Inside the TRT workup: How a qualified doctor screens for root causes before testosterone levels are ever treated

Finding the right doctor before starting testosterone replacement therapy matters more than which brand of gel or injection you end up with. The wrong provider skips the workup, misses underlying causes and writes prescriptions without proper follow-up bloodwork.

How Do I Find a Doctor Who Understands TRT?

A doctor who genuinely understands TRT treats lifestyle causes before writing a prescription and refers to an andrology-focused urologist or endocrinologist when appropriate. Ask any prospective provider how often they treat hypogonadism.

Dr. Akhil Muthigi, a urologist at Houston Methodist, said he starts with lifestyle before considering testosterone replacement therapy. “First, I first promote healthy lifestyle habits, all of which can naturally boost testosterone production,” Muthigi said. That approach includes regular exercise, better sleep and stress management. Muthigi also emphasizes a protein-rich diet and weight loss when applicable.

If those steps do not raise a patient’s levels, Muthigi then discusses external supplementation. He also screens for reasons TRT would be unsafe, citing a desire to preserve fertility, a recent heart attack or stroke and certain advanced prostate cancers that require hormone therapy.

What Tests Should a Doctor Run Before Prescribing Testosterone Replacement Therapy?

Before prescribing testosterone, your doctor should confirm low levels through multiple blood tests, check your prostate-specific antigen (PSA) and measure your red blood cell count. One low reading is not enough.

Harvard Health notes that “doctors diagnose low testosterone based on a physical exam, a review of symptoms and the results of multiple blood tests since levels can fluctuate daily.” A normal blood level starts at 300 nanograms per deciliter, and levels drop about 1.6% per year beginning in a man’s mid-30s, according to the American College of Physicians as cited by Harvard.

Henry Ford Health recommends baseline PSA and red blood cell testing because testosterone therapy can push red blood cells to unhealthy levels. Your doctor may also order a bone density scan, since untreated low testosterone can accelerate bone loss.

Dr. Michael O’Leary, a urologist at Brigham and Women’s Hospital, told Harvard Health that ruling out other causes comes first. “The first step is to determine if any symptoms attributed to low testosterone are related to something else that’s treatable,” O’Leary said.

What Questions Should I Ask My Doctor Before Starting TRT?

Ask what is causing your low levels, whether lifestyle changes should come first, which specific risks apply to you and how often follow-up bloodwork will be repeated. A qualified doctor will welcome those questions.

The Mayo Clinic flags multiple risks worth raising with your provider. Testosterone therapy can worsen sleep apnea, trigger acne and stimulate benign prostatic hyperplasia or growth of existing prostate cancer. Other possible effects include breast enlargement, reduced sperm production and testicular shrinkage. The therapy can also boost red blood cell production enough to raise the risk of a blood clot or pulmonary embolism.

Harvard Health also advises against jumping straight to therapy even when levels are low. If a doctor can pinpoint a specific cause of the decline, such as weight gain or a particular medication, addressing that problem should come first, the outlet notes.

Muthigi tells patients showing hallmark symptoms of low testosterone to meet with an andrology specialist for a thorough history, physical exam and lab workup before any prescription is written.

How Often Should I See My Doctor During Testosterone Replacement Therapy?

Plan on visits every three months during your first year on TRT, then every six months if your labs stay stable, according to Henry Ford Health.

Those check-ins matter because dosing often needs to be adjusted. “The question typically comes down to dosing. 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,” New York Urology Specialists explains.

Your doctor should track testosterone, PSA and red blood cell counts at each visit. O’Leary notes that different delivery methods work about equally well, though injections may produce a faster change than gels, patches or long-acting implants. “There is no advantage over the different applications,” O’Leary said. “But injections may produce a faster change.”

This article was created by content specialists using various tools, including AI.

This story was originally published July 29, 2026 at 5:00 PM with the headline “Inside the TRT workup: How a qualified doctor screens for root causes before testosterone levels are ever treated.”