Low energy, poor recovery, low libido, and changes in body composition can have a hormonal cause, but often don't. Your clinician evaluates low testosterone by looking at your symptoms, health history, and lab work from a properly timed early-morning fasting blood draw. When it's appropriate, we also look for an underlying cause before discussing treatment. If treatment is right for you, your clinician sets and adjusts your plan based on your labs, your symptoms and regular follow-up.
Who this is for
Washington adults 18 and older with symptoms consistent with low testosterone, or a documented deficiency, who want a careful, monitored approach. Treatment isn't right for everyone; your clinician decides whether it's appropriate after an evaluation.
How it works
Start with a few eligibility questions and your health history in our patient portal, then an optional free info call. If labs are appropriate, they're drawn at a participating lab in Washington, then you meet Timothy Shawn Dannels, ARNP, FNP-BC by video. You'll leave with a written plan: what we found, what we recommend, and what we'll be monitoring.
Does this sound familiar?
This list is for general information only. It isn't a diagnosis and can't measure your testosterone level. These symptoms have many possible causes, not just low testosterone.
- You're tired most days, even after a full night in bed
- Your workouts take longer to bounce back from
- It's harder to focus or stay sharp at work
- You're shorter-tempered or flatter in mood than usual
- Your sleep feels lighter or more broken
- You've lost some strength or stamina
- Your interest in sex has dropped off
- Erections aren't what they used to be
- You're enjoying things less than you used to
If several of these sound familiar, only a lab test and an evaluation can tell you more.
Want to talk it through? See how it works.
This list isn't the ADAM questionnaire and isn't a diagnosis; it can't measure your testosterone, only lab testing and a clinician's evaluation can. For background on symptom screening, see Morley et al., Metabolism 2000.
How we approach testosterone
Testosterone is easy to prescribe and hard to prescribe well. These are the principles behind our protocols. Our protocols are informed by the Endocrine Society and AUA guidelines and the TRAVERSE trial; your clinician makes the diagnosis based on your symptoms, a properly timed early-morning lab draw, and your history.
A number is not a diagnosis
Testosterone moves with sleep, illness, stress, and time of day, so timing matters, and if a result doesn't fit the clinical picture, your clinician decides the next step before any treatment.
The assay matters too. We measure total testosterone with liquid chromatography mass spectrometry (LC-MS/MS), using standardized lab testing, because non-standardized immunoassays can read the same sample as low or normal depending on the lab.
Free testosterone and SHBG matter
Only a small fraction of testosterone is free to act on tissue; most is bound to SHBG and albumin. A man with a normal total testosterone and high SHBG can be functionally deficient, and a man with a modest total and low SHBG can be fine. We measure free testosterone and SHBG at baseline and read them together with the total, never the total alone.
Find the cause before treating the number
Our standard baseline panel, as your clinician directs, includes LH and FSH to distinguish a testicular problem from a pituitary or hypothalamic one, along with prolactin, thyroid, estradiol, A1c, lipids, and a CBC and CMP. We also ask about sleep apnea, medications, alcohol, and recent illness, all of which can suppress testosterone temporarily.
Weight is the most common reversible cause. For men whose low testosterone appears driven by excess weight with no other cause identified, weight loss is the first-line treatment, not lifelong hormone replacement. Losing weight can restore levels on its own, and our weight management service, including medication when clinically appropriate, is often where we start.
Testing testosterone in men without symptoms mostly surfaces borderline or transient readings. Your clinician looks at your symptoms and your lab results together, which is why the intake asks about them in detail before anything is drawn.
Fertility comes up before treatment does
Testosterone therapy suppresses your own production and typically suppresses sperm production with it. If you may want children, we discuss that before anything is prescribed, and we consider options that preserve fertility, where they're appropriate.
If we treat: the lowest effective dose and close monitoring
- Individualized plans. Your plan is individualized. Your clinician sets and adjusts it based on your labs, your symptoms and regular follow-up.
- Target physiologic, not supraphysiologic. We aim to relieve your symptoms, keeping your testosterone at a level your clinician sets based on your labs and symptoms, using the lowest effective dose. Your clinician adjusts your dose based on your symptoms and follow-up labs, and may lower it if your levels or side effects suggest it's too high. Supraphysiologic, meaning above-normal, levels aren't the goal and can add risk.
- Estradiol is usually managed by adjusting dose or frequency first. Your clinician decides whether any other medication is needed. Suppressing estradiol carries its own costs for bone, joints, mood, and libido.
- Match the delivery method to you. Injections are the most adjustable and cost-effective. Creams and gels avoid needles but absorb less predictably. We'll walk through the trade-offs.
Monitoring is part of treatment
Blood pressure and symptoms are reviewed at check-ins. After you start treatment, we typically repeat labs at 6–8 weeks, again about 6 months in, then about every 6 months with a yearly comprehensive panel, as your clinician directs. These are included in membership. Rising hematocrit is managed by adjusting dose or frequency, and by phlebotomy if needed. Prostate risk is assessed before starting and monitored throughout. If symptoms persist despite good levels, we look at thyroid, sleep, and metabolic health before raising the dose.
What the safety data actually shows
The TRAVERSE trial, over 5,000 men followed for one to four years, found no meaningful increase in heart attack or stroke with testosterone therapy in properly selected patients. The same trial showed an increase in pulmonary embolism and in fractures among treated men, and long-term prostate cancer risk is not yet established. In 2025 the FDA updated testosterone labels to include these results and to warn that testosterone can raise blood pressure. Testosterone therapy is not risk-free, and it's not a reason to prescribe without a diagnosis. Your clinician will review heart health and other risks with you before starting therapy.
Sources
- Endocrine Society. Statement on Testosterone Replacement Therapy. July 16, 2026.
- Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.
- Mulhall JP, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423–432.
- Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE). N Engl J Med. 2023;389:107–117.
Cost
TRT membership is $129 a month, or less in combination with other treatments. First-visit deposit: $99, non-refundable. Initial labs are paid separately, at our cost, with no markup. Axiom's fees are listed up front. For TRT, your membership includes the follow-up labs your clinician orders on our standard schedule: usually at 6–8 weeks, about 6 months in, then about every 6 months, with a yearly full panel. You pay for your first panel, labs after a later dose change, and add-on labs, at our cost with no markup. Before we order any lab you'll pay for, we'll tell you the price. Medications aren't included in membership. You pay for them separately. See all memberships.
Other services
Ready to start with a plan?
Adults located in Washington. Cash-pay membership from $49 a month, with a plan built around your labs.