What testosterone level is considered low?

Most laboratories flag a total testosterone below roughly 300 ng/dL, but the number alone decides nothing. Free testosterone and SHBG determine how much hormone your tissues can actually use, which is why two men with the same total can feel completely different.

What is tested before starting TRT?

Total and free testosterone drawn in the morning and confirmed on a second draw, plus SHBG, LH, FSH, estradiol, prolactin, hematocrit, PSA where age-appropriate, a metabolic panel, lipids and thyroid. Anything less is not a workup.

What do the first ninety days feel like?

Sleep and mood usually respond first, within two to four weeks. Training recovery and libido follow. Body composition change is a twelve-week conversation, and the six-to-eight-week follow-up panel exists to correct the dose before any of it is judged.

Does TRT cause infertility?

Exogenous testosterone suppresses LH and FSH and can substantially reduce sperm production. If fertility matters now or later, say so at intake — protocols that preserve the axis, and sperm banking, are decisions to make before starting, not after.

What should I ask any clinic before starting?

Which biomarkers they draw, whether a physician reads the results, how often they re-test, what they monitor hematocrit and estradiol against, and what their plan is if you want to come off. A clinic that cannot answer those five is selling a subscription, not care.

For men · Education

TRT in Chicago: what to actually expect.

Written by the Elevate Clinical Team

Citations independently verified against PubMed, ClinicalTrials.gov, and FDA sources on August 19, 2026. Independent clinical review pending.

Testosterone therapy is neither a miracle nor a shortcut. Done properly it is a monitored medical protocol with a real workup, a real titration period, and real follow-up. Here is what that looks like.

One number does not decide anything

Most men arrive with a single total testosterone result and a question. That number, alone, is close to useless. What determines how you feel is free testosterone — the fraction actually available to your tissues — and that depends heavily on SHBG. Two men with an identical total of 480 can have completely different free levels and completely different symptoms.

Estradiol matters too. Men need estradiol for bone density, libido and mood; too little is as miserable as too much. And thyroid, insulin, ferritin, vitamin D and sleep apnea all produce symptoms that look exactly like low testosterone. Treating the wrong one wastes a year.

What we run before prescribing anything

Total and free testosterone, SHBG, albumin, estradiol, LH and FSH, prolactin, DHEA-S.
Full thyroid panel — not just TSH.
Fasting insulin, glucose, HbA1c and a complete lipid panel.
CBC with hematocrit, comprehensive metabolic panel, PSA where age-appropriate.
Inflammatory markers, ferritin, vitamin D and other micronutrients.

Sixty-five markers in total, drawn at a Quest location near you. If the picture points somewhere other than testosterone, we say so.

The first ninety days

Weeks one to three are usually quiet. Some men notice sleep and mood shifting early; many notice nothing, which is normal and not a sign that it is failing.

Weeks four to eight are where energy, drive and training recovery typically move. This is also when we retest, because this is when hematocrit and estradiol tell us whether the dose is right. Almost nobody lands on the perfect dose first try — titration is the job, not an admission of error.

Weeks eight to twelve are where body composition starts to visibly respond, assuming training and protein intake are actually in place. Therapy amplifies good inputs. It does not replace them.

What has to be monitored

Hematocrit, because testosterone stimulates red blood cell production and unmanaged elevation is the most common real risk. Estradiol, because aggressive suppression causes its own set of problems. PSA and prostate health where age-appropriate. Blood pressure and lipids. And fertility — exogenous testosterone suppresses natural production and sperm count, which matters if children are still on the table. Tell your physician early; there are approaches that account for it.

Questions worth asking any clinic

How many markers do you test before prescribing — and do you test free testosterone and SHBG, not just total?
How long is the visit with the physician, and is it the same physician each time?
When is the first retest, and what is adjusted based on it?
How is hematocrit managed if it rises?
What happens to my fertility, and what are the options?
Where do the medications come from?

If a clinic cannot answer these in plain language, that is the answer.

How we do it

Elevate Chicago is physician-led and entirely virtual. A $100 application fee reserves your intake and is credited toward your first order. Labs are drawn at Quest, your visit is thirty minutes by video, and prescribed therapies are dispensed through FDA-registered compounding pharmacies and licensed pharmacy partners when available.

More detail on the Hormone Optimization program, or read hormone therapy in Chicago.

This article is educational and is not medical advice. Treatment decisions require an individual evaluation by a licensed clinician.

Frequently asked questions.

What testosterone level is considered low?: Most laboratories flag a total testosterone below roughly 300 ng/dL, but the number alone decides nothing. Free testosterone and SHBG determine how much hormone your tissues can actually use, which is why two men with the same total can feel completely different.
What is tested before starting TRT?: Total and free testosterone drawn in the morning and confirmed on a second draw, plus SHBG, LH, FSH, estradiol, prolactin, hematocrit, PSA where age-appropriate, a metabolic panel, lipids and thyroid. Anything less is not a workup.
What do the first ninety days feel like?: Sleep and mood usually respond first, within two to four weeks. Training recovery and libido follow. Body composition change is a twelve-week conversation, and the six-to-eight-week follow-up panel exists to correct the dose before any of it is judged.
Does TRT cause infertility?: Exogenous testosterone suppresses LH and FSH and can substantially reduce sperm production. If fertility matters now or later, say so at intake — protocols that preserve the axis, and sperm banking, are decisions to make before starting, not after.
What should I ask any clinic before starting?: Which biomarkers they draw, whether a physician reads the results, how often they re-test, what they monitor hematocrit and estradiol against, and what their plan is if you want to come off. A clinic that cannot answer those five is selling a subscription, not care.

Sources

1.Testosterone therapy in men with hypogonadism — clinical practice guideline— Endocrine Society
2.FDA cautions about using testosterone products for low testosterone due to aging— U.S. Food & Drug Administration
3.FDA-approved prescribing information for testosterone cypionate— DailyMed, U.S. National Library of Medicine
4.Published literature on testosterone replacement therapy hypogonadism— PubMed, U.S. National Library of Medicine
5.Test directory and patient service center locator— Quest Diagnostics

Testosterone

The full picture behind one lab value — free testosterone, SHBG, estradiol and what monitoring requires.

Hormone therapy in Chicago

Physician-led testosterone, estradiol and thyroid work for Chicago patients, delivered entirely by video.

Perimenopause and hormone therapy

Why 'your labs are normal' keeps happening, and what treatment looks like when it is done properly.

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