Testosterone replacement therapy restores testosterone in men whose bodies don't make enough — a medical condition called male hypogonadism (low T). It treats a diagnosed deficiency; it is not a lifestyle, anti-aging, or performance product.
Testosterone replacement therapy is not suitable for all patients - particularly men under 40 or who plan to have children.
Two Types of Low Testosterone
Primary (testicular): the body doesn't produce enough despite normal brain signals.
Secondary (brain/pituitary): the brain isn't signaling the testicles to produce testosterone.
Common Symptoms of Low Testosterone
Low libido
Fewer or weaker morning erections
Erectile dysfunction
Low energy or fatigue
Reduced motivation
Depressed mood or irritability
Brain fog or trouble concentrating
Loss of muscle mass or strength
Increased body fat
Poor workout recovery
Lower endurance
Sleep changes
Reduced sense of drive or confidence
Labwork
Patients can only be diagnosed as low T with bloodwork, so labs are required before a prescription can be approved. TRT also requires ongoing monitoring so regular labs are also required to safely monitor patients' ongoing treatment.
Patients on TRT must complete labs every three months. These labs help the provider evaluate testosterone levels, blood counts, safety markers, and whether the dose is still appropriate.
Lab costs are separate from the medication cost. The first round of labs may be more expensive because it is typically more comprehensive. Ongoing labs help monitor safety and guide adjustments over time.
Patients can complete labs through a lab provider close to them. When placing a testosterone order, patients are given available lab options to choose from. Since each lab company sets its own price for the same panel of tests, prices may differ by lab company, however, the tests performed and the accuracy of results are identical.
TRT Delivery Options
Testosterone replacement therapy can be prescribed in different forms depending on the patient’s needs, preferences, and provider recommendation. At GobyMeds, available testosterone options may include injectable testosterone, topical testosterone cream, and testosterone hypospray.
Injectable testosterone
Injectable TRT is one of the most common delivery methods. It is typically given on a regular schedule based on the prescribed dose and treatment plan. Some patients prefer injections because they do not require daily application, but injections can cause temporary soreness or irritation at the injection site.
Topical testosterone cream
Topical cream is applied to the skin as directed by the provider. Some patients prefer this option because it avoids injections, but it must be used carefully and consistently. Because testosterone cream can transfer to other people through skin-to-skin contact, patients must follow all application and handwashing instructions closely.
Testosterone hypospray
Hypospray is a needle-free topical testosterone option designed to deliver testosterone through the skin. Some patients prefer it because it is easy to apply and avoids injections. Like other topical testosterone products, it should be used exactly as directed and patients should follow all instructions related to application and avoiding unintended transfer.
The best delivery method depends on factors like lifestyle, tolerance, convenience, consistency, and provider guidance. Not every option is right for every patient, and the provider will help determine which form of TRT is most appropriate.
Who may not be a good candidate for Testosterone
Testosterone may not be appropriate for men with certain health conditions or risk factors.
Patients should tell their provider if they:
Are actively trying to conceive
Want to preserve fertility in the near term
Have elevated hematocrit
Have untreated severe sleep apnea
Have known or suspected prostate or breast cancer
Have significant uncontrolled heart, liver, or kidney concerns
Recently had a heart attack or stroke
Have certain clotting risks
Do not have lab-confirmed testosterone deficiency
Want testosterone for general “optimization” without a medical indication
Eligibility is determined through provider review of lab results and symptoms, performed during a synchronous video visit with a licensed provider.
Possible side effects
Side effects from testosterone replacement therapy may include:
Acne or oily skin
Injection-site soreness or irritation
Mood changes or irritability
Water retention
Breast tenderness or swelling
Increased red blood cell count
Elevated hematocrit
Higher blood pressure
Worsening sleep apnea
Testicular shrinkage
Reduced sperm production
Changes in cholesterol markers
Headaches
Hair thinning in men genetically prone to male-pattern hair loss
Not everyone experiences these side effects, and some can be managed with dose adjustments or closer monitoring. The important thing is to immediately report symptoms to a provider rather than trying to push through them.
When to seek emergency care
Patients should seek emergency medical care if they experience signs of a severe allergic reaction, stroke, or blood clot, such as:
Chest pain
Difficulty breathing or shortness of breath
Severe headaches
Vision changes
Swelling, warmth, pain, or redness in one leg
Sudden weakness, slurred speech, face droop
When to contact GobyMeds
Patients should contact their provider through Medical Chat if they experience:
Significant mood changes
New or worsening acne
Breast tenderness or swelling
Severe injection-site pain, redness, warmth, or drainage
Worsening sleep apnea symptoms
Blood pressure concerns
Symptoms that feel worse after starting treatment
TRT and Fertility
Before starting testosterone replacement therapy, men should understand possible impacts to their fertility.
TRT can suppress the body’s natural hormone signaling. When the body senses testosterone coming from outside, it may reduce the signals that tell the testes to produce testosterone and sperm, which can lead to lower sperm production and may affect fertility.
For men who want children soon, are actively trying to conceive, or want to preserve fertility, TRT may not be the best option. In those cases, a testosterone-support option like enclomiphene may a better option because it works through the body’s own signaling pathway rather than replacing testosterone directly.
Fertility goals should always be discussed with a provider before starting treatment with testosterone.
An Important Note about Testosterone Topical Cream
Testosterone cream can transfer to others through skin-to-skin contact if proper precautions are not followed. This can put children, women, and pets at risk. However, the risk is manageable with proper use.
To minimize transfer risk:
Apply the cream to the area directed by your provider (often the scrotum or inner thigh)
Allow the cream to fully absorb and dry before any contact with others. Follow
Wash hands thoroughly after application
Cover the application site with clothing before close contact, especially around children
Be especially cautious around children and women who are pregnant or breastfeeding.
If some comes into contact with an untreated application area, they should wash the area with soap and water right away.
Storage and handling
Patients should store medication in accordance with the guidance of the dispensing pharmacy.
Follow the pharmacy label and included pharmacy instructions.
Do not use medication that appears discolored, cloudy when it should be clear, contaminated, or visibly changed unless the pharmacy confirms it is safe.
Do not use medication that has been frozen unless the pharmacy specifically confirms it is acceptable.
Keep medication out of reach of children and pets.
Contact GobyMeds Customer Support if your medication was exposed to unusual temperatures, damaged in transit, or if you have any concerns.