Deep Dive

Your Guide to Low T Treatment Options

Making sense of all the options 

Okay – so you’ve had your testing.

You’re sitting on low results. And now you’re heading into that next appointment with your doctor to figure out what comes next.

Let’s cut through the noise. If you’re considering treatment, here’s what’s worth understanding – and how to make the right call for you.

We’ve Covered the Basics Before. Here’s the Recap.

Yes, testosterone is a number.

But it’s also a pattern of symptoms:

Low drive. Lower mood. Less muscle. More fatigue. Worse erections.

We test it twice, in the early morning – ideally before 8 a.m., always before 10. 

If your levels are under 300 and you’re feeling it, that’s when we consider treatment.

But I’ve treated plenty of men with a “normal” 330 who are wiped out – and held off treating others with lower levels who feel fine.

This isn’t a math problem. It’s a conversation.

If You’re Going to Treat It, What Are Your Options?

This is where it gets real-world. 

You don’t need every detail – just what you’d want to know if you’re deciding what fits your life.

1. Injections (SubQ > IM)

This is my go-to for most men. A small needle, under the skin, once or twice a week. 

Easier and less painful than the traditional “into the muscle” method.

Most men learn to do it themselves in a single visit.

Heads-up: It can take a few weeks – or even a month or more – to dial in your dose. 

That’s normal. Trough and peak blood testing helps us calibrate. This is a process, not a quick fix.

2. Gels

Rub it on your shoulders or upper arms each morning. 

The daily application is the closest thing to your normal daily testosterone surge that happens in the morning as we are waking up.

Daily gels mimic this. 

It’s clean, painless, and easy to apply – but:

• You need to wait before showering, sweating, swimming, or hitting the gym.

• You must be careful about skin-to-skin contact with kids or partners.

• Always shower before intimate contact.

Absorption varies. For some men it works well, for others, not so much. Letting it dry completely makes a big difference. 

3. Oral Testosterone (Jatenzo, Kyzatrex, Tlando)

These FDA-approved capsules are taken with food, and they avoid the liver risks of older oral testosterone.

They’re a solid option if you don’t want needles or gel routines – but still require proper monitoring to make sure your levels stay in range.

4. Pellets

We insert these under your skin, and they slowly release testosterone over 3–6 months.

Convenient if you want a “set it and forget it” option.

Downside: If the dose isn’t quite right, you’re stuck with it until it wears off. Over time men can get some scarring in the area of the implants. 

5. Long-Acting Injections (Aveed)

Given every 10–12 weeks in a clinic.

No self-injecting required – but less flexibility if the dose doesn’t feel right.

You Don’t Have to Treat It

Low testosterone symptoms aren’t always dangerous.

And not every man wants or needs medication.

You might choose to:

• Focus on lifestyle changes (sleep, stress, weight, diet)

• Reassess in 3–6 months

• Start treatment later, when symptoms feel more disruptive

If you’re on the fence, you’re not failing anything by waiting. There is real value in doing the basics well – and sometimes that’s enough.

What About Risks?

Testosterone therapy isn’t a free-for-all. It’s safe for many men, but not for everyone.

It may not be right if you have:

• Active prostate or breast cancer

• Uncontrolled heart failure

• High red blood cell counts (polycythemia)

• Sleep apnea not yet evaluated

• Plans for future fertility (see below)

That’s why good prescribing means proper screening, follow-up labs, and regular check-ins – not just a bottle and a wish.

Monitoring: This Is What Good Care Looks Like

A responsible TRT prescriber will check labs at least every 6 months – sometimes every 3, especially early on.

We track:

• CBC (for blood thickening)

• PSA (prostate health)

• Estradiol (for hormonal balance)

• Liver and kidney function

• Testosterone (timed for your delivery method)

• Lipids annually

You don’t need labs every week. 

But you do need the right ones, at the right intervals, with someone who knows what they’re looking at.

Planning for Kids? Pause Before You Start TRT.

Testosterone therapy usually shuts down sperm production – temporarily or sometimes longer.

If you want kids (or think you might):

• Clomiphene citrate: oral med that boosts your own production

• hCG: preserves fertility, used alone or with TRT
  

Not every doctor offers this – so ask. 

It matters.

What Should You Expect If You Start?

No, it’s not instant. This isn’t Red Bull for your libido.

But the men who respond well often tell me:

• Mornings feel clearer

• Energy doesn’t bottom out at 3 p.m.

• They want sex again – and it actually works

• The gym isn’t such a grind

• They just feel more like themselves again

Not superhuman. Just better.

Here’s how I explain it:

If I started 100 men on TRT today, it might take three months for half of them to feel better.

Testosterone doesn’t flip a switch – it sets a new pace.

Like when a new manager takes over a struggling team – it takes time for the system to adapt and run well again.

And no – this isn’t the anabolic stuff gym bros inject in locker rooms.

This is clinical, guided therapy. 

Different goal. Different dose. Different outcome.

Final Word: This Isn’t About Chasing Youth

If you’re trying to become who you were at 28, you’re going to be disappointed. That guy’s gone.

Testosterone therapy isn’t for everyone. 

But if your levels are low, your symptoms are real, and you want to feel more connected to yourself again – it might be the right next step.

Just do it with someone who listens.

Who looks at your symptoms and your labs, not just your credit card. 

And who isn’t just handing out prescriptions from behind a screen.