What Does My Doctor Monitor Throughout My Testosterone Therapy Journey?

• Initial consultation: $190. If you qualify and decide to start treatment, it includes your first month of testosterone, supplies and shipping.
• After that: $190/month, OR
• Pay $2,000 upfront for the whole year and save $280. ($190 consultation fee is credited toward membership, leaving a balance of $1,810)
• Follow-up visits are included in both plans.
• Lab work is billed separately by the lab you choose. (If you don't have a preference, we can refer you to a lab.)

Request a Consultation

Usually, yes. Call us for a lab order, complete the labs, and then book your visit so Dr. Ewals can review the results with you. Low testosterone is generally confirmed with early-morning blood tests on more than one day, not symptoms alone.

The most common symptoms of low testosterone (low T) are:

1. Reduced sex drive (low libido)
2. Difficulty getting or keeping an erection, including fewer morning erections
3. Persistent fatigue and low energy
4. Loss of muscle mass and strength
5. More body fat, especially around the midsection
6. Depressed mood or irritability
7. Difficulty concentrating, forgetfulness or brain fog
8. Poor sleep
9. Reduced facial or body hair
10. Enlarged or tender breast tissue

Every one of these has other possible causes, including sleep apnea, thyroid problems, medicines and stress. Low testosterone is confirmed with early-morning blood tests, not symptoms alone, which is why we test rather than guess.

Alternative Health's approach to evaluating low testosterone is informed by established medical guidelines from the Endocrine Society, American Urological Association (AUA), and European Association of Urology (EAU).

A diagnosis of testosterone deficiency generally requires:

• Symptoms or signs consistent with low testosterone.
• Low testosterone confirmed by two separate early-morning blood tests.
• Medical evaluation to identify possible underlying causes.
• Individualized assessment of treatment benefits, risks, and monitoring requirements.

Sexual symptoms, including reduced libido, fewer morning erections, and erectile dysfunction, are more specifically associated with testosterone deficiency than fatigue, low motivation, or mood changes alone.

Symptoms do not confirm a diagnosis. Testosterone replacement therapy (TRT) should be considered only after appropriate laboratory testing and clinical evaluation.

Clinical References:

• Endocrine Society — Testosterone Therapy Guidelines
• American Urological Association — Testosterone Deficiency Guidelines
• European Association of Urology — Sexual and Reproductive Health Guidelines
• European Male Ageing Study — NEJM

Testosterone replacement therapy comes in five main forms. Injections and gels are the most commonly prescribed.

• Injections: testosterone cypionate, enanthate, Xyosted or long-acting Aveed.
• Gels: applied to the skin once a day, such as AndroGel.
• Oral capsules: Jatenzo, Tlando or Kyzatrex, usually twice a day.
• Pellets: implanted under the skin, lasting about three to six months.
• Nasal gel: Natesto, used three times a day.

The right option depends on your labs, health history and fertility plans. Compare all five types.

According to the Endocrine Society and American Urological Association (AUA), diagnosing low testosterone (male hypogonadism) requires compatible symptoms, low testosterone confirmed by two separate early-morning blood tests, and a medical evaluation to identify potential underlying causes.

Dr. Ewals sets a dose and shows you how the medicine is taken. Your medication and home-use supplies are shipped to you as part of the TRT membership. Follow-up visits are every 8 to 24 weeks, depending on the person, and your dose is adjusted from your lab results.

Once your levels are stable, usually after 2 to 4 months, labs are typically every 3 to 6 months. They check testosterone, red blood cell count and other markers. Labs are billed by the lab and aren't included in the TRT membership.

PSA (prostate-specific antigen) is a protein made by the prostate. A blood test measures it, and a higher level can point to a prostate problem, such as an enlarged or inflamed prostate or, less often, prostate cancer.

Testosterone therapy can raise PSA slightly, usually in the first months of treatment. That's why the guidelines call for:

• A PSA test before starting for men over 40 (American Urological Association).
• A repeat test 3 to 12 months after starting, then on a regular schedule.
• A urology referral if PSA rises by more than 1.4 ng/mL in the first year, or is confirmed above 4.0 ng/mL (Endocrine Society).

Men with prostate cancer, or who are being evaluated for it, should not start testosterone. PSA is part of the labs reviewed before and during treatment.

Two things. After a large trial (TRAVERSE) found no increase in major heart problems, the FDA had testosterone labels updated to reflect those results. It also required a warning that testosterone can raise blood pressure, so Dr. Ewals monitors yours.

Men with or being evaluated for prostate or breast cancer, untreated severe sleep apnea, uncontrolled heart failure or a very high red blood cell count, and men trying to conceive now. Dr. Ewals goes through all of this before anything is prescribed.

Yes. Testosterone therapy can lower sperm production. If you might want children, say so at your first visit so you can discuss other options.