Where to get Testosterone prescriptions?

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.

I check the local TRT type places and they're 400 a month and they require you go into their office 4 times a month for injections and I already do my own. I pay 25 bucks a month for 1 vial of enanthate at CVS.

I pay out of pocket anyway since it's cheaper than going through insurance. What's the best way to get a prescription called into my pharmacy. What types of medical options are there? Online options?
-Thanks

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Briefing Document: Navigating Testosterone Replacement Therapy (TRT) Prescriptions​

This briefing document summarizes key themes and practical advice from the Excel Male TRT Forum regarding obtaining and managing testosterone replacement therapy (TRT) prescriptions. It highlights challenges patients face, optimal treatment approaches, and various provider options.

I. Challenges in Obtaining and Managing TRT Prescriptions​

Patients on TRT often encounter difficulties, primarily concerning physician understanding of optimal testosterone levels and the financial burden associated with certain clinics.

• Physician Discrepancies in Optimal Levels: A significant challenge is the differing opinions among physicians regarding "optimal" testosterone levels. As one user, DocGeezer, states, after his primary care physician retired, his "new guy want's it to be below 750. 'Don't care how you feel, it's too high!!!'" This highlights a common conflict between a patient's felt experience and a doctor's adherence to specific lab ranges, even when those ranges may be artificially low or not aligned with symptom resolution. "testiculus" notes that "Each lab has their own range and in general labs have been lowering their 'normal' range which really just represents the 2.5 percentile cutoff, not really normal. So going by the lab range as a treatment guideline is meaningless."
• Cost and In-Office Requirements of TRT Clinics: Many "local TRT type places" are expensive, with DocGeezer stating they are "$400 a month and they require you go into their office 4 times a month for injections," despite him already self-injecting. This financial strain and inconvenient requirements push patients to seek more affordable and flexible options. "jayt" explicitly advises: "My advice is simple.... go to a Urologist and forget the 'male' clinics. 'Male' clinics overcharge for blood work and the prescriptions, they prey on men's desires..." This sentiment is echoed by "amphibiousnick," who agrees, "They are mostly experts in marketing."
• Insurance Coverage Issues: While some patients pay out of pocket because it's "cheaper than going through insurance," as DocGeezer notes, others like "jayt" have found success with insurance coverage for urologist visits and prescriptions, with T eventually being covered "100%."

II. Optimal TRT Treatment and Monitoring​

The forum emphasizes a patient-centric approach to TRT, prioritizing symptom resolution over strict adherence to laboratory ranges, while also acknowledging potential risks of supraphysiological levels.

• Focus on Symptom Resolution and "Feeling Good": Many users advocate for prioritizing how the patient feels. DocGeezer found "800 to 1000 seems to be the sweet spot for me" and describes TRT as "life changing." "testiculus" asserts, "In general a good urologist will look to find the lowest dose that fully resolves your symptoms of hypogonadism rather treating to a number." Similarly, "FunkOdyssey" argues against changing a "dialed-in" protocol that has delivered "consistent results over a relatively long period of two years," even if lab results are high, provided other health markers are stable. "tropicaldaze1950" supports this, stating, "If you feel good physically/mentally on your dose, labs and BP are in range, no problem. This isn't about how everyone else feels; it's about you."
• Beyond Total Testosterone: Importance of Free T and Other Markers: While total testosterone levels are discussed, "Sergel" and "Cataceous" stress the importance of free/bioavailable testosterone and Sex Hormone Binding Globulin (SHBG). "Total T is not very useful. What is your SHBG/Free T number?" and "As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high."
• Monitoring Health Risks: Despite the emphasis on feeling good, there is a strong cautionary note about the risks of supraphysiological levels. "Cataceous" warns that a dose like 180-200 mg/week is "about triple the testosterone the average healthy young guy makes naturally. This is not TRT." He advises understanding "the uncertain long-term risks related to blood viscosity and cardiotoxicity," and emphasizes checking "hematocrit and lipids." "Wilson7" also advises to "Watch BP, HCT and PSA, other that that general chems once or twice year."

III. Recommended Medical Options for Prescriptions​

The forum provides several recommendations for obtaining TRT prescriptions, with a strong preference for specialists over general practitioners and a nuanced view on online clinics.

• Urologists: This specialty is widely recommended due to their expertise. "testiculus" states, "Try a local urologist. In general urologists are more informed than other medical specialities with TRT." He suggests seeking those with fellowships under experts like Lipshultz at Baylor or Morgentaler at Harvard. "jayt" directly advises: "go to a Urologist and forget the 'male' clinics."
• Online/Telehealth Clinics (with caveats): While some "telehealth or clinic" options are noted as more expensive (e.g., "$175/month for telehealth thru a clinic" by "Daveleeander"), "Defy" is repeatedly mentioned as a reputable online option. "testiculus" states, "If you're unable to find a good urologist locally. Defy would probably be your best option." "tumbleweed" also endorses them: "Defy Medical. Been there 10 years. Pay for what you get. Reasonable prices. They go by how you feel. They don't care about 1000+ test levels."
• Compounding Pharmacies and GoodRx: For cost-effective solutions, users recommend compounding pharmacies like Wells or APS, where one can get a "10ml vial delivered" for about "$100." "Wilson7" mentions that "GoodRx 10 cc 200 mg/ml is about $40."
• Naturopathic Doctors (for holistic care): "amphibiousnick" suggests "finding a good naturopathic doctor that well-versed in TRT instead of a urologist if you can afford to. They will lookout for your health in a much more holisitic manner than a urologist would."
• Avoid "Pill Mills" and Marketing-Focused Clinics: There's a consensus to avoid "HRT clinics" that are seen as "the equiv of pill mills for opioids IMO and they can rape you on cost and unnecessary labs," as stated by "Wilson7."

In conclusion, the forum discussions reveal a strong desire among TRT patients for physicians who prioritize patient well-being and symptom resolution over arbitrary lab ranges, alongside a need for affordable and accessible prescription options. Urologists, especially those with specialized training, and certain patient-focused online clinics like Defy Medical, appear to be preferred choices over expensive and marketing-driven "male clinics."

Click: Looking for a TRT doctor?

 

Try a local urologist. In general urologists are more informed than other medical specialities with TRT. If you're in a major metro area look for a urologist that did a fellowship at Baylor in Houston under Lipshultz or Harvard in Boston under Morgentaler. If you're unable to find a good urologist locally. Defy would probably be your best option.

 

If you are with a good doctor not trying to mark up prescriptions like crazy, get a 90-120 day supply from Wells or APS compounding pharmacies. I pay about $100 for a 10ml vial delivered.

 

Try a local urologist. In general urologists are more informed than other medical specialities with TRT. If you're in a major metro area look for a urologist that did a fellowship at Baylor in Houston under Lipshultz or Harvard in Boston under Morgentaler. If you're unable to find a good urologist locally. Defy would probably be your best option.

I'm in Texas so finding a urologist educated at Baylor is very easy, actually rather hard to find any not educated at Baylor. How would you search for Fellowships under Lipshultz?

...and when did 155-721 (ng/dL) become the range, I thought everyone was shooting for 800 to 1100?

 

I'm in Texas so finding a urologist educated at Baylor is very easy, actually rather hard to find any not educated at Baylor. How would you search for Fellowships under Lipshultz?

...and when did 155-721 (ng/dL) become the range, I thought everyone was shooting for 800 to 1100?

I don't have a good answer. The only thing I can suggest is to look at each Urologist's background and see if they mention a residency or fellowship in Lipshultz's clinic. He usually has 2 research fellows and 2 clinical fellows every year, plus who knows how many residents.

Each lab has their own range and in general labs have been lowering their "normal" range which really just represents the 2.5 percentile cutoff, not really normal. So going by the lab range as a treatment guideline is meaningless.

In general a good urologist will look to find the lowest dose that fully resolves your symptoms of hypogonadism rather treating to a number.

 

You also have to consider what level of free/bio available T this 800~1000 total T takes you... Total T is not very useful. What is your SHBG/Free T number?

1000 is high, unless you have high SHBG this puts most males in superphysiological free T ...

I think you need a good TRT doc... I would not knock the lower doses until you have tried them, you might feel better... many, including me do...

 

With telehealth or clinic you’re certainly gonna pay a considerable bit more than $25/ month. I pay $175/month for telehealth thru a clinic. If you’re looking for inexpensive go over to naps and order some. Or answer one of those ads on fb where you call in, get diagnosed and get a script. Don’t know what that costs though

 

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.
...

Don't be so quick to dismiss the new doctor. It sounds like you're taking 180-200 mg of testosterone enanthate once a week, is this right? If so then you are taking about triple the testosterone the average healthy young guy makes naturally. This is not TRT. Feeling good in the short term is not the whole story. How are hematocrit and lipids? As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high. If you are injecting once a week and measuring at trough then your peak serum testosterone is probably 2,000-3,000 ng/dL. Your doctor is right to want to avoid this. Of course, as an adult you are free to disregard cautionary advice, but you should try to understand the uncertain long-term risks related to blood viscosity and cardiotoxicity, in case they end up applying to you.

 

Don't be so quick to dismiss the new doctor. It sounds like you're taking 180-200 mg of testosterone enanthate once a week, is this right? If so then you are taking about triple the testosterone the average healthy young guy makes naturally. This is not TRT. Feeling good in the short term is not the whole story. How are hematocrit and lipids? As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high. If you are injecting once a week and measuring at trough then your peak serum testosterone is probably 2,000-3,000 ng/dL. Your doctor is right to want to avoid this. Of course, as an adult you are free to disregard cautionary advice, but you should try to understand the uncertain long-term risks related to blood viscosity and cardiotoxicity, in case they end up applying to you.

You make a bunch of good points as usual. I would personally be hesitant to make changes to a protocol described as "dialed-in, "life changing," and has delivered consistent results over a relatively long period of two years. Yes, check your HCT, lipids, blood pressure, etc, and read up on the risks of supraphysiologic levels so you are well-informed. However, if everything looks good and the only cause we have for alarm is your Total T lab result, I'd be on team "find a new doctor".

 

I'd say, try to lower the dose to get around 700 total T, to satisfy the new doctor. I don't believe a trough level of 700 and "between 800-1000" is a massive difference in terms of effects or side effects.

 

Don't be so quick to dismiss the new doctor. It sounds like you're taking 180-200 mg of testosterone enanthate once a week, is this right? If so then you are taking about triple the testosterone the average healthy young guy makes naturally. This is not TRT. Feeling good in the short term is not the whole story. How are hematocrit and lipids? As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high. If you are injecting once a week and measuring at trough then your peak serum testosterone is probably 2,000-3,000 ng/dL. Your doctor is right to want to avoid this. Of course, as an adult you are free to disregard cautionary advice, but you should try to understand the uncertain long-term risks related to blood viscosity and cardiotoxicity, in case they end up applying to you.

If he had never tried a lower dose, I would agree with you. But it sounds like he already went through titration with his previous physician and knows that it takes 180 mg/week to resolve his symptoms. Just because someone is taking a higher dose than most need doesn't mean it's inappropriate. Too much weight is placed on serum levels. Find the lowest dose that fully resolves symptoms. Otherwise what's the point. Why feel like crap all the time and lead a miserable life when you know you can be normal - it just takes a little higher dose.

 

If he had never tried a lower dose, I would agree with you. But it sounds like he already went through titration with his previous physician and knows that it takes 180 mg/week to resolve his symptoms. Just because someone is taking a higher dose than most need doesn't mean it's inappropriate. Too much weight is placed on serum levels. Find the lowest dose that fully resolves symptoms. Otherwise what's the point. Why feel like crap all the time and lead a miserable life when you know you can be normal - it just takes a little higher dose.

My suspicion is that this is yet another case of "start high, go higher", very common with injections. But maybe he's an exception. It's highly questionable that a guy needs more testosterone than any man on the planet could make naturally. But sure, if he's tried a range of physiological doses with long stabilization periods, and understands the risks, then have at it.

 

Defy Medical. Been there 10 years. Pay for what you get. Reasonable prices. They go by how you feel. They don't care about 1000+ test levels.

 

My non-medical two cents. GoodRx 10 cc 200 mg/ml is about $40. This business of HRT clinics is the equiv of pill mills for opioids IMO and they can rape you on cost and unnecessary labs that they get kick backs on bc they can, knowing most docs either won't or under treat with T. I've seen nothing in the lit that suggests that 800 - 1200 is going to put anyone in the grave faster than 400 - 800. Watch BP, HCT and PSA, other that that general chems once or twice year. It takes +300 mg/wk to affect lipids (Bhasin et al) and HDL is overrated esp if > 35 regardless. I am lucky I have had the same urologist for 30 yrs, at some point he'll retire and I'll sort it out. If you do your own injections, through Walk in labs (unless you live in a nanny state) do serial measures every 4 days for 2 weeks post inj and figure out how long after an inj you need to go to fall within a given lab value range (start from steady state not your first inj). Ask your doc what his/her sweet spot is and make it work. As long as the rest of your labs are good, keep it where you feel your best (as long as its not averaging >1000).

 

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.

I check the local TRT type places and they're 400 a month and they require you go into their office 4 times a month for injections and I already do my own. I pay 25 bucks a month for 1 vial of enanthate at CVS.

I pay out of pocket anyway since it's cheaper than going through insurance. What's the best way to get a prescription called into my pharmacy. What types of medical options are there? Online options?
-Thanks

If you’re in the DFW area I can recommend an outstanding urologist. I had the same issue with my PCP. As a rule they simply don’t have sufficient experience managing TRT. Anyone can prescribe it but not everyone can properly manage it.

I recently relocated out of the country and I have the same fear of getting a new doc as you. Fortunately where I’m located testosterone is OTC and far easier to get. So, I know what works for me and am really hesitant to tinker with it. If it ain’t broke don’t fix it.

 

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.

I check the local TRT type places and they're 400 a month and they require you go into their office 4 times a month for injections and I already do my own. I pay 25 bucks a month for 1 vial of enanthate at CVS.

I pay out of pocket anyway since it's cheaper than going through insurance. What's the best way to get a prescription called into my pharmacy. What types of medical options are there? Online options?
-Thanks

12 years ago I went to Boston Medical Group, they did blood tests and prescribed T and Viagra. Charged me $300. I then decided to go to a Urologist on my med plan. They did the same thing, blood tests and prescribed me T and Viagra. The office visit cost me $20 copay and both the T and Viagra were prescribed thru CVS. I have continued with visits to my Urologist 4 times a year and 5 years ago used GoodRX for the prescriptions at CVS. Today, T is covered by my health insurance 100% and I have moved from Viagra to Trimix. Trimix is prescribed and filled by a local compounding pharmacy and costs me $99 for 5ml, which is approximately 40 injections, lasting me about 3 months. My advice is simple.... go to a Urologist and forget the "male" clinics. "Male" clinics overcharge for blood work and the prescriptions, they prey on men's desires...

 

12 years ago I went to Boston Medical Group, they did blood tests and prescribed T and Viagra. Charged me $300. I then decided to go to a Urologist on my med plan. They did the same thing, blood tests and prescribed me T and Viagra. The office visit cost me $20 copay and both the T and Viagra were prescribed thru CVS. I have continued with visits to my Urologist 4 times a year and 5 years ago used GoodRX for the prescriptions at CVS. Today, T is covered by my health insurance 100% and I have moved from Viagra to Trimix. Trimix is prescribed and filled by a local compounding pharmacy and costs me $99 for 5ml, which is approximately 40 injections, lasting me about 3 months. My advice is simple.... go to a Urologist and forget the "male" clinics. "Male" clinics overcharge for blood work and the prescriptions, they prey on men's desires...

Agreed about male clinics. They are mostly experts in marketing. The only other thing I would recommend is finding a good naturopathic doctor that well-versed in TRT instead of a urologist if you can afford to. They will lookout for your health in a much more holisitic manner than a urologist would.

 

Call the urology department at Baylor, tell them where you're located and that you're looking for a urologist who prescribes TRT. I've read that Dr. Lipshultz prescribes 200 mg, weekly. If you feel good physically/mentally on your dose, labs and BP are in range, no problem. This isn't about how everyone else feels; it's about you.

 

1. What are the common challenges when seeking testosterone replacement therapy (TRT) prescriptions?​

A primary challenge is finding a doctor who is well-informed and comfortable managing TRT, especially concerning optimal testosterone levels. Many primary care physicians may be hesitant or lack sufficient experience, often adhering strictly to lab "normal" ranges rather than considering a patient's symptoms or well-being. This can lead to situations where patients are told their levels are "too high" despite feeling optimal, forcing them to seek new providers. Additionally, the cost of TRT can vary significantly, with some clinics charging high monthly fees and requiring frequent in-person visits, while pharmacy prescriptions can be much cheaper, especially when paid out of pocket or using discount programs.

2. What types of medical professionals are generally recommended for prescribing TRT?​

Urologists are frequently recommended for TRT prescriptions, as they are often more informed about the therapy than other specialties. It's suggested to look for urologists with specific fellowship training in men's health or under prominent figures in the field, like those from Baylor in Houston (Lipshultz) or Harvard in Boston (Morgentaler). While some "male clinics" exist, they are often criticized for overcharging and prioritizing marketing over patient care. Some users also suggest considering a naturopathic doctor well-versed in TRT for a more holistic approach, if affordable.

3. How do "optimal" testosterone levels differ from "normal" lab ranges, and why is this distinction important?​

"Normal" lab ranges for testosterone are often determined by the 2.5 percentile cutoff, which may not reflect what is optimal for an individual's well-being and symptom resolution. Many TRT users report feeling their best at total testosterone levels between 800-1000 ng/dL, or even higher, while "normal" lab ranges can be significantly lower (e.g., 155-721 ng/dL). A good TRT doctor will prioritize resolving symptoms of hypogonadism with the lowest effective dose rather than strictly adhering to a lab-defined numerical range. It's crucial to consider free and bioavailable testosterone levels as well, not just total testosterone, as these provide a more accurate picture of how much testosterone is actually usable by the body.

4. What are the cost considerations for TRT, and how can patients save money?​

The cost of TRT can vary significantly. Local "TRT type places" or specialized clinics might charge as much as $400 a month, often requiring frequent in-office injections. In contrast, obtaining a prescription through a regular physician and filling it at a retail pharmacy like CVS can be as low as $25 a month for a vial of enanthate, especially when paying out of pocket (which can sometimes be cheaper than going through insurance). Compounding pharmacies like Wells or APS can also offer more affordable options, with a 10ml vial costing around $100 for a 90-120 day supply. Telehealth clinics might fall in between, with costs around $175/month. Using discount cards like GoodRx can also significantly reduce prescription costs.

5. What are the potential risks and considerations with higher TRT doses?​

While some patients feel optimal at higher total testosterone levels (e.g., 800-1000 ng/dL), particularly if they have high SHBG, there are concerns about supraphysiological levels. Doses that result in peak serum testosterone of 2,000-3,000 ng/dL or triple the natural production are generally not considered standard TRT. Potential long-term risks include issues related to blood viscosity (hematocrit), cardiotoxicity, and effects on lipids. Doctors often emphasize monitoring hematocrit, lipids, and blood pressure, and aim for the lowest dose that resolves symptoms to mitigate these risks. It's essential for patients to understand these uncertain long-term risks and have regular lab checks to ensure safety.

6. Is it acceptable to prioritize how one feels over specific lab numbers when on TRT?​

There is a significant debate on this point. Many patients and some doctors advocate for a "feelings-based" approach, where the primary goal is to resolve symptoms and improve quality of life, even if it means slightly exceeding standard lab "normal" ranges. If a patient is "dialed in" and feeling good, with supporting labs (hematocrit, lipids, blood pressure) in a healthy range, some argue that sticking to a protocol that works is paramount. However, other medical professionals emphasize the importance of physiological levels to minimize long-term health risks, even if a slightly lower dose might lead to minor symptomatic changes. Ultimately, it requires an informed discussion between the patient and a knowledgeable doctor who considers both symptomatic relief and objective health markers.

7. How does self-injection compare to in-office injections, and what are the cost implications?​

Self-injection of testosterone is common among TRT patients and is generally much cheaper than relying on in-office injections. Some local TRT clinics may require patients to visit their office multiple times a month for injections, adding significant cost ($400/month in one example). Patients who are comfortable administering their own injections can greatly reduce monthly expenses by obtaining a prescription and filling it at a retail or compounding pharmacy.

8. What information should patients gather or consider when discussing TRT with a new doctor?​

When discussing TRT with a new doctor, especially if current levels are higher than what the doctor prefers, patients should be prepared to discuss their symptom resolution, how long they've been on their current protocol, and the results of other relevant lab tests like hematocrit, lipids, and blood pressure. It's also important to understand the doctor's philosophy on TRT management – whether they prioritize symptomatic relief, strict adherence to lab ranges, or a balance of both. Patients might also ask about the doctor's experience with TRT, particularly if they have fellowship training or a track record of successfully managing patients with various TRT needs.