Testosterone replacement therapy sits at the honest end of the men’s wellness menu: a real drug, a real diagnosis, a real trial behind its safety, and a real cost to getting it wrong. In the past five years it has moved from urologists and endocrinologists into med spas, men’s health franchises and telehealth, and searches for a clinic nearby have followed. This page covers who it is for, what the evidence says, what a monitored program looks like, and how to tell a clinic that practices medicine from one that sells vials.
Who TRT is for
Hypogonadism is a medical diagnosis, and it has two halves. The first is symptoms: low libido, weaker erections, fatigue that sleep does not fix, loss of muscle and strength, low mood, loss of body hair, sometimes anemia or low bone density. The second is the number: total testosterone that is unequivocally low, measured on two separate mornings, fasting, because levels peak early and swing through the day. The Endocrine Society’s guideline requires both. A low number without symptoms is not treated. Symptoms with a normal or borderline number get worked up for the usual suspects first (sleep apnea, weight, thyroid, depression, medications), because those are more common causes of feeling terrible at 45 than testosterone is.
Age matters too. Testosterone drifts down about one percent a year from the thirties on, and the FDA’s labeling explicitly says testosterone products are not approved for low levels caused by aging alone. The guideline suggests against routinely treating every man over 65 with a low number, while allowing it case by case for men with symptoms after a frank discussion.
The forms and what they cost
Injections. Testosterone cypionate or enanthate, self-injected into muscle or under the skin once or twice a week at home. Cheapest, most adjustable, most common in clinic programs. $150 to $250 a month at a US med spa including supplies and check-ins.
Gels and patches. FDA-approved daily products applied to the skin. Steady levels, no needles, but the gel can transfer to a partner or child on contact, and cash prices run $200 to $500 a month. Often cheaper with insurance through a regular physician.
Pellets. Small cylinders implanted under the skin of the hip in a five-minute office procedure every three to six months, $500 to $1,000 per insertion. Convenient, and popular in med spas because the visit is the product. The dose cannot be changed once implanted, the pellets are usually compounded rather than FDA-approved, and a level that runs too high stays high for months. Compounded drugs are not FDA-approved and the agency does not check their quality before sale, so the pharmacy matters.
Add-ons. Some programs bundle hCG (to preserve testicular function and fertility), anastrozole (to control estradiol) or enclomiphene (which raises your own production and is used instead of testosterone in men who want to keep fertility). Each adds $50 to $150 a month. hCG for a man who does not care about fertility, and anastrozole for a man whose estradiol is normal, are upsells.
What the evidence says about safety
For years the boxed warning on every testosterone product warned of heart attack and stroke, based on weak observational data. The TRAVERSE trial settled it as well as anything can: 5,246 men aged 45 to 80 with hypogonadism and existing heart disease or high risk, randomized to testosterone gel or placebo, followed for nearly three years. No increase in heart attack, stroke or cardiovascular death. In February 2025 the FDA removed that language from the boxed warning on the whole class.
What the FDA added is a warning that testosterone raises blood pressure, confirmed by the ambulatory monitoring studies every manufacturer was required to run. So blood pressure is checked at every visit, and men with poorly controlled hypertension are treated carefully or not at all. TRAVERSE also saw more atrial fibrillation, blood clots and acute kidney injury in the testosterone group, small in absolute terms but real.
The everyday risk is thicker blood. Testosterone raises hematocrit, and a hematocrit above the normal range is the most common reason a dose is cut or therapy paused. Acne, fluid retention, breast tenderness, testicular shrinkage and mood changes are the others. Sperm production usually falls to near zero on therapy and can take up to a year to recover, which is why the guideline lists a desire for children in the near term as a reason not to start.
Men with prostate or breast cancer, a prostate nodule or elevated PSA that has not been evaluated by a urologist, elevated hematocrit, untreated severe sleep apnea, a recent heart attack or stroke, or uncontrolled heart failure should not be started. A clinic that does not ask about every one of those is not screening you.
What a monitored program looks like
Before the first dose: two morning testosterone levels, hematocrit, PSA, blood pressure, and a history that covers prostate, sleep apnea, fertility plans and heart disease. At three months: testosterone level to set the dose, hematocrit, PSA, blood pressure, symptoms. Then yearly, or sooner if the dose changes. In the first year, a PSA that rises more than 1.4 above baseline, or above 4.0, means a urologist, not a dose tweak. That schedule is the minimum; it is also, at most reputable clinics, exactly what you get.
Choosing a clinic
Ask who the prescriber is and who the medical director is. Ask whether they require two morning labs before starting, and what result would make them say no. Ask which product and, if pellets or compounded testosterone, which pharmacy. Ask what the monthly cost is after the first visit and what the labs cost. Ask what happens to your fertility. A men’s health clinic or med spa that answers all five plainly is doing this properly, and many of them also run peptide therapy and medical weight loss programs on the same labs, which is convenient as long as each one is prescribed on its own merits. Women’s hormone therapy has its own page on ClinicCompass, since the drugs, the evidence and the questions are different.
Where to compare TRT
Compare men’s hormone programs at clinics in Phoenix, Seattle, Atlanta and Austin, or browse testosterone replacement therapy providers in your city. Dedicated men’s health clinics that do not offer aesthetic treatments are not listed on ClinicCompass; the clinics here run TRT alongside a med spa menu, so ask specifically about the prescriber’s experience with hormone therapy.