So here’s what I tell patients about testosterone therapy clinics in Lewisville when they sit down in my exam room and lower their voice a little, like they’re about to ask something awkward. Look, in my practice, I see this all the time—men in their late 30s, 40s, 50s, sometimes younger, who feel off. Low energy, low drive, brain fog, weight that won’t budge. And they’re wondering if testosterone replacement therapy is the missing piece.
The short, honest answer? Testosterone therapy can help the right patient. But it’s not magic. And it’s not for everyone. Hormone replacement for men works best when it’s done thoughtfully, with proper labs, medical oversight, and an understanding of why testosterone is low in the first place—not just because a number came back borderline. That’s the part that gets skipped way too often.
The Questions Patients Ask Me—Usually in This Order
And then patients ask me… well, usually the first thing is:
“Doc, how do I even know if my testosterone is low?”
So. This is where it gets tricky. Symptoms matter. A lot. Fatigue, low libido, erectile dysfunction, depressed mood, decreased muscle mass, increased visceral fat. But symptoms alone aren’t enough. We check morning total testosterone, usually between 7–10 a.m., because levels fluctuate. And if it’s low, we confirm it. Twice.
Now, here’s a diagnostic pearl I’ve learned the hard way—free testosterone sometimes matters more than total testosterone, especially in older men or guys with obesity or insulin resistance. SHBG can mess with the numbers. And yes, I’ve seen “normal” total testosterone with clearly low free testosterone and real symptoms. That’s where experience comes in.
“Can’t I just go to one of those testosterone clinics and start shots?”
You can. But whether you should is a different question. Some TRT clinics do great work. Others… not so much. I’ve seen patients started on testosterone after one lab draw, no discussion of fertility, no PSA baseline, no hematocrit monitoring. And that makes me nervous.
Actually, let me rephrase that. It doesn’t make me nervous—it makes me annoyed. Because testosterone is a controlled substance for a reason, and improper dosing can cause erythrocytosis, worsen sleep apnea, and mask underlying problems like pituitary disease.
“Is testosterone replacement safe?”
Probably. When it’s done right. But the literature is mixed. The cardiovascular risk debate is still ongoing. I’ve sat through CME lectures arguing both sides. My takeaway? In properly selected patients, with monitoring, TRT is generally safe. But blanket statements don’t help anyone.
A Real Patient Story (Details Changed, Obviously)
I had a patient—mid-40s, lives near Highland Village, works in tech. Married, two kids, stressed, sleeps like garbage. He came in saying, “I just don’t feel like myself.” That’s how he put it.
Labs showed borderline low testosterone. Not terrible. But his A1c was creeping up. Vitamin D was low. Sleep apnea—undiagnosed at that point.
Here’s where I almost made a mistake. I almost focused on the testosterone number alone. But we slowed down. Addressed sleep. Weight. Stress. Rechecked labs. And guess what… testosterone improved without starting TRT.
Six months later, then we revisited the conversation. And that time, hormone replacement made sense. Smaller dose. Better response. Fewer side effects.
I used to think testosterone therapy was either on or off. Now I realize it’s more like a dimmer switch.
What Testosterone Therapy Actually Looks Like in Real Life
So. Let’s talk logistics, because patients always want specifics.
Forms of TRT I use or discuss:
- Injections (weekly or biweekly—though weekly is usually smoother)
- Topical gels or creams
And yes, pellets exist, but I’m cautious. Hard to adjust once they’re in.
Dosing isn’t one-size-fits-all. I’ve seen guys feel awful on “standard” doses and great on lower ones. And monitoring matters—hematocrit, PSA, lipids, liver enzymes. This is not set-it-and-forget-it medicine.
And… fertility. This gets missed. Testosterone can suppress spermatogenesis. If a guy wants kids? We pause. Or we talk alternatives like clomiphene or hCG. Medical school did not prepare me enough for how often this comes up.
North Texas Men Are a Little Different
I’ll say this out loud. Men in North Texas—Lewisville, Flower Mound, The Colony—tend to be busy, stressed, under-slept, and carrying extra weight. That combo alone lowers testosterone. Add insulin resistance and you’ve got a perfect storm.
I’ve also learned a lot from patients. One guy taught me about how much alcohol on weekends was wrecking his hormones. Another about how night shift work destroyed his circadian rhythm. You don’t learn that from textbooks.
Teaching Moment (For the Med Students Reading This)
If you’re a student or resident—here’s a pearl. Always ask why testosterone is low. Primary vs secondary hypogonadism matters. LH, FSH. Pituitary red flags. Don’t skip the basics. And don’t let convenience override physiology.
FAQ: The Stuff Patients Ask After They’ve Googled Everything
“Doctor, when should I actually worry about low testosterone?”
If symptoms are persistent and labs confirm low levels—especially with fatigue, sexual dysfunction, or mood changes—it’s worth evaluating. Not every low number needs treatment.
“How long does TRT take to work?”
Energy and libido may improve in 3–6 weeks. Muscle changes take months. Mood varies. It’s gradual.
“Is it safe to take testosterone with blood pressure meds?”
Usually yes, but monitoring is key. Blood pressure, hematocrit, and cardiovascular risk all matter.
“Will testosterone therapy make my prostate cancer risk higher?”
Current evidence does not show increased risk when monitored appropriately. But PSA tracking is essential.
“Can I stop TRT once I start?”
Yes, but expect symptoms to return. And sometimes there’s a transition period. We talk through that.
“What can I do naturally before starting TRT?”
Sleep. Weight loss. Resistance training. Reduce alcohol. Fix vitamin deficiencies. Boring advice… but it works.
“Is online TRT the same as in-person care?”
Sometimes. But labs, exams, and follow-up quality vary widely. Be careful.
My Personal Take as a Family Doctor
Look. Testosterone replacement therapy isn’t good or bad. It’s a tool. And like any tool, it depends on how you use it. I’ve seen it change lives. I’ve also seen it overused.
My philosophy? Start with the whole patient. Hormones don’t exist in isolation. And if you’re looking for TRT treatment in Highland Village or Lewisville, make sure whoever you see is asking more questions than just “How low is your testosterone?”