Quick Takeaway
TRT can effectively treat low testosterone symptoms like fatigue, low libido, and muscle loss when levels fall below 300 ng/dL. Online TRT clinics make access easier, with all-inclusive pricing around $150-250/month including medication and monitoring. It's not a magic solution—it requires ongoing commitment, regular blood work, and comes with real trade-offs including potential fertility impacts.
What Is Testosterone Replacement Therapy?
Testosterone replacement therapy (TRT) is exactly what it sounds like: replacing testosterone that your body isn't producing enough of on its own. It's prescribed to treat hypogonadism—the medical term for when your testes don't produce adequate testosterone.
This isn't about getting testosterone levels to "superhuman" heights (that's steroid abuse, which is different). TRT aims to restore your levels to the normal physiological range—typically between 400-700 ng/dL for most treatment goals.
Signs You Might Have Low Testosterone
Low testosterone (often called "Low T") doesn't announce itself with a single obvious symptom. It's usually a combination of issues that creep up gradually. Here's what to look for:
Physical Symptoms
- •Fatigue that doesn't improve with rest
- •Decreased muscle mass despite exercise
- •Increased body fat, especially around the midsection
- •Reduced body and facial hair
- •Decreased bone density
Sexual & Mental Symptoms
- •Low libido and reduced interest in sex
- •Erectile dysfunction
- •Brain fog and difficulty concentrating
- •Depression or irritability
- •Poor sleep quality
Important Note
These symptoms overlap with many other conditions—thyroid issues, depression, sleep apnea, diabetes, and simple aging. Never self-diagnose. Blood work is required to confirm low testosterone before starting treatment.
Understanding Testosterone Levels
Let's cut through the confusion around testosterone numbers. Here's what the research and clinical guidelines actually say:
| Level (ng/dL) | Classification | Notes |
|---|---|---|
| <250 ng/dL | Clearly Low | Strong candidate for TRT; guidelines recommend treatment |
| 250-350 ng/dL | Borderline Low | Treatment threshold per AUA guidelines (300 ng/dL cutoff) |
| 350-500 ng/dL | Low-Normal | May treat if symptomatic; consider optimization strategies first |
| 500-800 ng/dL | Optimal Range | Target range for most TRT protocols |
| 800-1000+ ng/dL | High-Normal | Upper end of reference range; some clinics target this |
The Diagnostic Standard
Per AUA and Endocrine Society guidelines, diagnosis should be based on:
- At least two morning blood tests showing low testosterone (levels are highest in the morning)
- Symptoms consistent with low T—numbers alone aren't enough
- Same lab, same assay—results can vary between labs
- Testing both total and free testosterone—free T can be low even when total is normal
TRT Treatment Options
Testosterone comes in several forms. Each has trade-offs in terms of convenience, consistency, and side effects:
Injections (Testosterone Cypionate/Enanthate)
The most common and cost-effective method. Self-administered intramuscularly or subcutaneously every 1-2 weeks.
- • Most affordable option
- • Highly effective
- • Flexible dosing
- • Peaks and troughs between doses
- • Requires learning to inject
- • Can cause injection site reactions
Topical Gels & Creams
Applied daily to skin (shoulders, upper arms, or inner thighs). Brands include AndroGel, Testim, and compounded creams.
- • No needles required
- • More stable levels (daily application)
- • Easy to adjust dose
- • Transfer risk to partners/children
- • Must let dry before contact
- • More expensive than injections
Pellets (Testopel)
Small pellets implanted under the skin every 3-6 months in a quick office procedure.
- • Set it and forget it
- • Very consistent levels
- • No daily/weekly routine
- • Minor surgical procedure required
- • Harder to adjust if levels too high
- • Pellets can extrude
Patches (Androderm)
Applied nightly to clean, dry skin. Changed every 24 hours.
- • Mimics natural testosterone rhythm
- • No injections
- • Consistent daily levels
- • Skin irritation common
- • Can fall off during activity
- • Less commonly prescribed now
Benefits of TRT: What to Actually Expect
Let's be realistic. TRT can significantly improve quality of life for men with genuinely low testosterone, but it's not a miracle drug. Here's what the research shows:
Improved Energy & Mood
Many men report decreased fatigue and improved motivation within 3-6 weeks. Depression symptoms often improve, though TRT isn't a treatment for clinical depression.
Increased Muscle Mass & Strength
TRT combined with resistance training leads to meaningful muscle gains. Effect is most noticeable after 3-6 months.
Improved Libido & Sexual Function
Sexual desire typically improves within the first month. Erectile function may improve, though this depends on the underlying cause.
Better Body Composition
Modest decreases in body fat and increases in lean mass. Not a shortcut for weight loss—diet and exercise still matter.
Improved Bone Density
Long-term TRT can help maintain or improve bone mineral density, reducing fracture risk.
Risks & Side Effects: The Full Picture
TRT isn't without downsides. Here's what you should discuss with your doctor before starting:
Common Side Effects
- Acne and oily skin — Especially in the first few months
- Increased red blood cell count (polycythemia) — This is why regular blood monitoring is essential; levels too high can increase clot risk
- Testicular shrinkage — Your body stops producing its own testosterone, so the testes shrink
- Fluid retention — Some men experience mild swelling or weight gain from water retention
- Sleep apnea worsening — Existing sleep apnea can worsen on TRT
Serious Considerations
- Fertility impact — TRT suppresses sperm production, sometimes to zero. If you want children, discuss alternatives like hCG or clomiphene first.
- Cardiovascular concerns — Research is mixed. Some studies show benefit, others show risk. Discuss your cardiovascular health profile with your doctor.
- Prostate health — TRT doesn't cause prostate cancer, but it can accelerate existing cancer. PSA monitoring is standard.
- Lifetime commitment — Once you start, your body relies on external testosterone. Stopping can be difficult.
Who Should NOT Use TRT
- • Men with prostate or breast cancer
- • Men actively trying to conceive (use alternatives)
- • Untreated severe sleep apnea
- • Hematocrit above 50% (high red blood cell count)
- • Uncontrolled heart failure
How Much Does TRT Cost?
Cost varies significantly based on how you access treatment:
| Option | Monthly Cost | What's Included |
|---|---|---|
| Online TRT Clinics | $150-250/mo | Consultation, labs, medication, ongoing monitoring |
| Urologist + Insurance | $30-100/mo | Copays for visits, labs, medication (if covered) |
| Testosterone Injections (generic) | $30-60/mo | Medication only (Cypionate/Enanthate) |
| AndroGel (brand) | $400-600/mo | Retail price without insurance |
| Comprehensive Men's Clinic | $250-500/mo | Full optimization including additional hormones/peptides |
Best value: Online TRT clinics offer all-inclusive pricing that's predictable and usually includes everything you need. Going through insurance can be cheaper but often involves more hoops and may not cover the medication itself.
Online TRT vs. Traditional Doctor: Which Is Better?
Online TRT Clinics
Telemedicine platforms specializing in hormone optimization. Examples: Fountain TRT, Marek Health, TRT Nation.
Traditional Doctor (Urologist/Endo)
In-person care through a urologist, endocrinologist, or primary care physician.
What to Expect: The TRT Timeline
Week 1-2: Getting Started
Blood work, consultation, prescription. You may feel a subtle boost in mood/energy early, but this is often placebo—give it time.
Week 3-6: Early Changes
Libido often increases noticeably. Energy levels improve. Sleep may improve or worsen (varies by individual).
Month 2-3: Stabilization
Blood work to check levels. Dose adjustments if needed. Muscle and body composition changes begin. Most side effects that will occur have appeared.
Month 6+: Full Effects
Maximum benefits realized. Ongoing monitoring every 6-12 months. You'll know by now if TRT is working for you.
Alternatives to TRT
If you want to address low testosterone without committing to exogenous testosterone, there are alternatives:
- Clomiphene (Clomid) — Stimulates your body to produce more testosterone naturally. Often used for men wanting to preserve fertility.
- hCG (Human Chorionic Gonadotropin) — Stimulates the testes to produce testosterone. Sometimes used alongside TRT to maintain testicular function.
- Lifestyle optimization — Better sleep, weight loss, strength training, and stress management can boost testosterone 10-30% in some men.
- Enclomiphene — Newer, cleaner version of Clomid with fewer side effects.
The Bottom Line
TRT can be genuinely life-changing for men with clinically low testosterone. The fatigue lifts, motivation returns, and quality of life improves significantly.
But it's not a decision to take lightly. You're committing to:
- Ongoing treatment (potentially for life)
- Regular blood monitoring
- Managing side effects
- Cost ($150-250/month is realistic for most)
Best candidates: Men with confirmed low testosterone (<300 ng/dL on two tests), clear symptoms, no contraindications, and realistic expectations about what TRT can and can't do.
Find TRT Treatment
Choose telehealth convenience or find local hormone clinics with hands-on care.
Related Resources
Medical Disclaimer
This guide is for educational purposes only and does not constitute medical advice. Testosterone replacement therapy is a prescription treatment that should only be used under physician supervision. Individual results vary. Always consult with a qualified healthcare provider before starting TRT.