Purpose of Treatment

Hormone optimization therapy for men is used to evaluate and treat symptoms related to low or suboptimal testosterone levels and related hormone imbalances. Symptoms may include:

• Low energy or fatigue

• Reduced libido or erectile changes

• Decreased muscle mass or strength

• Increased body fat

• Poor recovery from exercise

• Low motivation, mood changes, or brain fog

• Reduced bone density
  

The goal of treatment is symptom improvement and restoration of hormone levels into a healthy physiologic range, not performance enhancement or supraphysiologic dosing.

Hormone Optimization Membership:

$149/month for new hormone patients then $49/month for maintenance.
This includes initial evaluation, lab review, treatment plan, follow up labs and video visits at a monthly cadence until a hormone plan and balance is achieved, then you will transition to the $49/month with labs every 3-6 months.

Active $299/month Weight Loss Members: hormone evaluation and management included in membership fee

Bridge $199/month Weight Loss Members: new hormone evaluation is an additional $149/month and $49/month for hormone maintenance management

GLP-1 Maintenance + Hormone Optimization Maintenance Membership: $129/month

For current GLP-1 maintenance members:
If you are starting a hormone optimization evaluation, you will pay the standard new hormone patient fee of $149/month in addition to your GLP-1 maintenance membership until your hormone treatment reaches maintenance status.

Once both programs are in maintenance, your memberships will be combined into a single $129/month maintenance membership.

This low monthly maintenance fee is designed to make ongoing provider expertise more affordable by distributing costs over time rather than requiring large annual or quarterly payments.

Monthly Fee Covers:

• Medical Provider Oversight

• Medication Management and Ordering

• Lab Review Visits

• Video visits scheduled on as needed basis

• Access to low cost GLP-1 and peptides

Medication Costs are in addition:

• Prescription medications are not included in the monthly fee and vary based on medication and route of administration. They are provided at wholesale pricing (no markup).

• FDA-approved medications (e.g., testosterone gel for men) may be covered by insurance at retail pharmacies

• Compounded medications (e.g., specialty creams, injections, oral testosterone) are out-of-pocket expenses, but typically affordable.

Lab Tests are in addition:

• Labs may be completed using insurance or self-pay (insurance coverage is not guaranteed but often covers a portion).

• Other labs, such as DUTCH test or 4 point cortisol saliva testing are out of pocket expenses.

• New patients: initial recheck at 8-12 weeks, then typically every 3 months until steady state is reached 

• Established patients: typically every 6 months

Self-Pay Lab Fees (can vary):

Initial Comprehensive Labs

• Males: $200

• Females: $170

Repeat Labs

• Males: $110

• Females: $85

You can also choose to use insurance to cover labs at Quest Diagnostics, though this does not guarantee coverage and you may be responsible for copay up to $250 or the full amount depending on your insurer. With the self-pay rates listed above, this is what you pay upfront without insurance. I can customize your labs as well.

Program Details

• The initial consultation will review current symptoms, health goals, medical history and lifestyle. After the first visit, lab work will typically be requested to understand hormone levels. This could range from blood, urine, and/or saliva testing.

• The next visit will occur once the labs have returned and this will help guide your treatment options and recommendations. Your provider will be reviewing your labs to understand your entire hormone picture, from sex hormones, adrenals, thyroid, and metabolism.

• Each additional followup visit will be typically every 12 weeks or as needed by treatment plan.

• Typically blood labs are repeated 12 weeks after initiating therapy. Dosing and/or formulations of hormone therapy may be adjusted in the first few months.

• Your provider may recommend advanced hormone testing using the DUTCH (Dried Urine Test for Comprehensive Hormones), which is a highly accurate and safe method for evaluating hormone metabolism. I understand that this test is offered at wholesale pricing (approximately $300–$400) and is not typically covered by insurance.

• A medications through compounding are provided at-cost. Depending on the medication and formulation, you may be able to use insurance to offset some costs. However, all compounded medications (such as testosterone or compounded creams) are not covered by insurance and will require out-of-pocket payment.

• You may discontinue the hormone program at any time by providing written notice to the medical provider or their assistant. Discontinuation will terminate the prescribing and management relationship.
  

Hormone Therapy Options and Cost Reviewed

Treatment options are individualized based on symptoms, lab results, fertility goals, medical history, cost, and patient preference.

Option 1: Enclomiphene (Fertility-Preserving Therapy)

• What it is: An oral medication that stimulates the body to produce its own testosterone while preserving sperm production and testicular size.

• Dosing: Take one capsule orally daily.

• Cost: Dispensed through a compounding pharmacy, $60–$70/month.

• Why it may be chosen: Men wishing to maintain fertility, younger patients, or those with secondary (brain-signaling) low testosterone.

• Potential benefits: Increased natural testosterone production, preserved fertility and testicular size, oral dosing without injections. It usually moderately raises testosterone, but not as high as direct testosterone.

• Risks and side effects: Headaches, mood changes, rare visual disturbances, and possible reduced effectiveness in primary testicular failure. Titrating the dose slowly may avoid side effects.

• Can also be used in combination with injectable testosterone to help preserve testicular size instead of taking gonadorelin or hCG

Option 2: new Oral Testosterone (Kyzatrex)

• What it is: New to market FDA-approved oral testosterone absorbed through the lymphatic system rather than traditional liver metabolism.

• Dosing: Twice a day with fat-containing food

• Cost: Dispensed through a compounding pharmacy and is not covered by insurance
  $180 for a 2-month supply (400 mg daily) - starting dose and most stay here.
  $360 for a 2-month supply (800 mg daily). Price subject to change.

• Why it may be chosen: Preference for oral therapy and avoidance of injections or skin transfer risks with topical.

• Potential benefits: Raises testosterone levels consistently, avoiding the peaks and troughs associated with twice-weekly injections.

• Risks and side effects: Suppression of sperm production, increased red blood cell count, strict dosing requirements with meals, and lack of insurance coverage. Not showing same sperm production as injections in trials, though there is still a risk.

Option 3: Injectable Testosterone (Subcutaneous Route)

• What it is: Testosterone injected under the skin using small needles. It has the same effectiveness as old-school intramuscular injections.

• Dosing: Typically injected twice weekly. Does not require refrigeration.

• Cost: $60 for 20 weeks of medication. Dispensed through a compounding pharmacy and is not covered by insurance. 

• Why it may be chosen: Most reliable and consistent absorption, lower cost compared to oral options, and improved symptom control for many patients.

• Potential benefits: Stable testosterone levels, less daily management, and good tolerability when dosed appropriately.

• Risks and side effects: Suppression of sperm production, increased red blood cell count, acne or oily skin, and the need for self-injection. If used alone, testicular atrophy/shrinkage may occur. If this is a major concern, we could add gondarelin or hCG injections or oral enclomiphene to keep endogenous testosterone production.

Option 4: Topical Testosterone Gel

• What it is: Daily applied testosterone gel absorbed through the skin.

• Why it may be chosen: Preference for non-injectable therapy and potential insurance coverage if criteria are met.

• Cost: may be covered by insurance only if strict lab criteria for hypogonadism are met; otherwise, retail cost is approximately $50/month.

• Potential benefits: Easy daily application and no injections.

• Risks and side effects: Risk of transferring testosterone to partners or children, skin irritation, variable absorption, and suppression of sperm production.

• Most patients do not choose this as it requires a daily topical application.

Patients are encouraged to request medication cost estimates prior to starting therapy.

Updated Safety & Regulatory Information

• The FDA has removed the prior black box cardiovascular warning associated with testosterone therapy.

• Current evidence supports that testosterone therapy, when appropriately prescribed and monitored, does not increase cardiovascular risk in healthy men.

• Risk assessment remains individualized based on dose, formulation, route, and patient health.

• This update does not eliminate all risks, and ongoing monitoring is required.
  
  

Monitoring and Follow-Up Requirements

Patients agree to:

• Complete baseline labs prior to therapy

• Repeat labs 8–10 weeks after initiation or dose changes

• Continue monitoring every 3–6 months

• Report side effects promptly

• Attend required follow-up visits
  

Therapy may be adjusted, paused, or discontinued for safety reasons.

Potential Side Effects of Testosterone Replacement Therapy (TRT)

Testosterone therapy is generally well tolerated when appropriately prescribed and monitored, but side effects can occur. Not all patients experience these effects.

Common or Mild Side Effects

• Acne or oily skin

• Increased sweating

• Fluid retention or mild swelling

• Increased facial or body hair

• Mood changes, such as irritability or anxiety

• Changes in libido (increase or, less commonly, decrease)

• Injection site irritation (for injectable therapy)

• Skin irritation or rash (for topical gels)
  

Blood & Cardiovascular-Related Effects

• Increased red blood cell count (hematocrit), which can thicken the blood and increase clot risk if not monitored

• Changes in cholesterol levels, including possible lowering of HDL (“good cholesterol”)

• Fluid retention, which may worsen blood pressure or heart conditions in susceptible individuals

Current evidence shows no increased cardiovascular risk in healthy men when TRT is appropriately dosed and monitored, but individual risk factors must be considered.

Fertility & Testicular Effects

• Reduced sperm production

• Decreased fertility, which may be reversible after stopping therapy but is not guaranteed

• Testicular shrinkage, due to reduced natural testosterone production
  

Prostate-Related Effects

• Increase in PSA (prostate-specific antigen) levels

• Worsening of urinary symptoms in men with benign prostate enlargement

• Testosterone therapy does not cause prostate cancer, but may accelerate growth of existing prostate cancer
  

Sleep & Respiratory Effects

• Worsening of untreated sleep apnea

• Increased snoring in some individuals

Hormonal & Estrogen-Related Effects

• Breast tenderness or enlargement (gynecomastia) due to conversion of testosterone to estrogen

• Water retention or bloating
  

Rare or Serious Side Effects

• Blood clots (rare when monitored appropriately)

• Liver strain (primarily associated with certain oral formulations)

• Allergic reactions to medication components (rare)
  

When to Contact Your Provider Immediately

• Shortness of breath or chest pain

• Severe swelling in legs

• Sudden vision changes

• Severe headaches

• Signs of infection at injection sites
  

Individuals Who Should Use Caution

Careful evaluation is required for men with:

• History of prostate cancer

• Elevated PSA without evaluation

• Untreated sleep apnea

• Elevated hematocrit

• Significant cardiovascular disease

• Liver disease

Contraindications

Testosterone therapy is generally contraindicated in individuals with:

• Active prostate or breast cancer

• Uncontrolled polycythemia

• Severe untreated sleep apnea

• Hypersensitivity to medication components

• Use of supraphysiologic or non-prescribed dosing
  

Acknowledgment and Consent

I acknowledge that I have discussed the benefits, risks, alternatives, and limitations of men’s hormone optimization therapy. I understand that no hormone therapy is risk-free, fertility may be affected depending on treatment choice, and ongoing lab monitoring is required. I understand the program costs, insurance limitations, and that I may discontinue treatment at any time by notifying the clinic in writing. I consent to treatment as outlined above.