Testosterone replacement therapy for men should begin with a blood draw, not a symptom quiz — and the fact that so many online programs skip that step is exactly why the field has a credibility problem. Low energy, low libido, poor recovery, and brain fog are real, but they are not a diagnosis. A diagnosis of hypogonadism requires confirmed low morning testosterone on more than one occasion, alongside symptoms. Anything less is guessing, and guessing with a hormone is not a shortcut worth taking.

Key Takeaways
  • Testosterone replacement therapy for men requires two confirmed low morning testosterone readings plus symptoms — not a questionnaire.
  • The workup includes total and free testosterone, LH, FSH, estradiol, prolactin, PSA, and a CBC.
  • Treatment is titrated to a target range and monitored, not set once and forgotten.
  • A clinician who reads your labs is the difference between optimization and a liability.

Start with the right labs

The workup is specific. Total testosterone drawn in the morning, when levels peak, and repeated to confirm — the Endocrine Society recommends against diagnosing on a single reading. Free testosterone, because sex-hormone-binding globulin can mask a true deficiency. LH and FSH, to separate a testicular cause from a pituitary one. Estradiol, prolactin, a PSA, and a complete blood count as a safety baseline. Our hormone optimization program orders this full panel before anyone discusses treatment, because the panel is the plan.

What the numbers mean

A total testosterone consistently below roughly 300 ng/dL with symptoms supports a diagnosis, but the free fraction and the LH/FSH pattern tell you why. High LH with low testosterone points to a testicular problem; low or normal LH with low testosterone points upstream to the pituitary. That distinction changes the treatment and sometimes reveals a cause that has nothing to do with aging. This is the analysis an algorithm cannot do and a rushed visit will not — it is the reason we read the labs with you.

See our membership options and how it works to start with a clinician who reads your labs.

Frequently Asked Questions

How is low testosterone actually diagnosed?

With two separate morning blood draws showing low total testosterone, alongside symptoms. A single reading or a symptom questionnaire is not sufficient, because levels fluctuate and symptoms are non-specific.

What labs are checked before starting?

Total and free testosterone, LH, FSH, estradiol, prolactin, PSA, and a complete blood count. This separates the cause, establishes a safety baseline, and guides the treatment choice.

Is testosterone therapy safe?

It is safe when monitored. Follow-up labs track testosterone level, estradiol, hematocrit, and PSA. The dose-related risks are manageable when someone is actually watching them.

References

  1. Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. 2018. doi.org/10.1210/jc.2018-00229