Testosterone replacement therapy is one of the fastest-growing corners of men’s health, and picking the wrong doctor can mean missed diagnoses, unnecessary prescriptions or side effects that get worse before anyone notices. If you are considering TRT, the physician you choose matters as much as the therapy itself.
The right doctor rules out other causes, orders the correct baseline tests and monitors your bloodwork on a schedule. The wrong one hands over a prescription and hopes for the best.
What to Look for in a TRT Doctor
Start with a specialist who treats low testosterone regularly. Urologists and andrology-focused practices see these cases every day, which matters because diagnosis is not straightforward. If you visit your primary care doctor first, they may refer you to a specialist.
“For some older men, raising low testosterone levels can improve some aspects of their physical and mental well-being,” Dr. Michael O’Leary, a urologist at Harvard-affiliated Brigham and Women’s Hospital, told Harvard Health. “But TRT won’t suddenly turn back the clock.”
A good doctor will first look for treatable explanations behind your symptoms. “The first step is to determine if any symptoms attributed to low testosterone are related to something else that’s treatable,” O’Leary said. Fatigue, brain fog and reduced libido often trace back to poor nutrition, an inactive lifestyle or chronic sleep deprivation. Erectile dysfunction can trigger stress, anxiety and depression on its own. “Raising low testosterone levels alone won’t fix these problems,” O’Leary added.
What Questions to Ask Before Starting TRT
Bring a short list to your first appointment. The answers will tell you quickly whether the doctor is following clinical guidelines or shortcutting them.
- How many blood tests will you run before recommending therapy? Levels fluctuate daily, so a single low reading is not enough.
- Will you check my prostate-specific antigen and red blood cell count first? Henry Ford Health notes this baseline is critical because TRT can push red blood cells to unhealthy levels.
- What symptoms are you treating? According to Harvard Health, men typically need both low blood levels and clear symptoms, especially fatigue and sexual dysfunction, before therapy is appropriate.
- Could weight gain or a medication be driving my numbers down? If so, your doctor should address that first.
- What are the risks for me specifically? The Mayo Clinic lists worsening sleep apnea, acne, benign prostate growth, breast enlargement, reduced sperm production, shrinking testicles and elevated red blood cell counts that can raise clot risk.
If a provider skips the workup or downplays the risks, walk out.
What Tests and Follow-up Visits Should Look Like
Diagnosis is built on a physical exam, a symptom review and multiple blood draws. Harvard Health notes your doctor may also order a bone density test, since low testosterone can accelerate bone loss.
Once treatment starts, expect frequent check-ins. “When you start testosterone replacement therapy, you will have to see your doctor regularly to have your blood and testosterone levels checked. Most men visit their doctor every three months for the first year and then every six months if you’re healthy,” Henry Ford Health advises.
Dosing is where many patients get shortchanged. “For testosterone to be effective, an adequate and correct dose of the hormone needs to be administered. Often, the dose needs to be adjusted over time to reach therapeutic levels. One of the most common reasons for the failure of testosterone replacement is due to suboptimal dosing,” according to New York Urology Specialists.
How a Specialist Approaches TRT
Dr. Akhil Muthigi, a urologist at Houston Methodist, described his approach in detail on the hospital’s site.
“First, I first promote healthy lifestyle habits, all of which can naturally boost testosterone production,” Muthigi said. “That includes regular exercise, both strength training and cardio, adequate sleep, stress management, a nutrient-rich diet high in protein, and weight loss if applicable.”
Only after lifestyle changes fall short does he raise the option of supplementation. “In my practice and most other andrology-focused practices, if a patient meets the criteria of hypogonadism, I offer testosterone therapy as long as there are no contraindications that make it unsafe for them to take,” he said. Those contraindications can include a desire to preserve fertility, a recent heart attack or stroke and certain advanced prostate cancers.
Muthigi also emphasized that TRT is not one-size-fits-all. Formulations include topical gels, nasal sprays, oral tablets and short- and long-acting injections. “The form of testosterone we ultimately decide upon involves shared decision-making with the patient based on their goals and preferences,” he said.
His advice for anyone weighing the therapy is direct. “If men harbor any of the hallmark symptoms of low T and hypogonadism, I advise they meet with an andrology specialist for a thorough history and physical exam and to have their testosterone levels checked,” Muthigi said.
