Most men who ask me how to get on TRT have already done some homework. They have read about the symptoms, maybe taken a home test, maybe heard a friend say his energy came back once he started. What they usually have not seen is the actual sequence: what has to be true before a prescription is appropriate, why one lab result is not enough, what gets ruled out along the way, and what the first three months look like once treatment starts.
That sequence is the same at both of our offices, and it is what this article lays out. If you want the general picture of how a hormone visit runs for men and women alike, I covered that in what to expect at your first hormone consultation. This piece is narrower. It is the men's testosterone pathway, step by step, from the first symptom you notice to the 90-day mark.
One framing point before the steps. TRT treats a diagnosis, low testosterone confirmed by labs in a man who has the symptoms to go with it. It is not a general energy booster, and starting it without that diagnosis tends to create problems rather than solve them. Every step below exists to make sure the diagnosis is real before treatment begins.
Step 1: Recognize the pattern, not just one symptom
Low testosterone rarely announces itself with a single complaint. The pattern I take seriously usually includes several of these:
- Reduced sex drive, often the most specific symptom, sometimes with fewer morning erections or weaker erections.
- Fatigue that sleep does not fix, present most days rather than after a hard week.
- Losing muscle or strength despite training that used to work, with more fat collecting around the midsection.
- Lower mood, irritability, or flat motivation.
- Hot flashes or night sweats, less common in men but worth mentioning.
None of these is unique to testosterone. Sleep apnea, thyroid problems, depression, heavy alcohol use, and several common medications produce the same picture, which is why the next step is blood work rather than a prescription.
If you are not sure your symptoms point toward hormones at all, start here. The pathway sorts out whether your first conversation should be about testosterone, weight, sleep, or something else before you commit to a visit.
Step 2: Two early-morning lab draws
This is the step most often skipped, and it is the one that matters most. Testosterone is usually highest in the morning and drifts lower through the day. It also moves from one day to the next. A poor night of sleep, a recent cold, or a sugary breakfast before the draw can pull a result down.
Both major guidelines account for this. The Endocrine Society's 2018 guideline calls for symptoms plus consistently low testosterone, confirmed by repeating a fasting, morning measurement. The American Urological Association's 2018 guideline frames it practically: two separate early-morning draws, with a total testosterone below 300 ng/dL as a reasonable cutoff for low. I follow that logic. One low number starts the conversation. Two low numbers, drawn the right way, are what support a diagnosis.
To make your draws count:
- Book them early, before roughly 10 a.m.
- Come fasting unless we tell you otherwise.
- Avoid testing while you are sick or right after a run of very short nights.
- Use the same lab for both draws when you can, so the results are comparable.
If you have already used a finger-prick or saliva kit, bring the result. It is useful background, and I explained what those kits can and cannot show in at-home testosterone tests: what they miss. It does not replace the morning draws.
Step 3: The workup that rules things in and out
Testosterone is only one number on the panel. Before starting treatment, the labs we run at both offices typically include total and free testosterone, SHBG, estradiol, DHEA, PSA, a complete blood count, and a metabolic panel, with LH and FSH added when the pattern calls for them. Each one answers a specific question.
Free testosterone and SHBG show how much testosterone is actually available to your tissues. A man with high SHBG can have a total that looks acceptable and a free testosterone that is genuinely low.
LH and FSH tell us where the problem starts. High values with low testosterone point to the testes. Low or normal values with low testosterone point to the brain's signaling, which can come from obesity, opioids, high-dose steroids, heavy drinking, or occasionally a pituitary problem that needs its own evaluation.
The blood count gives us a baseline hematocrit. Testosterone raises red blood cell production, so starting from a value that is already high is a reason to pause.
PSA establishes a prostate baseline. An elevated or rising PSA gets evaluated by urology before testosterone starts, not after.
The history matters as much as the labs. Snoring, gasping at night, or daytime sleepiness raise the question of sleep apnea, which can lower testosterone on its own and should be evaluated before starting TRT. Sometimes the workup shows that a reversible cause is driving the low number, and treating that cause is the better first move.
Step 4: The fertility conversation comes before the prescription
I ask about children at the first visit, because the answer changes the plan. Testosterone given from outside the body tells the brain to turn down the hormones that drive sperm production. In many men, sperm counts fall sharply, sometimes to zero. Recovery after stopping usually happens, but it can take many months, and the timing varies from man to man.
That leads to three practical rules in our practice:
- We do not start standard TRT in men who are actively trying to conceive. The AUA guideline says the same.
- If children are still a possibility, we talk about a baseline semen analysis, usually arranged through urology, and about whether to defer testosterone or consider a fertility-preserving approach under specialist guidance.
- TRT is not birth control. It suppresses sperm production in many men, but not reliably enough to prevent pregnancy.
I went much deeper on the biology and the options in TRT and male fertility. If you are under 40 or not sure you are done having children, read that before your first visit.
Step 5: A shared decision about delivery
Ready to find out whether TRT is the right call?
Starting testosterone begins with an in-person evaluation and repeat morning labs, at either our Columbus office (6901 Ray Wright Way, Suite I) or our Warner Robins office (840 SR 96, Suite 3300). Book online, or call (762) 261-3880 in Columbus or (478) 366-1244 in Warner Robins if you would rather talk it through first.
Once the diagnosis is confirmed and nothing in the workup argues against treatment, we sit down with your labs and choose a delivery method together. Both of our offices offer two.
Weekly injections. The testosterone injection therapy protocol uses testosterone cypionate exclusively, injected subcutaneously or into the muscle on a weekly schedule. Weekly dosing keeps levels more even than injecting every two weeks, and it lets us adjust the dose in small steps. Men with high SHBG, men who have run high estradiol before, and men who want close dose control often do best here.
Biote pellets. Small pellets placed under the skin in the office every few months. Levels peak in the first weeks after insertion and then taper toward the next visit, and the dose cannot be changed once a pellet is in. Men who do not want to inject and have a stable lab pattern sometimes prefer this.
The full side-by-side, along with how men switch between the two, is on the men's hormone therapy page. I am not listing doses here. Your starting dose depends on your labs, your history, and your response, and a number on a blog tends to become a target.
Step 6: Injection training on day one
If you choose injections, training happens in the office. We walk through both subcutaneous and intramuscular technique, you draw up and give your first dose under supervision, and most men leave comfortable doing it on their own. Once you are trained, the weekly injection itself takes a few minutes, including setup.
What I want every new patient to leave with:
- A fixed injection day that fits your week.
- How to store, draw, and dispose of supplies safely.
- What to do if you miss a dose (take it when you remember, never double up, and call if several weeks were missed).
- The short list of symptoms that warrant a call.
The step-by-step technique, including the mistakes I correct most often, is in how to self-inject testosterone.
The first 90 days
The first three months are about establishing your response, not reaching a finish line.
Weeks 1 to 4. Some men notice better energy, sleep, or mood within the first few weeks. Others notice little at first. Both are normal. Libido often responds in a similar window. Mild acne or a little fluid retention can show up early and often settles.
Weeks 8 to 12. First follow-up labs. We recheck testosterone and free testosterone, estradiol, hematocrit, and PSA, and set them beside how you actually feel. This is where dose adjustments happen, if any are needed. A number that looks fine on paper while you still feel poorly is clinical information too.
Around month 3 and beyond. Body composition changes, more muscle and less fat around the middle, build over three to six months and depend heavily on training and protein. Once you are stable, labs move to every 6 to 12 months depending on your protocol.
I sort the side effects we watch for, and the ones that need a same-day call, in TRT side effects: what we monitor. The short version: hematocrit, estradiol, and PSA can change without symptoms, which is why skipping follow-up labs is not an option on this protocol.
Who should not start yet
Some men should not start testosterone at all, and others should start only after something else is handled. Based on the Endocrine Society guideline and our own candidacy criteria, that includes men who:
- Are trying to conceive now.
- Have active prostate or breast cancer, or a PSA or prostate exam finding that has not been evaluated.
- Have a hematocrit that is already elevated.
- Have untreated, significant sleep apnea.
- Have had a heart attack or stroke in roughly the last six months, or have uncontrolled heart failure.
- Are not willing to come back for follow-up labs.
If any of those apply, the answer is not necessarily never. It is usually "not yet," with the other issue addressed first, sometimes with a specialist involved.
Seek emergency care, not a clinic appointment, for chest pain, sudden shortness of breath, swelling or pain in one leg, or signs of a stroke such as facial droop, arm weakness, or slurred speech, whether or not you are on testosterone.
Getting started at our Columbus and Warner Robins offices
The pathway is identical at both clinics. I see patients at each office on a published rotating schedule, and the labs, protocols, and follow-up are the same.
Columbus. For men in the Chattahoochee Valley, including Phenix City and the Fort Benning area, TRT in Columbus is offered at 6901 Ray Wright Way, Suite I, and that page covers the drive from the post and the office's cash-pay posture for military families. The direct line is (762) 261-3880.
Warner Robins. For men in Houston County, Bonaire, Perry, Centerville, and Kathleen, hormone therapy in Warner Robins is offered at 840 SR 96, Suite 3300. The direct line is (478) 366-1244.
Many of the men we see work rotating or overnight shifts, and that affects when a morning lab draw is realistic. Tell us your schedule when you book so we can plan the draws around it.
Care is cash-pay. We go over costs before anything is scheduled, and the payment plans page explains the financing options if you want to spread costs out.
When you are ready, book a consultation online and choose the office that suits you. Bring your medication and supplement list, any prior lab work or home test results, and a clear answer about whether children are still part of your plans. Those three things make the first visit far more productive, and they move you toward a decision based on your own numbers rather than someone else's protocol.
Medical disclaimer: This article is educational and describes how starting testosterone therapy generally works at our Columbus and Warner Robins offices. It is not medical advice and does not replace an in-person evaluation. Testosterone therapy requires a prescription, confirmed lab work, and ongoing monitoring, it is not appropriate for everyone, and it suppresses sperm production. Individual response varies. Chest pain, sudden shortness of breath, one-sided leg swelling, or stroke symptoms need emergency care right away.
Travis spent 17+ years in high-acuity clinical medicine — emergency, cardiac ICU, and cath lab — before founding Revitalize. He is a Certified Platinum Biote hormone therapy provider, the published author of You're Not Broken — You're Unbalanced, and the founder of the Rebuild Metabolic Health Institute. His clinical writing reflects the same precision he brought to critical care: specific, honest, and built around what actually works.
Ready to talk it through with a clinician?
Book online or call either Georgia location. Every visit starts with a consultation.