Silicon Valley Urologist – Dr. Jonathan C Hu

Optimizing Men's Health

A Comprehensive Guide to Testosterone Replacement Therapy

Testosterone Replacement Therapy (TRT) is a specialized medical intervention crafted to elevate testosterone levels in men grappling with low testosterone (low T) attributed to specific medical conditions. Its primary objective is to alleviate symptoms such as fatigue, diminished libido, and muscular atrophy.


Embarking on TRT might seem daunting, but rest assured, we’re here to guide you through every step. Your well-being and comfort are our top priorities, and our team is committed to ensuring a supportive and confidential environment throughout your TRT experience.



-Jonathan Hu. MD


What is testosterone?

Testosterone is a crucial male hormone responsible for various bodily functions, including muscle mass, bone density, and sex drive. Normal testosterone levels range between 280 and 1,100 ng/dL for adult males. Levels below 300 ng/dL may indicate low testosterone, warranting further medical evaluation.

What is free testosterone and SHBG?

Free testosterone refers to the portion of testosterone in the bloodstream that is not bound to proteins and is readily available to exert its biological effects on tissues and organs throughout the body. It represents the active form of testosterone that can interact with androgen receptors to regulate various physiological functions, including muscle mass, bone density, libido, and mood.


Sex hormone-binding globulin (SHBG) is a protein produced by the liver that binds to sex hormones, including testosterone and estrogen, in the bloodstream. Its primary role is to transport these hormones through the bloodstream and regulate their distribution and availability to tissues and organs. By binding to testosterone, SHBG reduces the amount of free or unbound testosterone circulating in the bloodstream, thereby influencing the overall hormonal balance and physiological responses mediated by testosterone.

Indications for Testosterone Replacement Therapy

TRT is typically recommended for men who have low testosterone levels due to underlying health issues with primary goal of symptom improvement. 

The exception to symptom improvement are those with HIV infected men with weight loss and those with osteoporosis with T deficiency.

The AUA guidelines suggest consideration for men with unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, and chronic corticosteroid use. 

The Procedure for Testing and Diagnosis

  • Testing: Two simple AM (before 11am) blood test measures testosterone levels. It’s essential for diagnosis and is usually required before starting TRT.
  • Diagnosis: If testosterone levels are below the normal range, your doctor may conduct additional tests to determine the underlying cause. Other labs include: Luteinizing hormone (LH), follicle- stimulating hormone (FSH), prolactin, estradiol, dihydrotestosterone (DHT), insulin-like growth factor-1 (IGF-1), vitamin D, B12, thyroid function tests (TSH), T4 and complete blood count.

Treatment Options

TRT can be administered through various methods, including injections, patches, gels, or implantable tablets. The choice depends on individual preferences, medical history, and specific health conditions.

But 80% is mostly done with nonmedication: diet, exercise, sleep and stress reduction

Risks and Side Effects

While TRT can be beneficial, it’s not without risks. Potential side effects include:

  • Thick blood (erythrocytosis)
  • Acne, Oily skin
  • Gynecomastia
  • Low sperm production
  • Slight increased risk of heart disease
  • Hormonal imbalances

It’s crucial to discuss these risks with your healthcare provider.

Monitoring on TRT

Will have strict monitoring to ensure your safety. Testosterone, blood count and PSA levels every 3, 6, 12 months.


Results can vary, but most men notice improvements in symptoms like energy levels, mood, and libido within 3 to 6 weeks. Full benefits, especially in muscle strength and body composition, may take longer.

TRT may improve muscle strength in older males with low T, but it’s not a solution for bodybuilding or energy enhancement in normal or high T levels.

The safety of long-term TRT use requires careful monitoring by a healthcare provider due to potential risks.

Yes, lifestyle changes like diet, exercise, and sleep can naturally influence testosterone levels.

TRT can reduce sperm count and potentially impact fertility. If you’re considering future fatherhood, discuss alternative treatments or sperm banking with your doctor.

TRT can be administered through injections, skin patches, gels, or oral tablets. The method depends on personal preference, lifestyle, and medical advice.