A Comprehensive Guide for Men Starting Testosterone Replacement Therapy
Introduction: Finding the Right TRT Doctor
Choosing the right TRT doctor is one of the most important decisions you will make on your hormone optimization journey. A knowledgeable TRT doctor can mean the difference between a life-changing treatment experience and years of frustration with suboptimal protocols, unnecessary side effects, and inadequate monitoring.Not all physicians are created equal when it comes to testosterone replacement therapy. Many general practitioners and even some endocrinologists have limited experience managing male hypogonadism. The best TRT doctor will have treated hundreds of patients, understand the nuances of different delivery methods, know how to manage estradiol and hematocrit, offer fertility preservation options, and most importantly, treat you as a partner in your healthcare rather than just a number.
This guide provides over 80 questions designed to help you evaluate any potential TRT doctor or clinic before committing to treatment. These questions cover everything from diagnostic approach and treatment protocols to practical matters like cost, communication, and accessibility. Whether you are seeing your first TRT doctor or considering switching providers, this comprehensive checklist will help you make an informed decision.
Remember: You are interviewing the TRT doctor as much as they are evaluating you. A good physician will welcome your questions and appreciate a well-prepared patient. If a doctor seems threatened by your knowledge or dismisses your concerns, that tells you everything you need to know about whether they are the right fit for your long-term care.
Note: I know these are too may questions. No need to ask each one but it is a good thing to get the flavor of what your discussion should be covering. Just pick the main questions that you deem important for you. If the doctor wants to rush you or acts "insulted", then consider that as a warning for what your relationship will be like.
Print this guide, bring it to your consultation, take notes, and trust your instincts. Your first visit sets the tone for your entire patient-doctor relationship.
1. Physician Experience & Credentials
How many male patients are you currently treating for hypogonadism or low testosterone? (Look for doctors managing at least 50-100+ patients regularly)What percentage of your practice is dedicated to hormone therapy or men's health?
How long have you been prescribing testosterone replacement therapy?
Are you board-certified, and in what specialty? (Endocrinology, urology, internal medicine, family medicine with additional training?)
Do you attend continuing education specifically related to hormone optimization?
Are you familiar with the current Endocrine Society and AUA guidelines on testosterone therapy?
2. Diagnostic Approach
What blood tests do you require before initiating TRT? (Expect at minimum: total testosterone, free testosterone, LH, FSH, estradiol, CBC, PSA, lipid panel, metabolic panel)Do you test testosterone levels on two separate mornings before diagnosis, per guidelines?
At what testosterone level do you consider treatment? (Understanding their threshold philosophy)
Do you evaluate symptoms in addition to lab values, or do you treat by the numbers only?
Do you investigate the underlying cause of low testosterone before prescribing? (Primary vs. secondary hypogonadism)
Do you check prolactin levels and consider pituitary evaluation when appropriate?
Do you assess thyroid function as part of your workup?
3. Treatment Protocols & Options
What testosterone delivery methods do you prescribe? (Injections, gels, creams, pellets, oral—and which do you prefer and why?)If using injections, do you offer both cypionate and enanthate? What about propionate for more frequent dosing?
What is your typical starting dose and injection frequency?
Are you open to more frequent, smaller injections (e.g., twice weekly or every other day) if needed for symptom stability?
Do you allow patients to self-inject at home, or do you require office visits for every injection?
How do you feel about subcutaneous injections versus intramuscular?
Do you work with compounding pharmacies to access customized formulations and more affordable options?
What are your thoughts on testosterone cream applied to the scrotum for enhanced DHT conversion?
4. Estrogen & Aromatase Management
How do you monitor and manage estradiol levels?At what estradiol level do you consider intervention?
Do you prescribe aromatase inhibitors (anastrozole/Arimidex) if estradiol becomes elevated? (Note: Many modern clinicians are moving away from routine AI use)
What is your philosophy on aromatase inhibitors—routine use, symptom-based, or avoid entirely?
Do you use the sensitive estradiol assay (LC-MS/MS) or the standard immunoassay?
5. Fertility & Testicular Function
Do you offer HCG (human chorionic gonadotropin) therapy to maintain testicular size and function?If fertility preservation is important to me, what is your protocol? (HCG, clomiphene, or referral to reproductive endocrinology)
Do you discuss sperm banking before initiating TRT?
Are you familiar with using enclomiphene or clomiphene as alternatives or adjuncts to testosterone?
If I am on TRT and want to conceive, what is your protocol for restoring fertility?
6. Hematocrit & Blood Management
How do you monitor hematocrit and hemoglobin levels?At what hematocrit level do you become concerned, and what actions do you take?
Do you provide orders for therapeutic phlebotomy or blood donation if hematocrit rises?
Have you had patients who needed to reduce dose or frequency due to polycythemia?
Do you check ferritin levels in patients requiring regular phlebotomy?
7. Monitoring & Follow-Up
How often do you require lab work after starting TRT? (Expect: 6-8 weeks initially, then every 3-6 months once stable)What labs do you include in routine monitoring? (Total T, free T, estradiol, CBC, PSA, metabolic panel at minimum)
Do you check trough levels (right before next injection) or peak levels?
How frequently will I need office visits once stabilized?
Do you share complete lab results with patients, or just tell them things are normal?
Do you provide lab orders so I can get blood work done locally or use direct-to-consumer labs?
Do you monitor cardiovascular markers (lipids, hsCRP, homocysteine)?
8. Complementary Therapies & Comprehensive Care
Do you prescribe or manage medications for erectile dysfunction (sildenafil, tadalafil) if needed?Do you address other aspects of men's health—sleep apnea screening, blood pressure, metabolic syndrome?
Do you recommend or prescribe DHEA supplementation when appropriate?
Are you familiar with thyroid optimization in conjunction with TRT?
Do you monitor and address vitamin D, zinc, and other micronutrients relevant to testosterone?
What are your thoughts on growth hormone peptides or HGH for appropriate candidates?
Do you have protocols for managing potential hair loss from TRT?
9. Practical & Administrative Questions
Do you accept my insurance, or is this cash-pay only?What is the cost of the initial consultation and follow-up visits?
What is the approximate monthly cost for testosterone and any adjunct medications?
What is the total estimated annual cost (visits, labs, medications)?
Is a contract or long-term commitment required?
Do you offer telemedicine visits, or must all appointments be in-person?
Do you have email access for non-urgent questions between appointments?
What is the typical wait time for an appointment when I need to be seen?
Who covers your patients when you are unavailable—and are they equally knowledgeable about TRT?
Can your staff (nurses, PAs) answer TRT-related questions, or must I always speak with you?
10. Philosophy & Red Flags to Probe
What do you consider a successful outcome of TRT? (Symptom relief? Specific lab numbers? Quality of life?)How do you individualize treatment rather than using a one-size-fits-all protocol?
What would make you discontinue or refuse TRT for a patient?
What is your view on long-term TRT—do you see this as a lifetime commitment?
How do you handle patients who want to discontinue TRT? Do you have a tapering or restart protocol?
What is your experience with patients who did not respond well to their previous doctor's protocol?
"What would you do if you were me?" (A revealing question when presented with treatment options)
11. Safety & Risk Management
What are the risks you discuss with patients before starting TRT?How do you screen for prostate health, and how often do you perform/recommend DREs?
Do you require a baseline PSA, and what PSA changes concern you?
Do you screen for sleep apnea before and during treatment?
What cardiovascular screening do you recommend?
How do you approach TRT in men with a history of cardiovascular disease?
What conditions would you consider absolute contraindications to TRT?
12. Communication & Partnership
How do you prefer patients communicate concerns or questions between visits?Are you open to reviewing research or studies I bring to appointments?
How do you feel about patients who are well-educated about their condition?
Will you work with me as a partner in my treatment, or do you prefer patients who simply follow orders?
Do you participate in any online forums or professional communities focused on TRT?
Can you provide references from other patients (or point me to reviews)?
Final Preparation Tips
Bring a written list of your questions—doctors appreciate patients who respect their timeBring copies of recent lab work if you have it
If referencing research, bring the actual study (not a blog post or article)
Be educated but courteous—delivery matters
Take notes during the visit or ask if you can record
Trust your instincts—if something feels off, seek another opinion
The first visit sets the tone for your entire patient-doctor relationship. A knowledgeable, collaborative TRT doctor who sees you as a partner in your health will make your testosterone replacement therapy journey far more successful.
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ExcelMale.com
Your Men's Health Community
For more information on testosterone replacement therapy, visit www.ExcelMale.com
ExcelMale.com
Your Men's Health Community
For more information on testosterone replacement therapy, visit www.ExcelMale.com
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