Testosterone Replacement Therapy: Complete Guide

Everything you need to know about TRT — from qualification to treatment to long-term management.

Updated December 202515 min read

FDA Update (February 2025): The FDA removed the black box cardiovascular warning from testosterone products following the TRAVERSE trial, which showed no increased cardiovascular risk.

What Is TRT?

Testosterone Replacement Therapy (TRT) is medical treatment for men with clinically low testosterone. It restores testosterone levels to normal range through injections, gels, or other delivery methods.

TRT is not the same as steroid abuse. It's prescribed by physicians to treat a legitimate medical condition (hypogonadism) and aims for normal, healthy testosterone levels — not supraphysiological levels.

Who Qualifies for TRT?

To qualify for TRT, you typically need:

<300

ng/dL

Clinically low

+

Symptoms

Fatigue, low libido, etc.

2x

Tests

Confirmed on repeat

Some clinics treat men in the 300-450 "borderline" range if symptoms are significant.

Delivery Methods

Injections (Most Common)

Testosterone cypionate or enanthate. Self-administered 1-2x weekly. Most cost-effective option.

Topical Gels/Creams

Applied daily to skin. No needles, but risk of transfer to partners/children. More expensive.

Pellets

Implanted under skin every 3-6 months. Set it and forget it, but requires office procedure.

What to Expect

  • Week 1-2: Improved energy, mood, sleep
  • Week 3-6: Increased libido, better erections
  • Month 2-3: Body composition changes begin
  • Month 6-12: Maximum results, stable baseline

Important Considerations

  • Fertility: TRT suppresses natural production and can reduce sperm count. HCG is often added to maintain fertility.
  • Commitment: TRT is typically a long-term or lifelong treatment. Stopping can cause temporary symptoms as natural production recovers.
  • Monitoring: Regular blood work required to monitor levels, hematocrit, PSA, etc.

Check Your Levels

Hone Health offers at-home testosterone testing. No lab visit required. Results in about a week.

Get Tested →