You've decided testosterone replacement therapy might be right for you. You've read about the benefits. You understand the risks. Now you want to actually start. What comes next?
Getting started on TRT isn't complicated, but it does need to be done right. There's a proper sequence of steps that ensures you get the right treatment, at the right dose, with proper monitoring. This is my step-by-step guide for starting TRT in Southlake.
Step 1: Get Properly Tested (Not Just Total Testosterone)
You'd be surprised how many men start TRT based on inadequate testing. They get their total testosterone checked once and think they're done. That's not enough.
For proper testosterone replacement therapy, we need to test:
Core Hormone Testing
- Total testosterone (should be tested twice, in the morning, to confirm low levels)
- Free testosterone - the biologically active form
- Sex hormone binding globulin (SHBG)
- Estradiol (to establish baseline)
- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
Health Assessment Testing
- Complete metabolic panel (kidney function, liver function, glucose)
- Complete blood count (hematocrit, hemoglobin, white blood cells)
- Lipid panel (cholesterol profile)
- Prostate specific antigen (PSA)
- Digital rectal exam (DRE) for prostate health
- Blood pressure
Optional But Recommended
- Thyroid panel (TSH, free T3, free T4) - thyroid dysfunction often accompanies low testosterone
- Prolactin - elevated prolactin can suppress testosterone
- Cortisol - chronic stress suppresses testosterone
- Comprehensive micronutrient testing
- Sleep study if sleep apnea is suspected
This baseline testing tells us:
- Whether you actually have low testosterone (not just feeling bad)
- What's causing your low testosterone
- What your health status is before we start treatment
- How to tailor your TRT protocol to your specific situation
- What monitoring we'll need going forward
Learn more about comprehensive low testosterone testing.
Step 2: Detailed History and Physical Examination
Labs tell you numbers, but a proper exam tells you context. We need to understand:
Your Symptoms
- How long have you had these symptoms?
- How severe are they affecting your quality of life?
- Did they come on gradually or suddenly?
- What have you already tried?
Your Medical History
- Do you have heart disease or risk factors?
- Any blood clots or clotting disorders?
- Prostate problems or cancer?
- Liver or kidney disease?
- Sleep apnea?
- Testosterone sensitivity (have you used testosterone before and had reactions?)
Medication and Supplement Review
- What are you currently taking? (Some drugs interfere with testosterone or TRT effects)
- Are there supplements that could interact?
Lifestyle Assessment
- How much do you exercise? (TRT works better with training)
- What does your sleep look like?
- What's your stress level?
- Your diet quality?
- Alcohol consumption?
This isn't bureaucratic - it's critical. Understanding your full situation helps us decide if TRT is the right choice and how to do it safely.
Step 3: Decide If TRT Is Right for You
At this point, we know your labs and your situation. Is TRT actually indicated?
You're a Good Candidate If:
- You have confirmed low testosterone (usually below 300 ng/dL, ideally two morning tests)
- You have symptoms of low testosterone (not just low numbers)
- You don't have contraindications (untreated prostate cancer, active clotting disorder, etc.)
- You're willing to commit to monitoring and optimization
- You understand the benefits and realistic risks
You Might Not Be a Good Candidate If:
- Your testosterone is borderline (say 350-400) and you have minimal symptoms
- Your low testosterone is secondary to something treatable (untreated sleep apnea, for example)
- You have serious contraindications that can't be managed
- You're not willing to do the monitoring required
- You have unrealistic expectations about what TRT can do
If TRT isn't right for you, that's okay. We'll explore alternatives like enclomiphene or peptide therapy.
Step 4: Choose Your Delivery Method
There are several ways to deliver testosterone. Each has pros and cons.
Injectable Testosterone (What We Usually Recommend)
- Pros: stable levels, cost-effective, predictable, longest track record
- Cons: requires injections weekly or biweekly, weekly pharmacy trips
- Typical dose: 100-200mg per week
Topical Testosterone (Creams or Gels)
- Pros: no injections, can titrate dose easily
- Cons: more expensive, variable absorption, can transfer to others, needs twice-daily application
- Typical dose: 50-100mg daily
Testosterone Pellets
- Pros: set and forget, steady levels for 3-6 months
- Cons: expensive, can't adjust dose easily, requires minor procedure to insert
- Typical dose: 300-400mg implanted every 3-6 months
Oral Testosterone
- Pros: easy to take, no injections
- Cons: harder on liver, less stable levels, less evidence of safety long-term
- Not usually our first choice
For details on the options, see TRT injections vs pellets vs topicals.
At Magnolia Functional Wellness, most of our patients do injectable testosterone. It's cost-effective, reliable, and we can adjust doses precisely.
Step 5: Establish Your Initial Dose
We don't guess here. We start with a physiological replacement dose based on:
- Your body weight (heavier guys usually need more)
- Your baseline testosterone level (lower baseline might need more aggressive replacement)
- Your symptom severity
- Your response to other hormones and medications
- Your health markers (hematocrit, liver function, etc.)
For most men, we start with 100-150mg per week of injectable testosterone. This is enough to bring you to normal range without causing excessive side effects.
We don't start with megadoses. That's how guys end up with problems.
Step 6: Learn Proper Injection Technique
If you're doing injections, we need to teach you how to do this properly:
Injection Site
Usually the gluteus maximus (upper outer quadrant of the buttocks). Alternatively, the vastus lateralis (outer thigh). Some guys do deltoids, but this is less ideal.
Injection Frequency
Weekly injections are standard for most guys. You can do twice per week if you want more stable levels, but weekly usually works great.
Needle and Syringe Technique
We teach you proper technique to avoid nerve damage, excessive scar tissue, and infection. This matters more than guys realize.
Rotation of Sites
You rotate injection sites to avoid scar tissue buildup and abscess formation.
Sterile Technique
Every injection should be sterile. Clean skin, clean needle, clean everything. No shortcuts here.
Step 7: First Blood Work and Adjustment
After 6 weeks on your initial dose, we check labs to see how you're responding:
Labs at 6 Weeks Include:
- Total testosterone
- Free testosterone
- Estradiol
- Hematocrit and hemoglobin
- Liver function tests
- Lipid panel
- PSA
We're Looking For:
- Testosterone in the optimal range (typically 600-900 ng/dL)
- Free testosterone in a healthy range
- Estradiol not too high (no excess aromatization)
- Hematocrit stable
- Other markers unchanged or improved
Based on these labs, we might:
- Keep your dose the same if everything is perfect
- Increase your dose if testosterone is still too low
- Decrease your dose if testosterone is too high or side effects are occurring
- Add estrogen management if aromatization is excessive
See more about proper TRT monitoring and labs.
Step 8: Optimize and Stabilize
By 12 weeks, we do another full lab panel. At this point we're fine-tuning:
- Making sure testosterone is in your optimal range (not just "normal")
- Ensuring estrogen is managed properly
- Confirming no side effects are developing
- Checking all your metabolic markers
We might adjust your dose one more time based on 12-week labs. After that, we typically move to quarterly labs.
Step 9: Ongoing Monitoring
Once you're dialed in, you're not done. Ongoing monitoring is essential:
Every 3 Months (First Year):
- Lab work checking testosterone, estradiol, hematocrit, liver/kidney function
- Check-in on symptoms and side effects
- Adjustment of dose if needed
Every 6-12 Months (After First Year):
- Comprehensive lab panel
- PSA recheck (if your baseline was normal)
- Blood pressure check
- Symptom assessment
What About Cost?
This is a practical question. The cost of TRT depends on your delivery method and insurance:
Injectable Testosterone
- Generic testosterone is very inexpensive (often $20-50/month)
- Doctor visits and monitoring add cost
- Total monthly cost: typically $100-300 depending on monitoring frequency
Topical Testosterone
- More expensive than injectable ($300-500/month)
- Insurance may or may not cover
Pellets
- Usually $1500-3000 per insertion
- Done every 3-6 months
- Most insurance doesn't cover
See our article on how much TRT costs and pricing breakdown for details, and check whether your insurance covers TRT.
Get Started in Southlake
This whole process - from testing through optimization - typically takes 12-16 weeks. It's not instant, but it's a proven path to getting you dialed in properly.
At Magnolia Functional Wellness in Southlake, this is exactly what we do. We test comprehensively, establish proper protocols, monitor carefully, and adjust as needed. We're not here to push you onto TRT - we're here to help you make the right decision and then execute it perfectly.
Book your initial consultation today. Let's talk about whether TRT is right for you and how we can get you started properly.