# TRT Frequently Asked Questions > Medically reviewed by Dr. Michael Chen, MD — Board-certified Endocrinologist > Last updated: February 2026 ## What does TRT do? TRT (Testosterone Replacement Therapy) restores testosterone to normal physiological levels in men diagnosed with hypogonadism. It alleviates symptoms of low testosterone including fatigue, low libido, muscle loss, brain fog, and mood changes. TRT works by supplementing the body's testosterone from an external source — typically through injections, topical gels, or oral medications. ## How long before TRT results appear? TRT results develop gradually across several months: - **2-4 weeks:** Early mood and energy improvements - **3-6 weeks:** Libido changes and improved sexual function - **3-6 months:** Body composition changes (muscle gain, fat loss) - **6-12 months:** Full optimization of all benefits including bone density Individual response varies based on starting testosterone level, delivery method, adherence, age, and lifestyle factors. ## What are the risks of TRT? The most common risks include acne, fluid retention, testicular atrophy, and elevated red blood cell count (polycythemia). TRT also suppresses natural testosterone production and sperm production, which can cause infertility during treatment. Serious but rare risks include blood clots and potential worsening of sleep apnea. Regular monitoring through blood work minimizes these risks significantly. ## Can TRT affect fertility? Yes. TRT suppresses the hormones (LH and FSH) that stimulate sperm production, leading to reduced or absent sperm in most men. This effect is reversible in many cases after stopping TRT, though recovery typically takes 6-12+ months and is not guaranteed. Men who want to preserve fertility should discuss alternatives like hCG (human chorionic gonadotropin) or clomiphene (Clomid) with their provider. ## What testosterone level is considered low? Most medical guidelines define low testosterone (hypogonadism) as a total testosterone level below 300 ng/dL, measured via a morning blood draw. However, symptoms and free testosterone levels are also important. Some men with levels of 300-400 ng/dL may still be symptomatic and benefit from treatment, while others at 250 ng/dL may have minimal symptoms. ## Do I need a prescription for testosterone? Yes. Testosterone is classified as a Schedule III controlled substance in the United States and legally requires a prescription from a licensed physician. Purchasing testosterone without a prescription is illegal and potentially dangerous due to unregulated product quality. Licensed telehealth clinics can legally prescribe TRT after evaluating blood work and symptoms via telemedicine. ## What's the difference between TRT and steroids? TRT restores testosterone to normal physiological levels (typically 400-700 ng/dL) under medical supervision with regular monitoring. Anabolic steroid abuse involves using supraphysiological doses — often 5-10x normal levels — without medical oversight, significantly increasing health risks. TRT is a legitimate medical treatment for a diagnosed condition. ## Is online TRT safe and legitimate? Yes, when provided by licensed clinics that follow proper medical protocols. Legitimate online TRT providers require blood work before prescribing, use licensed physicians, prescribe only FDA-approved or pharmacy-compounded medications, and include ongoing monitoring. Red flags include providers that prescribe without blood work, offer testosterone without a doctor visit, or operate without clear medical licenses. ## What delivery methods are available for TRT? The main delivery methods are: - **Injections** (most common): Testosterone cypionate or enanthate, typically weekly self-injection - **Topical gels/creams**: Daily application to skin, no needles required - **Oral medications**: Taken by mouth, newer option with growing availability - **Pellets**: Implanted subcutaneously every 3-6 months - **Nasal gel**: Applied intranasally three times daily Injections remain the most popular due to effectiveness, cost, and dosing flexibility. ## How much does TRT cost? Online TRT clinics typically charge $99-$250 per month, often including medication, lab work, and provider consultations. Budget options start around $99/month, while comprehensive programs with full lab panels and ancillary medications range $150-250/month. Traditional in-person clinics and urologists may charge $300-500+ per month when accounting for separate lab, office visit, and pharmacy costs. ## Can I stop TRT once I start? Yes, TRT can be discontinued, but it's important to do so under medical supervision. Stopping abruptly can cause temporary worsening of low testosterone symptoms as the body's natural production restarts. Recovery of natural testosterone production typically takes weeks to months and depends on how long you've been on TRT and your pre-treatment hormone levels. Some men may not fully recover natural production. ## Does TRT cause hair loss? TRT can accelerate male pattern baldness in men who are genetically predisposed. Testosterone is converted to DHT (dihydrotestosterone) by the enzyme 5-alpha reductase, and DHT is the primary hormone involved in androgenic alopecia. However, TRT does not cause hair loss in men who lack the genetic predisposition. DHT-blocking medications (finasteride) can be used concurrently if hair loss is a concern. ## Does TRT affect the heart? The largest clinical trial to date — the TRAVERSE trial (2023) — found no increased risk of major cardiovascular events in hypogonadal men receiving TRT compared to placebo. Some observational studies have shown mixed results. Current evidence suggests that properly monitored TRT does not significantly increase cardiovascular risk in appropriately selected patients. Regular lipid panel and hematocrit monitoring are standard safety measures. ## What is the difference between TRT and Clomid? TRT directly replaces testosterone from an external source, providing predictable hormone levels but suppressing natural production and fertility. Clomiphene (Clomid) is a selective estrogen receptor modulator (SERM) that stimulates the body's own testosterone production by blocking estrogen feedback at the pituitary. Clomid preserves fertility and natural production but may produce less predictable testosterone levels. Clomid is often preferred for younger men who want to maintain fertility. --- *This content is for informational purposes only and does not constitute medical advice. Always consult with a licensed healthcare provider before starting any hormone therapy.*