TRT & Hormone Optimization Clinics 2026

Testosterone Replacement Therapy (TRT) is a medical treatment for men with clinically low testosterone levels (hypogonadism). Symptoms can include fatigue, low libido, depression, difficulty building muscle, and cognitive issues. TRT is typically recommended when blood tests confirm low testosterone and symptoms are present.

TRT costs range from $35/month (Fountain TRT - testosterone only) to $250+/month (Marek Health - comprehensive protocols). Most services fall in the $100-200/month range including medications, labs, and consultations. HSA/FSA funds can often be used.

Yes, all providers listed here offer telemedicine consultations. You'll complete blood work at a local lab, have a video consultation with a licensed provider, and receive medications shipped to your door. Most services operate in 40+ states.

Common TRT medications include testosterone cypionate or enanthate (injectable), HCG (to maintain fertility and testicular function), aromatase inhibitors (to control estrogen), and sometimes clomiphene (an alternative to testosterone). Some clinics also offer peptides and growth hormone protocols.

Most providers require blood work every 3-6 months to monitor testosterone levels, hematocrit, PSA, estradiol, and other markers. Many clinics include labs in their monthly fee, while others charge separately.

Some insurance plans cover TRT if you have a diagnosis of hypogonadism. However, most online TRT clinics operate on a cash-pay model. HSA/FSA funds are typically eligible for TRT expenses.

Most clinics consider total testosterone below 300 ng/dL as low, though symptoms matter more than numbers alone. Some men experience low-T symptoms at 400-500 ng/dL, while others feel fine at 300. Free testosterone, SHBG, and symptoms are also considered. Online TRT clinics may have different thresholds than traditional endocrinologists.

Yes, exogenous testosterone suppresses natural testosterone production and can significantly reduce sperm count, potentially causing temporary infertility. HCG is often prescribed alongside testosterone to maintain testicular function and fertility. If preserving fertility is important, discuss this with your provider before starting - alternatives like clomiphene may be recommended instead.

Timeline varies by symptom:libido and energy often improve within 3-6 weeks, mood and cognitive benefits appear around 6-12 weeks, body composition changes (muscle gain, fat loss) take 3-6 months, and maximum benefits are typically seen at 12+ months. Optimal dosing may require several adjustments based on blood work and symptom response.

Common side effects include acne, increased hematocrit (thickened blood), water retention, and testicular shrinkage. Elevated estrogen can cause gynecomastia (breast tissue growth) - managed with aromatase inhibitors. More serious risks include sleep apnea worsening, cardiovascular concerns in some populations, and fertility suppression. Regular blood work monitors these issues.