Men's Health
Testosterone Replacement Therapy: What to Know Before You Start
October 7, 2026 Vitality Medicine RX Editorial Team
Testosterone replacement therapy can help men with confirmed low testosterone, but it is not for everyone and requires ongoing monitoring of hematocrit, PSA and estradiol. It is considered only when symptoms and labs support it, after a full evaluation. Vitality Medicine RX offers nurse practitioner-led telehealth testosterone care in states where Dr. Miklos Major II, Sc.D., DNP, NP-BC, FAAMFM holds an active license.
What the evaluation includes
Before any treatment, a full evaluation covers symptoms, history, medications and labs: total and free testosterone, estradiol, LH and FSH, prolactin when indicated, complete blood count, metabolic panel, PSA in age-appropriate men and thyroid markers as appropriate.
Who should not start
Men with untreated severe sleep apnea, severe heart failure, active prostate or breast cancer, or plans for pregnancy may not be candidates. Some men with elevated hematocrit or other risk factors also may not qualify.
Monitoring that is required
- Hematocrit, checked regularly because testosterone can raise red blood cell levels
- PSA in age-appropriate men
- Estradiol, because some testosterone converts to estrogen
- Blood pressure and symptom review at follow-up visits
Fertility considerations
Testosterone therapy can suppress sperm production. Men planning to have children should discuss this before starting, and HCG may be discussed for fertility preservation, though this use is off-label.
What this means for you
Testosterone is a controlled substance, and telehealth prescribing follows federal and state rules, which can require additional steps depending on your state. The decision to treat is made together, with risks and benefits reviewed openly.
When to talk to a clinician
If you have symptoms of low testosterone and want a careful evaluation, book a discovery call to confirm we can see you in your state.
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Talk to a Clinician
This article is educational and does not replace individualized medical advice. If you have questions about your own health, book a discovery call with Vitality Medicine RX. Your care is led by Dr. Miklos Major II, Sc.D., DNP, NP-BC, FAAMFM, a Doctor of Nursing Practice (DNP) and Doctor of Science (Sc.D.), board-certified nurse practitioner (NP-BC). Care is available in states where he holds an active license.
Book a Discovery CallQuestions About This Topic
Is testosterone therapy safe?
Testosterone therapy has risks that are reviewed before starting, and it requires monitoring of hematocrit, PSA and estradiol, along with symptom review.
Who should not start testosterone therapy?
Men with untreated severe sleep apnea, severe heart failure, active prostate or breast cancer, or plans for pregnancy may not be candidates.
How is testosterone therapy monitored?
Monitoring includes hematocrit, PSA in age-appropriate men, estradiol, blood pressure and symptom review at follow-up visits.
Does testosterone therapy affect fertility?
Yes. It can suppress sperm production. Men planning to have children should discuss this before starting, and HCG may be discussed for fertility preservation, though this use is off-label.
How do I get started?
Book a discovery call. We will confirm your state, review your symptoms and history, and outline the evaluation steps.
Last updated 2026-10-07.