Compound Physician required

Testosterone Replacement (Clinical)

For documented deficiency with symptoms. Not a casual optimization tool.

Approved Verified 27 August 2026

What it does

Among the most consequential interventions when properly indicated, and one of the most misused when it is not. The indication is symptoms plus documented deficiency — not a number alone.

Exogenous testosterone restores serum levels in hypogonadal men, with downstream effects on muscle protein synthesis, erythropoiesis, mood, and sexual function.

  • testosterone
  • muscle mass
  • libido
  • bone density

What the evidence shows

Overall evidence strength: Moderate certainty

Who it's for, who should skip

Documented deficiency plus symptoms (low libido, fatigue, reduced muscle mass, depression) — not normal-range testosterone treated as a number to optimize. Casual optimization shifts the risk-benefit considerably: cardiovascular, fertility, dependency.

Skip it if

  • trying to conceive — TRT suppresses fertility — avoid while trying to conceive. hard block
  • normal-range testosterone without documented deficiency — Testosterone within the normal range correlates poorly with symptoms; a number alone is not an indication. discuss with physician

Running it

Dose
per physician protocol
Titration
injectable or transdermal; indication is symptoms + documented deficiency (typically total testosterone <300 ng/dL)

Measuring it

Retest Total testosterone — Total testosterone and hematocrit 3–6 months after starting, then yearly once stable — free testosterone only when SHBG is off. PSA per age-based screening guidance; settle fertility plans before starting..

  • Total testosterone baseline
  • Total testosterone annual
  • Estradiol baseline
  • SHBG baseline

Safety

  • polycythemia (elevated hematocrit)
  • suppressed fertility (often reversible, sometimes not)
  • accelerated benign prostatic hyperplasia, breast tenderness

Stacking & alternatives

Access & cost

Prescription or clinician order — typically via endocrinology or urology (Schedule III controlled substance).

Last reviewed 27 August 2026. Regulatory status verified 27 August 2026.