Why do I need two blood tests before starting TRT?

Testosterone fluctuates day to day and across a single day. Clinical guidelines call for two separate early-morning measurements before a diagnosis of testosterone deficiency is made. A clinic prescribing off one test, or off a symptom questionnaire alone, is skipping the diagnostic standard.

Does testosterone therapy improve erectile function and libido?

This is the best-supported outcome. The Testosterone Trials found substantially increased sexual activity, libido and erectile function, and a 2024 meta-analysis of 28 randomized trials found a 3.26-point mean improvement on the IIEF score versus placebo. Low testosterone is only one cause of erectile dysfunction, and evaluation matters because erectile difficulty can be an early sign of cardiovascular disease.

Does TRT help with depression?

A meta-analysis of 27 randomized trials covering 1,890 men found men on testosterone were roughly twice as likely to achieve a clinically meaningful improvement in depressive symptoms, with an odds ratio of 2.30. The effect is modest and a smaller pooled analysis did not find it. Testosterone is not an antidepressant and depression should be evaluated independently of testosterone level.

Will I be on testosterone therapy forever?

Often yes. Testosterone therapy suppresses your own production, so stopping usually means returning to baseline levels or lower for a period. Enclomiphene works differently and may be worth discussing.

How often will I speak to a provider?

An initial consult, a recheck at week eight, then quarterly for as long as you are with us, with the same provider each time and messaging in between.

What if my labs show TRT is not right for me?

Your provider tells you. Low testosterone is sometimes a symptom of something else such as thyroid disease, sleep apnea, or a pituitary problem, which is why a full panel is run rather than a single testosterone level.

Why does the timing of my blood draw matter for TRT?

Testosterone follows a daily rhythm and peaks in the morning, so an afternoon draw can read substantially lower than the same blood would at 8am. Draws should be taken before 10am after an eight-hour fast. Levels also vary between mornings, so a borderline result or one that does not match a patient's symptoms is repeated rather than acted on alone.

Does testosterone therapy improve erectile function and libido?

This is the best-supported outcome. The Testosterone Trials found substantially increased sexual activity, libido and erectile function, and a 2024 meta-analysis of 28 randomized trials found a 3.26-point mean improvement on the IIEF score versus placebo. Low testosterone is only one cause of erectile dysfunction, and evaluation matters because erectile difficulty can be an early sign of cardiovascular disease.

Does TRT help with depression?

A meta-analysis of 27 randomized trials covering 1,890 men found men on testosterone were roughly twice as likely to achieve a clinically meaningful improvement in depressive symptoms, with an odds ratio of 2.30. The effect is modest and a smaller pooled analysis did not find it. Testosterone is not an antidepressant and depression should be evaluated independently of testosterone level.

Will I be on testosterone therapy forever?

Often yes. Testosterone therapy suppresses your own production, so stopping usually means returning to baseline levels or lower for a period. Enclomiphene works differently and may be worth discussing.

How often will I speak to a provider?

An initial consult, a recheck at week eight, then quarterly for as long as you are with us, with the same provider each time and messaging in between.

What if my labs show TRT is not right for me?

Your provider tells you. Low testosterone is sometimes a symptom of something else such as thyroid disease, sleep apnea, or a pituitary problem, which is why a full panel is run rather than a single testosterone level.

Testosterone Replacement Therapy · Arizona

Is TRT Safe?

Q: Does TRT cause prostate cancer?

A 2024 meta-analysis of 28 randomized controlled trials covering 3,461 men found no significant difference in PSA, prostate volume, urinary symptoms, or prostate cancer incidence between testosterone and placebo. The narrower concern is that testosterone could accelerate a cancer already present but undetected, which is why baseline PSA is taken before starting and rechecked afterward.

Q: Do you treat patients outside Arizona?

No. Our provider is licensed in Arizona and can only treat Arizona residents.

What the clinical trials actually found — including the parts most clinics leave out — and exactly what your provider monitors because of them.

Medically reviewed by Lauren Orta, FNP-C · 5 September 2026

Medically reviewed by

Lauren Orta, FNP-C

Family Nurse Practitioner · Arizona State Board of Nursing licence #261957 · Certified by the American Association of Nurse Practitioners

Reviewed 5 September 2026

Most clinic pages answer this question with the word "yes" and a photograph of a man lifting something. That isn't an answer — it's a sales position, and it's why almost none of them can point you to a single study.

Testosterone replacement therapy has been studied properly, including two large randomized trials in the last decade that changed what we know. This page walks through what they found — the reassuring results and the concerning ones — and what each finding means for how you get monitored. Every claim is numbered to a citation at the bottom.

The short version

For men with genuinely low testosterone, TRT has a reasonable safety profile when it is monitored. The largest cardiovascular trial found no increase in heart attacks or strokes. The evidence for improvement in sexual function is solid, and for mood it is real but modest. The evidence for "energy" and mental sharpness is considerably weaker than the marketing suggests. And there are specific risks — hematocrit, fertility, and a few findings below — that require someone actually watching your bloodwork.

Your heart: what TRAVERSE found

For a decade this was the open question. In 2023 the TRAVERSE trial in the New England Journal of Medicine gave the first large randomized answer.¹

The trial

TRAVERSE — cardiovascular safety

≈5,200 men, aged 45–80, all with hypogonadism and existing cardiovascular disease or high cardiovascular risk. Randomized to testosterone gel or placebo.

Primary result: testosterone was non-inferior to placebo for major adverse cardiac events — cardiovascular death, non-fatal heart attack, and non-fatal stroke. In the population most likely to have a cardiac event, testosterone did not increase them.

What the same paper also reported

TRAVERSE found higher rates of atrial fibrillation, acute kidney injury, and pulmonary embolism in the testosterone group.¹ Those findings are from the same trial as the reassuring headline, and a clinic quoting one half without the other is selling to you.

Separately, the earlier Testosterone Trials found testosterone increased non-calcified coronary artery plaque volume more than placebo over one year.² The clinical meaning of that isn't settled, but it isn't nothing.

What it means in practice: a history of clotting, atrial fibrillation, or kidney disease belongs in your first conversation. Not because TRT is off the table, but because it changes how closely you get watched. More on this in TRT and heart health.

It's also worth being precise about scope. TRAVERSE studied men who already had cardiovascular risk, using a gel, over a defined period. It is strong evidence on a specific question, not a blanket endorsement of testosterone for every man in every form.

Your prostate

The belief that testosterone causes prostate cancer dates to research from the 1940s and has not held up. A 2024 systematic review and meta-analysis pooled 28 randomized controlled trials covering 3,461 men.³

The evidence

Testosterone therapy and the prostate — 28 RCTs, 3,461 men

Xu et al., Frontiers in Endocrinology, 2024

PSA: no statistically significant difference between testosterone and placebo. Urinary symptoms (IPSS): no meaningful change. Prostate volume: comparable between groups. The authors concluded TRT does not worsen benign prostatic hyperplasia or increase prostate cancer incidence.

The residual concern is different and narrower: testosterone can accelerate a cancer that is already present but undetected. That's why a baseline PSA is taken before you start, rechecked afterward, and why an unexplained rise sends you to urology rather than triggering a dose change. See TRT and prostate safety.

Hematocrit: the one that actually ends most protocols

Hematocrit is the percentage of your blood made up of red cells. Testosterone raises it — in the Testosterone Trials, erythrocytosis occurred in the testosterone group and not at all in the placebo group.²

In most men the shift is modest and harmless. In some it climbs far enough to thicken the blood, which is associated with clotting risk. This is genuinely the most common reason a man on TRT has to lower his dose, change injection frequency, donate blood, or stop — and it is almost entirely manageable if someone is looking.

Your provider watches the trend, not just the number. A hematocrit that has climbed six points in eight weeks is a different conversation from one stable at the top of the range for a year. More in hematocrit monitoring on TRT and donating blood on TRT.

Fertility — the conversation most clinics skip

Testosterone therapy suppresses your body's own production, and with it, sperm production. Counts fall substantially in most men and to zero in some. This usually reverses after stopping, but not always and not quickly.

If you may want children, say so before you start. hCG alongside testosterone can maintain testicular function, and enclomiphene raises your own production rather than replacing it. Both are real options that need choosing at the start, not retrofitted two years in. See TRT and fertility and testicular atrophy on TRT.

What TRT actually improves — and what it doesn't

This is where honest reporting separates from marketing. The Testosterone Trials — 788 men aged 65 and over with unequivocally low testosterone, randomized against placebo for a year — measured several outcomes at once, and did not find what most clinics imply it found.²

Outcome	Result	What the data showed
Sexual activity	Improved	Substantial increase, effect size 0.45 — the strongest finding in the trial.²
Libido	Improved	Around 20% of treated men rated desire "much better," versus under 10% on placebo.²
Erectile function	Improved	Improved in the Testosterone Trials, and confirmed in a 2024 meta-analysis of 28 RCTs: a 3.26-point mean improvement on the IIEF score versus placebo.^2,3
Depressive symptoms	Improved	The largest analysis — 27 randomized trials, 1,890 men — found men on testosterone roughly twice as likely to reach a clinically meaningful improvement in depressive symptoms (odds ratio 2.30).⁴ The Testosterone Trials agreed in direction.² A smaller pooled analysis did not find the effect.⁷ See below.
Bone density	Improved	Spine bone mineral density rose 6.8% more than placebo; estimated spine strength 8.5%.²
Anemia	Improved	In men with unexplained anemia, 54% had a meaningful hemoglobin rise versus 15% on placebo.²
Vitality and energy	Not confirmed	Small improvements appeared on continuous fatigue measures, but did not reach the demanding threshold the trial set in advance.² A separate pooled analysis also found no significant effect.⁷ See below — this is more complicated than "it doesn't work."
Memory in men over 65	No effect	In 493 men aged 65+ with diagnosed age-associated memory impairment, testosterone did not improve memory or executive function.² That population is not most men asking about mental clarity.

The sexual health findings are the strongest evidence in the field

If you are here because of libido or erectile difficulty, this is the outcome the research supports best. Sexual activity, desire and erectile function all improved on testosterone across two independent bodies of evidence — the Testosterone Trials and a 2024 pooled analysis of 28 randomized trials.^2,3

One important caveat: low testosterone is only one cause of erectile dysfunction, and often not the main one. Erectile difficulty can be an early sign of cardiovascular disease, which is a reason to get evaluated rather than to self-treat. ED versus low testosterone covers the distinction, and low libido and hormones covers the rest.

Mental health: what the strongest evidence shows

The largest and most focused analysis is favorable. Published in JAMA Psychiatry, it pooled 27 randomized placebo-controlled trials covering 1,890 men, with depressive symptoms as the actual subject of the analysis rather than an incidental measure.⁴

The evidence

Testosterone and depressive symptoms — 27 RCTs, 1,890 men

Walther, Breidenstein & Miller, JAMA Psychiatry, 2019

Testosterone treatment significantly reduced depressive symptoms compared with placebo. Men receiving testosterone were roughly twice as likely to achieve a clinically meaningful improvement — a 50% or greater reduction in symptoms — with an odds ratio of 2.30. Dropout rates were no different from placebo.

The Testosterone Trials pointed the same way: PHQ-9 depression scores fell in the treated group.²

You will also find a null result, and it's worth understanding why it exists. The meta-analysis accompanying the Endocrine Society guideline reported no significant effect on mood — but it pooled a handful of trials in which mood was one secondary outcome among many, not the question being investigated.⁷ When a large, purpose-built analysis and a small incidental one disagree, the purpose-built one is usually the better guide.

Where that leaves it: a real effect, modest in size, best supported in men who are both hypogonadal and experiencing low mood. The authors of the positive analysis noted that many included trials had methodological limitations and called for larger studies. Testosterone is not an antidepressant, and if you are depressed you should be evaluated for depression regardless of your testosterone level. More in can low testosterone cause depression and testosterone and mental health.

On the flip side of the mental-health question: the "roid rage" idea comes from supraphysiologic anabolic steroid abuse, not from therapeutic replacement dosing. See does TRT cause roid rage and testosterone and mental health.

Energy: the honest picture

Energy is what this industry markets on hardest, and it's the outcome where the trial evidence is weakest — but "weak evidence" is not the same as "doesn't work," and the distinction matters.

Why the energy question is harder than it looks

The vitality trial did show small improvements in fatigue on continuous measures. What it failed to do was clear the specific threshold — a four-point jump on a fatigue questionnaire — that the researchers set in advance as the bar for success.² That's a real result and it should temper any promise. It is not the same as finding nothing.

It's also worth asking what those instruments capture. A fatigue score administered to men in their seventies is a blunt tool for the thing men actually describe — feeling like themselves again, or not. Many men on properly monitored therapy report exactly that, consistently enough that it's worth taking seriously. What we can't do is show you a trial that confirms it, so we won't claim one.

And energy has causes other than testosterone

This is the part that's actually useful to you. Low energy usually has a cause, and testosterone is only one candidate. Untreated sleep apnea, poor sleep, thyroid disease, iron deficiency, depression, alcohol, and medication side effects all produce the same complaint — and several of them also suppress testosterone, which is why they show up together so often.

A proper workup looks for all of it. If your fatigue is coming from apnea you've never been tested for, finding that will do more for you than any prescription we could write — and your provider will tell you so rather than selling you testosterone and hoping.

What we monitor, and when

Marker	When	Why it's on the list
Total & free testosterone	Baseline, week 8, then quarterly	Measured early in the morning, when levels peak. Guidelines call for repeat testing where a result is borderline or inconsistent with symptoms.⁵See: free vs total testosterone
Hematocrit	Baseline, week 8, every 3–6 months	The most common reason a man has to come off therapy. Trend matters more than any single value.
PSA	Baseline, then 3–12 months, men over 40	Not because testosterone causes cancer, but because it can accelerate one already present.⁶
Estradiol	Baseline, week 8, as needed	Some testosterone converts to estrogen. The fix is usually a dose change, not another drug.See: estrogen management on TRT
Blood pressure	Every visit	Testosterone products carry an FDA labeling requirement on blood pressure.See: does TRT raise blood pressure
Lipids, CMP, CBC	Baseline, then annually	Often the first place something unrelated to testosterone shows up.See: TRT and cholesterol

Why the week-8 recheck exists

Testosterone takes roughly 8 to 12 weeks to stabilize on a new protocol. Before that, your levels are still moving and any number is a snapshot of a system in transit. Week 8 is the first point a dose decision can rest on real data — which is why it's built into every AZTRT protocol rather than sold as an upgrade. Background: bloodwork before starting TRT.

Who should not start testosterone therapy

Known or suspected prostate cancer, or breast cancer
A desire to conceive in the near term
Hematocrit already above the normal range at baseline
Untreated severe obstructive sleep apnea
Uncontrolled heart failure
Heart attack or stroke within the last six months
Personal or strong family history of blood clots
Severe lower urinary tract symptoms

Several of these are temporary. Untreated sleep apnea both suppresses testosterone and makes therapy riskier — treating it sometimes raises testosterone on its own, and always makes TRT safer if you still need it. That's a better outcome than a prescription. See TRT and sleep apnea.

What would make us change or stop your treatment

Hematocrit rising toward the threshold where clotting risk climbs — dose reduction, frequency change, or a pause
A meaningful or accelerating PSA rise — urology referral before anything else happens
New cardiovascular symptoms, or a new diagnosis of atrial fibrillation or clotting
Blood pressure that rises and doesn't come back down
No symptomatic benefit at an adequate dose with levels in range — at which point testosterone probably wasn't the problem, and continuing to sell it to you would be wrong

Who decides

Every one of these decisions is made by Lauren Orta, FNP-C, your independent Arizona-licensed provider, based on your labs and history. AZTRT LLC provides administrative and technology services and does not practice medicine. Her credentials →

Common questions

Why does the timing of my blood draw matter?

Testosterone follows a daily rhythm and peaks in the morning, so an afternoon draw can read substantially lower than the same blood would at 8am. Go before 10am and fast for eight hours. Levels also move between mornings, so if a result comes back borderline or doesn't match your symptoms, your provider repeats it rather than deciding on one reading. A clinic prescribing testosterone off a questionnaire with no bloodwork at all is skipping the diagnostic standard entirely. More in how low testosterone is diagnosed.

Does TRT cause prostate cancer?

The pooled evidence from 28 randomized trials found no increase in PSA, prostate volume, urinary symptoms, or prostate cancer incidence.³ The narrower concern is that testosterone could accelerate a cancer already present but undetected, which is why baseline PSA is taken first and rechecked after.

Will TRT give me my energy back?

Possibly, but we won't promise it. The Testosterone Trials measured fatigue and saw small improvements that didn't reach the threshold the researchers set in advance.² Many men on monitored therapy do describe feeling better, and that's worth taking seriously — it just isn't something a trial has confirmed, so we won't claim one. If low energy is your main complaint, the more useful step is finding out what's causing it. Sleep apnea, thyroid, iron and depression all produce the same symptom, and several of them suppress testosterone too.

Will I be on this forever?

Often, yes. Testosterone therapy suppresses your own production, so stopping usually means returning to baseline or lower for a period. That's a real commitment and you should understand it before your first injection. See do you stay on TRT for life and what happens if you stop.

How often will I actually speak to a provider?

Initial consult, a recheck at week eight, then quarterly for as long as you're with us — same provider each time, with messaging in between. Monitoring that only happens when you chase it isn't monitoring.

What if my labs say TRT isn't right for me?

Then she tells you. Low testosterone is sometimes a symptom of something else — thyroid disease, sleep apnea, a pituitary problem — which is why a full panel is run rather than a single level. Finding that is a better outcome than a prescription.

Do you treat outside Arizona?

No. Your provider is licensed in Arizona and can only treat Arizona residents. That's how medical licensure works.

Start with the labs, not the prescription

A free 15-minute video consult with Lauren Orta, FNP-C. Nothing is prescribed until she has read your bloodwork.

Book your consult

References

Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023;389(2):107–117. (TRAVERSE) doi:10.1056/NEJMoa2215025 · PMID 37326322
Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of Testosterone Treatment in Older Men. N Engl J Med. 2016;374(7):611–624, and associated Testosterone Trials reports. doi:10.1056/NEJMoa1506119 · PMID 26886521. Summary: Lessons From the Testosterone Trials.
Xu Z, Chen X, Zhou H, et al. An updated systematic review and meta-analysis of the effects of testosterone replacement therapy on erectile function and prostate. Front Endocrinol. 2024;15:1335146. doi:10.3389/fendo.2024.1335146
Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31–40. doi:10.1001/jamapsychiatry.2018.2734 · PMID 30427999
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. doi:10.1210/jc.2018-00229 · PMID 29562364
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. American Urological Association. Published 2018; reviewed and validity confirmed 2024.
Ponce OJ, Spencer-Bonilla G, Alvarez-Villalobos N, et al. The Efficacy and Adverse Events of Testosterone Replacement Therapy in Hypogonadal Men: A Systematic Review and Meta-Analysis of Randomized, Placebo-Controlled Trials. J Clin Endocrinol Metab. 2018;103(5):1745–1754. doi:10.1210/jc.2018-00404

Medically reviewed by Lauren Orta, FNP-C
Family Nurse Practitioner · Arizona State Board of Nursing licence #261957 · Certified by the American Association of Nurse Practitioners
Reviewed 5 September 2026 · Next scheduled review September 2027

This page is general health information about testosterone replacement therapy. It is not medical advice, does not create a provider–patient relationship, and is not a substitute for evaluation by a licensed clinician. Study findings described here are group averages from published clinical trials and do not predict any individual result. Treatment plans are individual and no clinical outcome is promised or implied. AZTRT LLC is a management services organization providing administrative and technology support; it does not practice medicine. All clinical decisions are made solely by independent, Arizona-licensed providers. Services are available to Arizona residents only.