Testosterone Therapy: The Right Questions Before You Start
By Dr. Brandon Nader, DO · Founder & Medical Director
Testosterone therapy occupies a strange place in modern medicine: underused in men with genuine, symptomatic hypogonadism, and overused in men whose fatigue has an entirely different cause. Both failures come from the same root, skipping the workup.
A single low-normal testosterone value on a Tuesday afternoon is not a diagnosis. Testosterone varies by time of day, sleep, illness, and assay. Careful practice requires at least two morning measurements, free testosterone and SHBG, LH and FSH to localize the cause, and a deliberate search for reversible drivers.
The reversible causes nobody checks
Obstructive sleep apnea, insulin resistance, significant weight gain, chronic sleep restriction, high alcohol intake, and several common medications all suppress testosterone, and all are treatable without lifetime hormone therapy. Treating the testosterone number while ignoring untreated apnea is not optimization; it is symptom masking with a controlled substance.
When the workup does support therapy, persistent symptoms, confirmed low levels, causes addressed, TRT done properly is safe, effective, and well-supported by evidence. Proper means conservative dosing titrated to symptoms and mid-range levels, monitoring of hematocrit, estradiol, PSA and lipids, and an honest fertility conversation before the first dose, since exogenous testosterone suppresses sperm production.
How to evaluate a provider
Ask three questions. Will you check LH, FSH and SHBG before prescribing? What reversible causes will you rule out first? What is your monitoring schedule after I start? A physician who welcomes those questions is practicing medicine. A provider who quotes you a monthly price before your labs exist is running a subscription business.
This article is educational and does not constitute medical advice. Decisions about testing and treatment should be made with your physician in the context of your personal history.