What is testosterone replacement therapy, and who is it for?
TRT replaces testosterone your body isn't making enough of. It's a treatment for a diagnosed medical condition, male hypogonadism, not a performance or anti-aging product.
Testosterone is made mainly in the testes, under signals from the pituitary gland. It supports sex drive and erections, muscle and bone, red blood cell production, body fat distribution, mood and energy. Hypogonadism means levels are consistently low and you have symptoms that fit. The cause can be in the testes (primary hypogonadism, for example after injury, infection or chemotherapy) or in the brain's signaling (secondary hypogonadism, which can follow pituitary problems, certain medications, opioid use, sleep apnea and, very commonly, obesity and type 2 diabetes).
Testosterone also drifts down slowly with age. The FDA approves testosterone only for men who have low levels together with an associated medical condition, and its labeling keeps a limitation that safety and effectiveness for age-related low testosterone alone have not been established. That's why a good clinic looks for the reason your level is low, rather than treating a number.
What are the signs of low testosterone in men?
Low testosterone rarely shows up as one dramatic symptom. It's usually a cluster that builds over months or years, and many of these symptoms have other causes too, which is why labs matter.
Sexual health
Lower sex drive, fewer spontaneous or morning erections, erectile problems. These are the symptoms most specific to low testosterone.
Energy and mood
Persistent fatigue, low motivation, irritability, a flat or depressed mood, trouble concentrating.
Body composition
Losing muscle and strength despite training, gaining fat around the middle, sometimes breast tissue tenderness or enlargement.
Longer-term signs
Thinning bones or a low-trauma fracture, mild anemia, less body hair, hot flashes in more severe cases.
Things that mimic low T include poor sleep or untreated sleep apnea, thyroid disease, depression, heavy drinking, some medications and excess weight. Excess body fat itself lowers testosterone, and losing weight often raises it. For many of the men we see, the best plan addresses both at once.
How is low testosterone diagnosed?
Testosterone levels swing during the day and are highest in the morning. Clinical guidelines from the Endocrine Society and the American Urological Association recommend confirming a low result with repeat testing, drawn early in the morning, before starting any treatment.
| Test | Why it's ordered |
|---|---|
| Total testosterone (two morning draws) | Confirms a consistently low level. The AUA considers below 300 ng/dL a reasonable cutoff. |
| Free testosterone and SHBG | Helpful when total testosterone is borderline or when binding protein levels are likely off, for example with obesity or aging. |
| LH and FSH | Shows whether the problem starts in the testes or in the brain's signals, which changes the work-up and the options. |
| Hematocrit / CBC | A baseline red blood cell count, because testosterone can raise it. |
| PSA | A prostate baseline for men in the age range where screening applies or who are at higher risk. |
| Metabolic and other markers | Estradiol, thyroid, glucose or A1c and lipids as your provider decides, since they affect symptoms and safety. |
If your results point to a secondary cause, such as a pituitary issue or very high prolactin, that needs its own evaluation, sometimes with a specialist, before or instead of TRT.
Free, no-obligation consultation
Find out if your symptoms are really low T.
A free, no-obligation consultation online, by phone or in Mesquite, Fort Worth or Grand Prairie. If labs are needed, we'll explain exactly what we're testing and why.
What are the treatment options?
FDA-approved testosterone comes in several forms. Each brings levels into the normal range in a different rhythm, and the right one depends on your labs, lifestyle and preferences.
Injections
The most common option at our clinic. Given on a regular schedule into muscle or under the skin. Levels rise after each dose and fall before the next, so timing is tuned with follow-up labs.
Gels
Applied to the skin daily for steadier levels. They can transfer to a partner or child through skin contact, which carries a boxed warning; covering the area and washing hands matters.
Patches and buccal systems
Daily patches on the skin, or a tablet that sticks to the gum. Skin irritation is the common complaint with patches.
Oral capsules
Newer oral testosterone undecanoate products, taken with food. Blood pressure monitoring is especially emphasized in their labeling.
Testosterone is a Schedule III controlled substance, so it's prescribed only after an evaluation and refilled under ongoing supervision. If you want to keep your fertility, your provider may discuss other approaches, since added testosterone switches off the signals that drive sperm production.
Is TRT safe? Risks and monitoring per FDA labeling
For men with confirmed hypogonadism, TRT is an established treatment, but it has real risks that are managed by checking, not by hoping. In 2025 the FDA updated every testosterone label: it added results of the large TRAVERSE trial, which found no increase in major heart events in men with hypogonadism treated with testosterone, removed the boxed-warning language about increased cardiovascular risk, and added or kept warnings about increased blood pressure.
- Higher red blood cell count (erythrocytosis). The most common lab problem, especially with injections. Hematocrit is checked before treatment, a few months in, then regularly; a high value means a dose change or a pause.
- Blood pressure. Testosterone can raise it. Expect it to be checked at visits.
- Prostate. Testosterone can enlarge the prostate and worsen urinary symptoms, and it isn't used in men with known or suspected prostate or breast cancer. PSA is followed when screening applies.
- Fertility. Sperm counts fall, sometimes to zero, while on therapy.
- Other effects. Acne, fluid retention, breast tenderness, worsening untreated sleep apnea, and rarely blood clots in the legs or lungs.
Women should know that no testosterone product is FDA-approved for women in the U.S. Women's hormone symptoms are handled in our perimenopause and women's hormone care.
How long does TRT take to work?
Results build gradually and vary from man to man. In clinical studies, sexual desire and function tend to improve first, often within the first weeks to a few months. Effects on mood and energy are more variable. Changes in muscle, fat and bone density take many months, and they're bigger when treatment is paired with strength training, enough protein and weight loss when it's needed.
- First month.Your first doses, with instructions on technique, timing and what to report.
- Around 3 months.Repeat labs: testosterone level at the right point in the dosing cycle, hematocrit and other markers. Dose is adjusted if needed.
- 3 to 12 months.Your provider reviews whether your symptoms have actually improved. If they haven't, continuing isn't automatic.
- Ongoing.Labs and check-ins on a regular schedule for as long as you're on therapy, typically at least yearly once you're stable.
How Regal handles testosterone therapy in DFW
Regal has offered coaching-led medical care across Dallas–Fort Worth since 2016, and our TRT program follows the same idea: no prescription without a real evaluation, and someone checking in with you after it starts.
- Free consultation.Online, by phone, or in person at our Mesquite, Fort Worth or Grand Prairie office. You pick the day and time and tell us what you're dealing with.
- Lab panel.Morning testosterone testing and the safety markers above, so the decision rests on numbers, not guesses.
- Medical evaluation.Eric Naifeh, FNP, PMHNP, DC, our medical director, reviews your history, medications and labs, and prescribes testosterone only when it's clinically appropriate.
- Treatment and follow-up.Most clients use injections. Follow-up labs and visits adjust the dose and catch side effects early.
Because low testosterone and excess weight feed each other, many men combine TRT with one of our medical weight loss programs: a nutrition plan, weekly coaching check-ins and, when appropriate, GLP-1 medication. Regal is self-pay and many clients use HSA or FSA funds; costs are explained at the free consultation. Questions first? Call (866) 580-6863.
Frequently asked questions
What testosterone level is considered low?
The American Urological Association considers a total testosterone below 300 ng/dL a reasonable cutoff, confirmed on at least two separate early-morning tests. A number alone doesn't make the diagnosis, though: you also need symptoms that fit, and your provider may check free testosterone and SHBG when the total is borderline or when weight or age is likely affecting binding proteins.
Can I get TRT if my levels are normal but I feel tired?
Usually not. Guidelines advise against testosterone therapy when levels are normal, because the risks remain and the benefit isn't there. Fatigue has many causes, including poor sleep, sleep apnea, thyroid problems, depression and excess weight. A good evaluation looks for those, and treating them often helps more than testosterone would.
Does testosterone therapy affect fertility?
Yes. Added testosterone signals the brain to stop the hormones that drive sperm production, so sperm counts drop, sometimes to zero, while you're on it. Recovery after stopping can take months and isn't certain. If you hope to father children in the near future, tell your provider before starting; there are other approaches to discuss.
Will TRT help me lose weight?
Testosterone can modestly shift body composition toward more muscle and less fat in men who are truly deficient, but it isn't a weight loss drug. The relationship also runs the other way: excess body fat lowers testosterone, and losing weight often raises it. That's why many of our clients pair hormone care with a nutrition plan and weekly coaching.
Do I have to stay on testosterone forever?
Not necessarily. Men with permanent testicular damage usually need long-term therapy. When low testosterone is driven by something reversible, such as excess weight, sleep apnea or a medication, treating the cause may restore levels. Your provider reviews whether therapy is still helping at each stage, and stopping should be planned rather than abrupt.
Is TRT bad for your heart?
Earlier concerns led to a cardiovascular warning on testosterone labels. The large TRAVERSE trial found no increase in major heart events in men with hypogonadism, and in 2025 the FDA removed that boxed-warning language. Testosterone can raise blood pressure and red blood cell counts, however, so both are monitored throughout treatment.
Medically reviewed by
Eric Naifeh, FNP, PMHNP, DC
Medical Director at Regal Weight Loss. Reviews labs, evaluates patients and approves prescriptions across every Regal location. This page was reviewed for medical accuracy on November 2, 2026. It is general education, not medical advice: your provider decides what's right for you after an evaluation.
Sources
- FDA: Class-wide labeling changes for testosterone products (2025)
- Bhasin S et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2018
- Mulhall JP et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018
- Lincoff AM et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med 2023
- MedlinePlus: Testosterone injection
