Thinking about testosterone replacement therapy (TRT)? Here are honest, research-based answers to the questions men ask us most. Every answer is reviewed by Eric Ruiz, MSN, APRN, FNP-BC, RNC-OB, the nurse practitioner and veteran owner of Axis Health Clinic in Wilbraham, MA. This page is general education, not personal medical advice. Your own plan starts with a consult and labs.
Understanding low testosterone
What are the signs of low testosterone?
Common symptoms include low sex drive, weaker erections, fatigue, low mood or irritability, trouble building muscle, more belly fat, and poor focus. Many of these have other causes too, like poor sleep, stress, thyroid problems, or medications. That's why symptoms alone are never enough to start treatment.
How is low T diagnosed?
Low testosterone ("testosterone deficiency") is diagnosed when you have both symptoms and low blood levels. The American Urological Association uses a total testosterone below 300 ng/dL as a reasonable cut-off. Because testosterone runs highest in the morning and can be lowered by eating, levels should be checked in the morning while fasting, and confirmed with a second test. About 30% of men with one low result have a normal level when retested.
What labs will I need?
Before starting, we typically check:
Total testosterone (two morning, fasting draws), plus free testosterone when needed
LH and FSH, to see whether the cause is in the testicles or the brain's signaling
Complete blood count (hemoglobin and hematocrit)
PSA (prostate test) for men over 40
Estradiol if you have breast tenderness or enlargement
We draw labs in house at set prices. You can also take a lab order to any outside draw site or try your insurance, at your own risk for cost and coverage.
Who is (and isn't) a good candidate
Do I qualify for TRT?
You may be a candidate if you have symptoms of low testosterone and your lab results confirm it. Eligibility is decided at your consult, after we review your symptoms, health history, medications, and labs.
Who should not start TRT?
Following Endocrine Society guidelines, TRT is not recommended for men who have:
Plans to father a child in the near future (see Fertility below)
Prostate or breast cancer
A prostate lump, or a PSA above 4 ng/mL (above 3 for higher-risk men) that hasn't been checked out by a urologist
A high red blood cell count (elevated hematocrit)
Untreated severe sleep apnea
Severe urinary symptoms from an enlarged prostate
Uncontrolled heart failure, or a heart attack or stroke in the last 6 months
A blood-clotting disorder
Some of these can be addressed first. For example, a man with a past high PSA may still be able to start after a urologist's evaluation, with closer monitoring.
Safety
Is TRT safe for my heart?
The best evidence so far is reassuring for men with truly low testosterone. The TRAVERSE trial followed about 5,200 men aged 45 to 80 who already had heart disease or a high risk for it. Major heart events (heart attack, stroke, or heart-related death) happened in 7.0% of men on testosterone and 7.3% on placebo, which is no meaningful difference. After reviewing that trial, the FDA in 2025 removed the heart-risk language from the boxed warning on testosterone products.
There are still risks to know about. In TRAVERSE, men on testosterone had slightly higher rates of atrial fibrillation (an irregular heart rhythm), blood clots in the lungs, and kidney injury. The FDA also added a warning that testosterone can raise blood pressure, so we check yours at visits.
Does TRT cause prostate cancer?
Current research has not shown that TRT causes prostate cancer in men with low testosterone. In TRAVERSE, prostate cancer rates were nearly identical: 0.46% on testosterone versus 0.42% on placebo. PSA levels rose slightly in the first year and then leveled off. Testosterone can still speed up a prostate cancer that already exists, which is why we check PSA before starting and during treatment.
I've had a high PSA before. Can I still start?
Often, yes, but not without a closer look. If your PSA is elevated, guidelines call for a urologist's evaluation before starting. That holds even if past biopsies were negative. If you're cleared, we monitor your PSA more often.
Fertility
Will TRT affect my ability to have children?
Yes. This is one of the most important things to know before starting. Testosterone from outside the body tells your brain to stop signaling the testicles. That shuts down the testosterone made inside the testicles, which sperm production depends on. Sperm counts can drop sharply, sometimes to zero.
For most men this is reversible after stopping, but recovery can take months, and some men need up to 2 years. In one study, 67% of men were back to a normal sperm count within 6 months. A small number of men, especially those with low sperm counts to begin with, may not fully recover.
If you want children now or in the future, tell us at your consult. Other treatments can raise testosterone while protecting fertility, and sperm banking before TRT is another option.
Side effects and monitoring
What are the possible side effects?
Thicker blood (higher hematocrit): the most common side effect that limits dosing. It's usually managed by adjusting the dose. If hematocrit goes above 54%, treatment is paused or reduced until it comes down.
Higher blood pressure
Acne or oily skin
Fluid retention
Breast tenderness or enlargement
Smaller testicles and lower sperm count
Worsening of untreated sleep apnea
A small rise in PSA
How often will I need labs?
We aim to keep your testosterone in the mid-normal range, not as high as possible. Typical monitoring follows AUA and Endocrine Society guidelines:
Testosterone level: a few weeks after starting, then every 6 to 12 months
Hematocrit (blood count): before starting, at 3, 6 and 12 months, then yearly
PSA (men 40+): before starting, at 3 to 12 months, then per screening guidelines
Blood pressure: at visits, especially in the first weeks
You may need checks more often if you have a past high PSA, high blood pressure, or other health conditions.
TRT at Axis Health
How is testosterone given?
TRT at Axis Health is a weekly testosterone injection. You can come in for your shot, or get a monthly or multi-month prescription and inject at home after we teach you how. Once your labs approve treatment, you can start in the office right away without waiting for a home delivery. Every plan is built around your labs, goals, and health history.
How soon will I feel a difference?
It varies from man to man. Many men notice changes in energy, mood, or sex drive within the first several weeks. Changes in muscle, body fat, and strength usually take several months. We'll track how you feel at follow-ups and adjust from there.
How much does it cost?
TRT is $150 per month, including your medication, supplies, and visits. Labs are billed separately. Veterans and first responders get 10% off all services with ID.
Do you take insurance?
No. Axis Health is cash-pay only, which keeps pricing simple and transparent. You're welcome to use your insurance for outside lab work.
Do I have to come in for every visit?
Your first visit is in person at our Wilbraham office. Many follow-ups can be done by telehealth or phone.
Other common questions
Can I take Viagra or Cialis while on TRT?
Usually, yes. ED medications like sildenafil (Viagra) and tadalafil (Cialis) can be used alongside TRT. The big exceptions: never combine them with nitrate heart medicines (such as nitroglycerin) or "poppers," since together they can cause a dangerous drop in blood pressure. If you take a prostate medicine like tamsulosin (Flomax), you'll likely start at a lower dose. Daily low-dose tadalafil is also FDA-approved for urinary symptoms from an enlarged prostate.
What happens if I stop TRT?
Your testosterone levels will drop, and your symptoms will likely return over time. It can take months for your body's own production and sperm count to recover. Please talk with us before stopping so we can plan it safely.
Is TRT the same as taking steroids?
No. TRT brings a man's low testosterone back into the normal range under medical supervision, with regular lab monitoring. Steroid misuse uses much higher doses to push levels far above normal, which carries much greater risk.
Ready to find out if TRT is right for you?
Book a consult and we'll review your symptoms, health history, and labs together. Book your consult or call 413-515-7320.
Axis Health Clinic · 2038 Boston Road, Suite 1, Wilbraham, MA 01095 · By appointment only · Veteran-owned
This page is for general education and does not replace a medical evaluation. Results vary from person to person. Treatment is prescribed only after a consult and lab review.
Sources
Endocrine Society: Testosterone Therapy in Men With Hypogonadism (2018)
American Urological Association: Evaluation and Management of Testosterone Deficiency
Bhasin et al. Prostate Safety Events During Testosterone Replacement Therapy. JAMA Netw Open 2023
FDA: Class-wide labeling changes for testosterone products (2025)
Preserving spermatogenesis in testosterone deficiency. Transl Androl Urol