Men's health · Hormones
Five questions to ask before you start TRT
Testosterone therapy is easy to start and easy to run badly. These are the five questions that separate a managed protocol from a subscription.
Dr. Ryan Ramos · April 29, 2026
The market for testosterone therapy has grown much faster than the standard of care within it. These five questions will tell you quickly which kind of clinic you are dealing with.
1. How many times will you test me before prescribing?
The answer should be at least twice, both in the morning. Testosterone follows a daily rhythm and a single afternoon draw can put a normal man in the treatment range. A clinic that prescribes off one convenience-timed sample is not diagnosing anything.
2. Will you look for a cause first?
Low testosterone is frequently downstream of something else — sleep apnoea, obesity, thyroid disease, or a medication you are already on. Several of those are worth treating for their own reasons, and some men do not need TRT once they are addressed.
A clinic that never declines anyone is not screening anyone.
3. What will you monitor, and how often?
Three answers matter here: haematocrit, oestradiol and PSA. Haematocrit is the one that ends carelessly-run protocols — testosterone thickens blood, and a rising haematocrit needs a dose change, not a shrug. Quarterly is a reasonable cadence.
Ask whether labs are included or billed each time. It tells you what the business model actually is.
4. What happens to my fertility?
Exogenous testosterone suppresses your own production and can substantially reduce sperm count. If children are a possibility now or in ten years, this belongs in the first conversation. hCG alongside TRT, or enclomiphene instead of it, are both real options — and both are much easier to plan for at the start than to retrofit after two years.
If nobody raises this with you, they are not thinking past the current quarter.
5. How do I stop?
There is a recovery period when you come off a long course, and it should be managed rather than left to you. A clinic with no answer to this question has not thought about you as a patient with a life beyond their billing.
What this looks like here
Two morning draws, a workup for the cause, a protocol chosen with you, labs at six weeks and then quarterly, all included in the membership. If your numbers are fine and your symptoms are real, we will tell you that and look somewhere else — weight and metabolic health or sleep are the usual somewhere else.
