✓You are likely a fit if
TRT is appropriate for men with both clinical symptoms and confirmed low testosterone on labs, not one or the other.
- Two morning total testosterone readings below ~300 ng/dL (some labs use 264 as the threshold), drawn between 7-10am, fasting.
- Clear symptoms: low libido, erectile changes, persistent fatigue, decline in mood, loss of strength or muscle mass, brain fog.
- Free testosterone is also low (or SHBG is elevated, masking a real deficit).
- You are not actively trying to conceive, or you understand TRT will suppress fertility.
- You're committed to follow-up labs at week 8-12 and every 6 months.
×Hard contraindications, we will not prescribe
If any of these apply, TRT is off the table at OPTML.
- Active prostate cancer, or history of prostate cancer not in long-term remission with urology clearance.
- Active breast cancer in men.
- Untreated severe obstructive sleep apnea.
- Hematocrit above 54% at baseline (polycythemia).
- Severe untreated benign prostatic hyperplasia (BPH) with significant lower urinary tract symptoms.
- Uncontrolled heart failure (NYHA class IV).
- Recent (within 6 months) stroke, MI, or unstable cardiovascular disease.
- Active desire to father a child within the next 6-12 months, we'll route you to enclomiphene instead.
- Known hypersensitivity to testosterone esters or carrier oils.
!Conditions that require extra care
Manageable, but the protocol is adjusted and monitoring is more frequent.
- PSA elevated for age, urology evaluation required before starting.
- Hematocrit 50-54%, we'll start lower, dose more frequently (subq twice-weekly), and may require periodic phlebotomy.
- BPH on alpha-blocker or 5-AR inhibitor, manageable; coordinate with your urologist.
- Treated obstructive sleep apnea, OK if CPAP-adherent; we'll monitor.
- History of DVT/PE, relative contraindication; physician will weigh risk.
- Significant CVD with stable management, possible with cardiology coordination.
- Mood disorder or unstable mental health, TRT can amplify; we screen and we coordinate.
- Future fertility may be desired, we'll discuss enclomiphene first or hCG add-on.
Pre-start labs we require
Upload existing labs from the past 6 months or use the OPTML Optimized Health (Male) panel.
| Lab | Why |
|---|
| Total testosterone (AM, fasting) × 2 | Confirms diagnostic threshold. |
| Free testosterone & SHBG | Real bioavailable T; SHBG can mask true deficit. |
| Estradiol (sensitive assay) | Aromatization baseline. |
| LH & FSH | Primary vs. secondary hypogonadism. |
| CBC (hemoglobin, hematocrit) | Polycythemia risk. |
| PSA | Required if age ≥ 40 or family history of prostate cancer. |
| CMP, lipids, A1c | Cardiometabolic baseline. |
| TSH, prolactin | Rule out other causes of low T. |
What to disclose at intake
All of these change the protocol. Hidden facts always surface.
- Any current or past anabolic steroid, SARM, or peptide use, with dates and dosing.
- Any prior TRT, brand, dose, frequency, duration, why you stopped.
- Family history of prostate or breast cancer.
- Sleep apnea status: diagnosed, treated, or never tested.
- Plans for future children, even uncertain plans.
- Mental health history.
- All current medications, including blood thinners.