Testosterone replacement therapy via telehealth
Testosterone replacement therapy (TRT) is for men with clinically low testosterone confirmed by morning bloodwork on two separate days, with symptoms. It is not for men with normal-range testosterone who want to feel better. Telehealth has made TRT more accessible, sometimes for better, sometimes for worse.
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Real eligibility
Total testosterone < 300 ng/dL on two morning blood draws (8-10am, fasting), with symptoms (low libido, fatigue, mood changes, muscle loss, ED). Free testosterone helps confirm. A single low value isn't enough. Borderline cases (300-400 ng/dL) require clinical judgment.
Delivery methods
Intramuscular injections (cypionate, enanthate) every 1-2 weeks: cheapest, most consistent. Subcutaneous injections: smaller volume, easier to self-administer. Topical gels (AndroGel, Testim, Fortesta): expensive, transfer risk to partners. Patches (Androderm): largely discontinued. Pellets: 3-6 month sustained release, requires office procedure.
What good TRT programs do
Order baseline bloodwork (testosterone, free testosterone, LH, FSH, prolactin, estradiol, CBC, PSA, comprehensive metabolic). Repeat labs at 6 weeks, 3 months, then every 6-12 months. Monitor hematocrit (high values from TRT). Manage estrogen with anastrozole only if needed. Discuss fertility preservation (TRT suppresses sperm production).
Red flags in telehealth TRT
Programs that prescribe TRT without two morning blood draws. Programs that don't monitor hematocrit. Programs that automatically pair TRT with anastrozole without estradiol levels. Programs that prescribe to men in fertility-relevant years without discussing sperm-preservation options. Costs: $100-250/month including medication, labs, follow-ups.