Questions to ask before testosterone treatment

Has low testosterone been confirmed?

A treatment decision needs symptoms and clinical assessment together with confirmed low testosterone, not one flagged result. Mayo Clinic describes repeat morning testing and further investigation when levels are low. Review the timing and repeat-test instructions, and ask whether free testosterone would help before a prescription.

Bring the actual reports, including collection times and reference ranges. Describe what changed in everyday life, when it began, and which symptoms matter most to you.

What might be causing it?

Testosterone can be low because of a problem in the testicles or in the hormone signals that tell them what to do. Tests such as LH and FSH help distinguish these possibilities, as MedlinePlus explains. The cause can change the treatment.

Some causes, including certain medicines, can be addressed; others need ongoing treatment. Discuss prescription medicines, supplements, previous hormone use and relevant illnesses openly. Don't stop a prescribed medicine yourself. Ask what should be investigated or treated before deciding on testosterone. MedlinePlus: male hypogonadism.

Could I want biological children?

Discuss current or future plans for biological children before the first prescription. Testosterone supplied from outside the body can suppress sperm production, sometimes enough that no sperm are found in semen. A higher testosterone blood level does not mean better fertility, as ASRM's 2023 guidance explains.

Ask whether you need a reproductive specialist, a semen analysis or a discussion about sperm banking. Recovery after stopping testosterone can take months and isn't guaranteed. Medicines that stimulate hormone production may suit some diagnoses, but they need their own assessment and monitoring. Don't assume a “fertility-friendly” label guarantees a pregnancy. AUA/ASRM infertility guidance, amended 2024.

What improvement should I realistically expect?

For men with age-related low testosterone, the American College of Physicians finds small potential benefits for sexual function. It advises against starting testosterone to improve energy, physical function or cognition in that population. Choose a concrete symptom goal with your clinician, such as improved sexual desire; this guidance does not cover every cause of hypogonadism.

Clarify the proposed medicine. Testosterone replacement and medicines intended to stimulate your own production are different approaches. Ask about evidence for your diagnosis, side effects and approval status. If a compounded medicine is proposed, understand that compounded drugs are not FDA-approved and do not undergo FDA review for safety, effectiveness and quality before marketing. FDA guidance on compounded medicines.

How do my health history and blood pressure affect the decision?

Your blood pressure and medical history can change whether treatment is appropriate and how closely it needs monitoring. Discuss raised red blood cell levels, sleep apnea, prostate or urinary problems, heart failure, previous cardiovascular events and blood clots. Ask which findings need assessment before treatment, using the EAU safety guidance as context.

In February 2025, the FDA announced removal of boxed-warning language about increased cardiovascular risk from testosterone products after reviewing TRAVERSE. It also required blood-pressure warnings, based on separate monitoring studies. FDA's 2025 labeling update.

In June 2026, the FDA requested further changes: removing the limitation for age-related hypogonadism and revising prostate-cancer and enlarged-prostate warnings. These are requested revisions, not confirmation that every product label has changed. Ask your prescriber to check the current label and assess your history. FDA's current testosterone information. The Endocrine Society's July 2026 statement continues to emphasize accurate diagnosis, reversible causes and monitoring; long-term safety remains uncertain. Endocrine Society's current position.

TRAVERSE compared testosterone gel with placebo in men aged 45 to 80 who had symptoms, two low fasting testosterone tests, and existing cardiovascular disease or high cardiovascular risk. Its main combined outcome of cardiovascular death, nonfatal heart attack or nonfatal stroke was similar between groups over about 33 months of average follow-up. Atrial fibrillation, acute kidney injury and pulmonary embolism occurred more often in the testosterone group. The study doesn't establish lifelong safety or the safety of high-dose use, and it did not test every formulation. Ask how its findings apply to you. TRAVERSE trial, 2023.

What will follow-up actually involve?

Plan checks of symptoms, side effects, testosterone, blood pressure and blood counts before and during treatment. The EAU recommends testosterone and hematocrit checks at 3, 6 and 12 months after starting, then annually. Higher-risk patients may need closer monitoring; these are treatment follow-up intervals, not the wait between diagnostic repeat tests.

Hematocrit is the proportion of blood made up of red cells and can rise with testosterone. Discuss prostate monitoring according to age and risk. The timing of the blood draw relative to a dose depends on the formulation, so ask for written instructions, who reviews results and how to reach someone between appointments. Compare this with the separate-day testing used to confirm a diagnosis.

When will we reconsider the plan?

The AUA recommends discussing stopping therapy after 3–6 months if testosterone normalizes but symptoms or signs do not improve. Set a review date with your prescriber and assess the original symptom goals. This is a shared treatment decision, not an instruction to stop on your own.

Also ask for the full ongoing cost, including medicine, appointments and repeat tests, and what happens if you change providers. Keep a copy of the agreed plan and your results.