# How TRT Works: Step-by-Step Treatment Guide

> Medically reviewed by Dr. Michael Chen, MD — Board-certified Endocrinologist
> Last updated: February 2026

## Step 1: Diagnosis Process

### Recognizing Symptoms
The journey typically begins when a man notices persistent symptoms that interfere with daily life — fatigue that doesn't improve with rest, declining libido, difficulty maintaining muscle, or mood changes that don't respond to lifestyle modifications.

### Initial Consultation
A licensed physician (in-person or via telehealth) will:
- Review your symptoms using validated screening tools
- Assess your medical history, medications, and family history
- Discuss your goals and concerns about treatment
- Order appropriate blood work

### Confirming Low Testosterone
Diagnosis requires:
- Total testosterone below 300 ng/dL on **at least two morning blood draws**
- Presence of clinical symptoms
- Exclusion of other conditions that mimic low testosterone (thyroid disease, depression, sleep apnea)

## Step 2: Lab Workflows

### Initial Panel (Before Treatment)
A comprehensive baseline panel typically includes:

| Test | Purpose |
|---|---|
| Total Testosterone | Primary diagnostic marker |
| Free Testosterone | Bioavailable hormone level |
| LH & FSH | Determine if cause is primary or secondary |
| Estradiol (E2) | Baseline estrogen level |
| SHBG | Binding protein assessment |
| CBC with Differential | Red blood cell baseline (hematocrit) |
| Comprehensive Metabolic Panel | Liver and kidney function |
| Lipid Panel | Cardiovascular risk baseline |
| PSA | Prostate health baseline |
| Thyroid Panel (TSH, T3, T4) | Rule out thyroid disorders |
| Hemoglobin A1c | Screen for diabetes/insulin resistance |

### Where to Get Labs
- **In-person clinics:** On-site blood draw or referral to Quest/LabCorp
- **Telehealth clinics:** At-home finger-prick kits or orders to local lab (Quest, LabCorp, or regional partners)

## Step 3: Prescription Telehealth Path

Modern telehealth TRT follows this workflow:

1. **Sign up online** — create an account with a licensed telehealth TRT clinic
2. **Complete health questionnaire** — detailed symptom and medical history intake
3. **Order lab work** — either at-home test kit or local lab order
4. **Complete labs** — blood draw (ideally fasting, before 10 AM)
5. **Results review** — physician reviews your labs and symptoms (typically 3-7 days)
6. **Virtual consultation** — video or phone call with a licensed provider
7. **Treatment plan** — if clinically appropriate, a personalized TRT protocol is prescribed
8. **Medication shipped** — prescription medication, supplies, and instructions delivered to your door
9. **Begin treatment** — start your protocol with provider guidance

### Legal Requirements
- A licensed physician must prescribe testosterone (Schedule III controlled substance)
- Telehealth prescribing is legal in all 50 states for TRT
- The prescribing physician must be licensed in the patient's state of residence
- A legitimate provider will always require blood work before prescribing

## Step 4: Monitoring & Adjustments

### First Follow-Up (6-8 Weeks)
After starting TRT, your first follow-up labs are typically drawn at 6-8 weeks to assess:
- Whether testosterone levels are in the target range
- Hematocrit levels (safety check for red blood cells)
- Estradiol levels (may require an aromatase inhibitor if elevated)
- Symptom improvement

### Ongoing Adjustments
Based on follow-up results, your provider may:
- **Increase dose** — if levels are still below target and symptoms persist
- **Decrease dose** — if levels are above range or side effects appear
- **Add ancillary medications** — such as anastrozole for estrogen management or hCG for fertility/testicular preservation
- **Change delivery method** — switch from gel to injections or vice versa if needed

### Regular Monitoring Schedule
| Timeframe | Tests | Purpose |
|---|---|---|
| 6-8 weeks | Testosterone, hematocrit, E2 | Initial dose assessment |
| 3 months | Comprehensive panel | Confirm stability |
| 6 months | Comprehensive panel + PSA | Safety check |
| Annually | Full panel + PSA + lipids | Long-term health monitoring |

## Step 5: Treatment Timelines

### What to Expect and When

| Timeframe | Expected Changes |
|---|---|
| **Week 1-2** | Possible mood and energy improvements; some men notice nothing yet |
| **Week 3-4** | Improved energy, better sleep quality, early libido changes |
| **Week 4-8** | Noticeable libido improvement, morning erections returning, mood stabilization |
| **Month 2-3** | Increased motivation, better workout recovery, beginning body composition changes |
| **Month 3-6** | Visible muscle gains, fat reduction (especially abdominal), significant mood improvement |
| **Month 6-12** | Full body composition optimization, bone density improvements, maximum cognitive benefits |
| **12+ months** | Sustained benefits with stable protocol; ongoing monitoring continues |

### Factors That Influence Timeline
- **Starting testosterone level** — severely low levels may take longer to optimize
- **Delivery method** — injections typically produce faster results than gels
- **Adherence** — consistent dosing is critical for steady results
- **Lifestyle factors** — exercise, diet, sleep, and stress management all influence outcomes
- **Age and overall health** — younger, healthier men may respond faster

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*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.*