The Ultimate TRT FAQ Masterpage

Testosterone Replacement Therapy (TRT) is a medical treatment designed to restore testosterone levels to a healthy physiological range in men who suffer from hypogonadism (clinically low testosterone) and associated symptoms. It involves the administration of exogenous testosterone via injections, creams, or gels.

Testosterone is the primary male sex hormone (androgen). It drives the development of male physical characteristics and plays a vital role in sperm production, sex drive, bone mass, fat distribution, muscle size and strength, and red blood cell production.

You cannot know for sure without a blood test. However, if you are experiencing persistent fatigue, loss of libido, erectile difficulties, mood changes, or loss of muscle mass despite exercise, you may be showing signs of deficiency.

The “classic” triad is reduced libido, erectile dysfunction, and loss of morning erections. Other common symptoms include profound fatigue, brain fog, depression, irritability, reduced exercise recovery, and increased abdominal fat.

Yes. Symptoms of low testosterone are non-specific and can overlap with stress, depression, sleep apnea, and thyroid issues. Conversely, some men have low-normal levels but high SHBG (Sex Hormone Binding Globulin), meaning their free testosterone is low, causing symptoms.

Causes are divided into Primary (testicular failure due to injury, infection, or genetics) and Secondary (pituitary/hypothalamus signaling issues due to obesity, stress, medications, opioids, or sleep apnea). Age is also a factor.

Testosterone naturally declines about 1% per year after age 30. However, “Low T” (Hypogonadism) is a clinical condition where levels fall below the reference range and cause symptoms that negatively impact quality of life, which is distinct from normal healthy aging.

Primary: The testicles cannot produce testosterone (High LH/FSH, Low T).
Secondary: The brain isn’t sending the signal to produce testosterone (Low/Normal LH/FSH, Low T). This distinction helps determine the root cause.

Not necessarily. Our AHPRA-registered doctors can issue pathology referrals and conduct the assessment. However, we encourage keeping your GP informed, and we can provide documentation to them upon request.

Yes. We utilize secure telehealth video consultations to treat patients in all Australian states and territories.

Yes, when prescribed by a registered medical doctor for a legitimate medical condition. It is a Schedule 4 medication. Possession without a prescription is illegal.

You book a time online. You receive a secure video link. You join via your phone or computer to speak with the doctor face-to-face. It is identical to an in-person consult, just more convenient.

The doctor reviews your medical history, symptoms, and lifestyle. They assess potential contraindications. If appropriate, they will issue a pathology request form for comprehensive blood work to confirm diagnosis.

Typically 2-3 weeks. Week 1: Initial consult & blood test. Week 2: Lab processes results. Week 3: Review consult. If eligible, medication is prescribed and dispensed immediately.

Yes. Our patient care team is available for administrative support, and medical questions can be addressed via follow-up consults or email protocols depending on urgency.

Sexual symptoms (loss of morning erections, low libido, ED) are statistically the most specific to low testosterone. Fatigue and mood changes are common but less specific.

Fatigue from sleep apnea, low motivation from depression/burnout, and weight gain from poor diet or thyroid issues are frequently mistaken for Low T.

Low Libido: You have no desire or “drive” to have sex.
ED: You have the desire, but the “plumbing” doesn’t work. Low T often causes both.

Yes. Testosterone receptors are abundant in the brain. Deficiency can lead to mood instability, irritability, anxiety, and a “flat” depressive state.

Absolutely. Many men report difficulty concentrating, memory lapses, and a feeling of mental sluggishness.

Yes. Hormonal fatigue feels like a lack of “vitality.” You may sleep 8 hours but wake up feeling unrefreshed and drained.

Yes. Testosterone is anabolic. Low levels make it very difficult to build or maintain muscle mass and strength, even with good training.

Yes. Low T promotes fat storage (particularly visceral belly fat) and muscle loss, lowering your metabolic rate.

Yes. Prolonged soreness (DOMS) and an inability to recover from standard workouts is a common sign.

Yes, low levels are associated with lower sleep efficiency and fragmentation (waking up often).

Yes. Testosterone drives dopamine activity. Low levels often manifest as a loss of “mojo,” drive, and confidence.

Irritability and lack of intimacy caused by Low T can severely strain relationships.

Low testosterone is linked to increased cardiovascular risk factors, including obesity, insulin resistance, and metabolic syndrome.

Yes. Testosterone helps regulate insulin sensitivity. Low levels are strongly correlated with Type 2 Diabetes.

Yes. Chronic low testosterone can lead to osteopenia and osteoporosis (brittle bones) in men.

A comprehensive panel typically includes: Total Testosterone, Free Testosterone, SHBG, LH, FSH, Estradiol (E2), Prolactin, Full Blood Count (FBC), PSA (Prostate), Liver Function, Kidney Function, and Lipids.

This is the total amount of testosterone floating in your blood. It gives a broad overview of production.

This is the testosterone not bound to proteins. It is the biologically active fraction that actually enters cells to exert effects. It is often more important than Total T.

Sex Hormone Binding Globulin (SHBG) is a protein that binds to testosterone, rendering it inactive. High SHBG can cause low Free Testosterone even if Total Testosterone is normal.

Differences in androgen receptor sensitivity (CAG repeat lengths) and SHBG levels mean one man may feel great at a level where another feels symptomatic.

Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) are signals from the brain. High levels suggest the testicles are failing (Primary Hypogonadism). Low levels suggest the brain isn’t signaling (Secondary Hypogonadism).

Prolactin is a hormone that, if very high, can suppress testosterone and indicate a pituitary tumor (prolactinoma).

Estradiol is a form of estrogen. Men need some for bone and brain health. We test it to ensure it isn’t too high (causing side effects) or too low.

Testosterone pulses throughout the day and is affected by sleep, stress, diet, and illness. This is why we often require two tests to confirm diagnosis.

Between 7:00 AM and 10:00 AM. Levels naturally peak in the morning and drop in the afternoon.

Fasting is preferred for accurate glucose and lipid readings, though it doesn’t drastically change testosterone levels.

Guidelines usually require two separate morning samples showing low levels to confirm a diagnosis of hypogonadism.

“In range” simply means you fall within the statistical average of the population tested (which includes sick and elderly men). It does not necessarily mean optimal for your age or health.

Normal testosterone levels, very high hematocrit, uninvestigated high PSA, or untreated severe sleep apnea may rule out immediate TRT.

Extremely low T levels, extremely high Prolactin, or very high PSA may require referral to an endocrinologist or urologist to rule out tumors or cancer.

If levels are borderline, improving sleep, losing weight, and reducing stress can sometimes raise levels back to normal range. We encourage exploring this first.

Yes, we accept results from all major Australian pathology labs (e.g., QML, Laverty, Dorevitch, 4Cyte).

No. If symptoms are mild or caused by reversible lifestyle factors, we prioritize fixing those first.

Alternatives include lifestyle optimization, weight loss, sleep apnea treatment, or medications like Clomiphene (for fertility preservation) in specific cases.

In cases of mild secondary hypogonadism caused by obesity or poor sleep, fixing these issues can restore natural production significantly.

Resistance training can acutely raise testosterone and improve body composition, which supports hormonal health long-term.

Yes! Sleep apnea crushes testosterone production. CPAP therapy can sometimes restore levels to normal ranges without TRT.

Yes. Antidepressants (SSRIs), opioids, and blood pressure meds can cause sexual dysfunction and fatigue that looks exactly like Low T.

We look at the whole clinical picture. If you are borderline but highly symptomatic with no other cause found, a trial of therapy may be considered.

Yes. Protocols involving HCG or SERMs can boost natural testosterone without suppressing sperm production, ideal for men wanting to conceive soon.

Usually, yes, using a Post Cycle Therapy (PCT) protocol, though it is not guaranteed and depends on how long you were on treatment.

We primarily use testosterone esters (Enanthate or Cypionate) for injections, or transdermal creams/gels.

Very little. They have almost identical half-lives and effects. Enanthate is more commonly prescribed in Australia (e.g., Primoteston).

Short-acting (Propionate) requires daily injections. Long-acting (Undecanoate/Reandron) lasts 10-12 weeks but leads to less stable levels. Medium esters (Enanthate/Cypionate) are the “gold standard” for stable home use.

Yes, for patients who want to avoid needles. Compounded creams are often more effective than standard gels.

Rarely. Traditional oral testosterone pills can be liver-toxic and are generally avoided in modern TRT.

Reandron (Undecanoate) is available but often causes a “peak and trough” effect where men feel good for weeks, then crash before the next shot. We prefer more frequent, stable dosing.

Doses are individualized, but a typical starting protocol is 100mg–150mg per week (injectable), titrated based on follow-up bloods.

We treat the symptoms, not just the number. We start conservative, check bloods at 6-8 weeks, and adjust to find the “sweet spot” where symptoms resolve without side effects.

Libido and energy often improve in 3-6 weeks. Body composition and mood stability can take 3-6 months.

It means finding the lowest dose that resolves your symptoms fully. This minimizes side effects like high hematocrit or estrogen issues.

We generally aim for the upper-normal physiological range, but patient symptom relief is the primary metric.

Generally, yes. Hypogonadism is a chronic condition. While you can stop, symptoms usually return.

Your levels will drop, and symptoms will return. You may experience a period of suppressed natural production (“crash”) before your body recovers.

Yes. You can travel domestically with your prescription medication. International travel requires carrying your prescription and checking the laws of the destination country.

Store at room temperature away from direct sunlight. Do not refrigerate oils (they can crystallize).

Just take it as soon as you remember. Do not double dose.

No, creams are an option. However, injections are generally preferred for consistency, cost-effectiveness, and precise dosing.

Very little. With modern thin insulin needles or small gauge needles, it feels like a tiny pinch or mosquito bite.

Intramuscular (IM): Into the muscle (traditional).
Subcutaneous (SubQ): Into the fat layer (belly/love handles). SubQ is easier, less painful, and provides very stable levels.

Typically 2-3 times per week. Frequent micro-dosing prevents the “rollercoaster” of highs and lows associated with infrequent shots.

Splitting doses (e.g., Mon/Thu or Mon/Wed/Fri) provides more stable blood levels and minimizes estrogen spikes.

Common sites include the glute (buttock), ventroglute (hip), deltoid (shoulder), or thigh (quad). SubQ can be done in abdominal fat.

Drawing: 18G or 21G. Injecting: 27G to 30G (insulin needles) are popular for patient comfort.

1ml syringes are best for accurate measurement of TRT doses.

Inject slowly, relax the muscle, rotate sites, and use a fresh needle for every injection.

Rotate injection sites regularly and use the smallest needle gauge possible.

Redness spreading from the site, heat, swelling, pus, or fever. This is rare with proper hygiene but requires medical attention.

Apply pressure with a tissue. It’s usually minor. If you accidentally inject oil into a vein (rare), you may cough (Tren cough phenomenon) – sit down and relax; it passes.

This is called “pip.” It’s minor. Don’t re-inject. Just wait for your next scheduled dose.

You must use a yellow Sharps Container (available at pharmacies). Once full, return it to a pharmacy or community sharps disposal bin.

Typically: Before starting, then at 6-8 weeks, then at 6 months, and then every 6-12 months once stable.

We monitor Testosterone levels, Estradiol, Hematocrit (blood thickness), PSA (prostate), and Liver/Kidney function.

Adjustments are made based on blood results AND symptoms. We may change the dose, injection frequency, or administration method.

Chest pain, shortness of breath, severe swelling in legs, or lump in the testicle/breast area.

If blood gets too thick (Hematocrit >0.52-0.54), we may lower the dose, encourage hydration, or recommend a therapeutic blood donation.

We check for symptoms (nipple sensitivity, mood swings). If asymptomatic, we often leave it. If symptomatic, we may adjust dose frequency or lower the dose.

We investigate other causes (estradiol, prolactin, stress, relationship issues) or adjust the protocol.

TRT helps libido more than erection mechanics. You may still require Cialis/Viagra if there is vascular damage or performance anxiety.

This can happen during the transition phase. Contact us to review bloods; it may be an issue with estrogen balance or dose.

Yes. We don’t just give a script and disappear. We manage your care continuously.

Yes, protocols can be tweaked based on lifestyle demands or health changes.

It means your blood levels are consistent, your symptoms are resolved, and you feel “normal” every day without fluctuations.

Estradiol is crucial for men. It protects joints, bone density, brain function, and libido.

No. If you have higher testosterone, your body often needs higher estradiol to balance it. We treat symptoms, not just the number.

Creaky/painful joints, low libido, dry skin, fatigue, and anxiety.

Spicy/sensitive nipples, bloating/water retention, excessive emotions/crying, and weak erections.

Yes, because testosterone converts to estradiol via the aromatase enzyme. This is a natural process.

Only if a patient has significant high-estrogen symptoms (like gynecomastia) that cannot be managed by lowering the testosterone dose or increasing injection frequency.

No. Routine use of AIs (Anastrozole) is outdated and often harmful to heart and bone health. We avoid them unless absolutely necessary.

Yes, excess estrogen causes sodium retention.

Split your testosterone dose into more frequent injections (e.g., every other day). This prevents the “peaks” that trigger excess aromatization.

TRT significantly suppresses sperm production. It acts as a male contraceptive for many (but do not rely on it as birth control!). It is not necessarily permanent, but it does shut down production while on treatment.

It is difficult. Most men will need to add HCG or stop TRT to restore fertility.

Human Chorionic Gonadotropin (HCG) mimics LH. It keeps the testicles working and producing sperm/testosterone even while you are on TRT injections.

Yes. We can prescribe HCG alongside testosterone for men wishing to maintain testicular size and fertility.

Yes. Because the testicles stop working, they can shrink (atrophy). HCG prevents this.

It varies, but typically 3-12 months for sperm counts to return to baseline.

Oily skin, acne, water retention, testicular shrinkage, and elevated hematocrit (thick blood).

Yes, increased oil production can cause breakouts (back/shoulders). Hygiene and salicylic acid washes usually manage this.

If you are genetically predisposed to male pattern baldness, TRT may accelerate it by increasing DHT. It does not cause hair loss in men without the gene.

Yes, it can increase muscle tone in the throat or change breathing drive. Sleep apnea must be treated (CPAP) while on TRT.

Rarely, if estrogen gets too high. We monitor for nipple sensitivity to prevent this.

Yes, testosterone stimulates red blood cell production. This is the most common medical side effect we monitor.

Current evidence suggests TRT does not cause prostate cancer, but it should not be used in men with active prostate cancer.

Chest pain, shortness of breath, or deep vein pain (DVT signs) require immediate emergency attention (000).

For most men with low T, libido improvement is one of the first and most consistent benefits.

It improves the hormonal drive for erections. However, if you have blood flow issues (vascular ED), you may still need PDE5 inhibitors (Viagra/Cialis).

Many men report improved sensitivity and orgasm intensity after levels are restored.

This is a common dynamic. Open communication with your partner is essential as your drive returns.

Yes. Optimized testosterone improves insulin sensitivity and metabolic rate, making fat loss easier (provided diet is good).

Yes. Testosterone is anabolic. It increases muscle protein synthesis. You still need to train, but your effort will finally yield results.

Increased muscle glycogen and water retention in muscles can cause scale weight to go up initially. This is usually “good” weight.

Yes, dramatically. Recovery times often shorten significantly.

Yes, particularly “dysthymia” (chronic low mood) and irritability associated with hypogonadism.

Yes. Mental clarity, focus, and verbal memory often improve once levels are optimized.

“Roid rage” is associated with abuse-level doses. Therapeutic TRT usually calms men down, increasing confidence and assertiveness rather than aggression.

Costs generally include consultation fees ($150-$295) and medication costs. Medication ranges from $40/month to $150/month depending on the product and dosage.

Medicare rebates may apply to consultations. PBS subsidy for testosterone is very strict (requiring specific pituitary disease or extremely low levels confirmed by a specialist). Most TRT patients are on private prescriptions.

We send an electronic script (eScript) to your phone, which you can dispense at any pharmacy, or we forward it to a compounding pharmacy that mails the medication to you.

We email you a pathology request form. You take it to any collection centre (QML, Laverty, 4Cyte, etc.) near your home.

Yes. We can take over your care. You will need a consultation to review your history and current protocol.

Energy/Libido: 3-6 weeks. Muscle/Fat: 3-6 months. Bone density: 12 months.

No. TRT restores normal healthy levels. “Steroids” implies supraphysiological doses for performance enhancement. TRT is medical therapy.

Correcting a medical deficiency is not cheating; it is healthcare. However, TRT is banned in competitive WADA-regulated sports.

No. It typically improves mood stability.

Yes. All our doctors are fully registered with AHPRA and based in Australia.

We use encrypted, secure medical practice software compliant with Australian privacy laws.

Yes. We prioritize patient health and longevity. We do not facilitate bodybuilding “cycles” or abuse.