Testosterone, done like medicine.
Low testosterone is real, treatable, and wildly over-marketed. This practice treats confirmed hypogonadism the way it deserves: correct diagnosis first, root causes addressed, honest risk conversations, licensed pharmacies, and labs on a schedule — not a subscription box.
Is it actually low testosterone?
Fatigue, low drive, brain fog, and stalled workouts have many causes — and most of them aren't testosterone. The evaluation starts with the whole picture: sleep quality and possible sleep apnea, body composition, training and protein intake, alcohol, medications (opioids and some antidepressants suppress testosterone), stress physiology, thyroid, and metabolic health.
Then we measure properly: total testosterone drawn in the morning, on two separate days, with free testosterone, SHBG, LH/FSH to locate the problem (testis vs. brain signal), plus prolactin when indicated. Borderline numbers with a clear reversible cause get treated at the cause first — because a man whose testosterone rises when his sleep apnea is treated didn't need a lifetime prescription.
Symptoms that prompt a work-up
- Persistently low libido or erectile changes
- Flat energy and motivation that sleep doesn't fix
- Loss of morning erections
- Declining muscle and strength despite training
- Irritability or low mood without another explanation
- Reduced beard/body hair growth, or infertility
Related reading: protein & muscle, the five numbers that predict your decade.
What TRT does — and what it costs you.
Realistic benefits (confirmed low T)
- Libido and sexual function — the most consistent improvement in trials.
- Energy and mood — often meaningful when levels were truly low.
- Muscle mass and strength — real but modest without training; substantial with it.
- Bone density — improves with sustained treatment.
- Body composition — modest fat loss, better response to training.
Real trade-offs, said plainly
- Fertility suppression. TRT shuts down sperm production — often profoundly. If future children are possible, we plan for that first, not after.
- Blood thickening. Hematocrit rises in a meaningful minority; we monitor and manage it.
- Cardiovascular risk was debated for a decade; the large 2023 TRAVERSE trial was reassuring for major events in treated hypogonadal men, but blood pressure effects and individual risk still get respect here.
- Prostate monitoring. TRT doesn't appear to cause prostate cancer, but PSA is checked before and during therapy per guidelines.
- Dependence by design. Long-term TRT suppresses your own production. Starting is a commitment; stopping needs a plan.
- Acne, oily skin, sleep-apnea worsening, and testicular shrinkage occur in some men.
Testosterone is FDA-approved for diagnosed hypogonadism. It is not approved — and not prescribed here — as a general anti-aging, athletic, or "optimization" drug for men with normal levels.
Dosed carefully. Monitored relentlessly.
| Phase | What happens | Labs |
|---|---|---|
| Evaluation | Full history, exam, root-cause screen, fertility conversation | 2× morning total + free T, SHBG, LH/FSH, prolactin if indicated, CBC, CMP, lipids, A1c, PSA (age-appropriate) |
| Initiation | Physiologic dosing — typically injectable or transdermal from a licensed US pharmacy; no "sky-high and see" protocols | Levels + hematocrit at ~6–12 weeks, dose adjusted to symptoms and mid-range targets |
| Steady state | Symptom review, blood pressure, training & nutrition integration | Testosterone, CBC/hematocrit, PSA per guidelines — every 6–12 months ongoing |
| Reassessment | Annual honest review: is this still helping, at the lowest effective dose? | Full metabolic picture; deprescribing plan if goals change |
Injectable, transdermal, and other delivery routes each have trade-offs in stability, skin transfer risk, and convenience — chosen together at your visit. Telemedicine follow-ups available across Washington State; controlled-substance rules require appropriate in-person elements and identity verification.
TRT — common questions.
My testosterone came back "normal" but I feel terrible. Now what?
Then we've learned something valuable: testosterone probably isn't your bottleneck. The same symptoms come from sleep debt, sleep apnea, overtraining, under-eating protein, thyroid issues, depression, and medication effects — all findable and mostly fixable. That's the functional medicine work-up, and it comes before any prescription.
Will TRT make me infertile?
It suppresses sperm production while you're on it, sometimes for a long time after stopping. If future fertility matters, we discuss alternatives that preserve it — including treating reversible causes, and referral for fertility-sparing protocols when appropriate — before starting standard TRT.
Is TRT safe for my heart?
The best available evidence — including the large TRAVERSE randomized trial in higher-risk men — did not show an increase in major cardiac events with properly monitored therapy for diagnosed hypogonadism. Blood pressure, hematocrit, and individual risk factors still get monitored, because "reassuring on average" isn't the same as "irrelevant for you."
Do you prescribe TRT for "optimization" if my levels are normal?
No. Pushing normal levels higher trades real risks — fertility, hematocrit, dependence — for marginal benefit, and it's outside the FDA-approved use. What we will do is chase the same goals through training, body composition, sleep, and metabolic health, which is where "optimization" actually lives.
How fast will I feel a difference?
Libido and mood often shift within 3–6 weeks; body composition and strength build over 3–6 months alongside training. We define what "working" means for you at the start, and we check it with labs and symptoms — not vibes.
Can naturopathic doctors prescribe testosterone in Washington?
Yes — licensed NDs in Washington State have prescriptive authority that includes testosterone with appropriate DEA registration. Your care includes coordination with any other physicians you see.
Find out what's actually low.
Proper labs, straight answers, and a plan — whether or not it ends in a prescription.
Book a Hormone Evaluation