% or higher (hematocrit measures the proportion of red blood cells in your blood; testosterone can push this number higher, increasing clot risk)
- Uncontrolled congestive heart failure
- Active desire to preserve fertility (testosterone therapy suppresses sperm production)
Some conditions are considered relative contraindications, meaning your provider will weigh the risks more carefully rather than automatically ruling therapy out. These include a hematocrit between 48% and 50%, a family history of blood clots, and significant lower urinary tract symptoms. If any of these apply to you, a specialist referral is more likely than if your case is straightforward.
Choosing the Right Provider
For most men with symptoms of low testosterone and no major complicating conditions, a primary care physician is the fastest and most practical path. You likely already have one, the diagnostic workup is straightforward, and PCPs manage the majority of these cases successfully.
An endocrinologist is worth seeking out if your PCP finds something unusual in your lab work, if you have known pituitary or thyroid issues, or if you’ve been on therapy without improvement. A urologist makes the most sense when sexual health or fertility is your primary concern. And for gender-affirming testosterone therapy, look for providers or clinics that specifically advertise experience in that area, since protocols and monitoring differ from standard hypogonadism treatment.