1. What Labs Will You Run Before Prescribing TRT?
A comprehensive baseline panel is the foundation of safe TRT. The provider should test at minimum: Total Testosterone, Free Testosterone, Estradiol (sensitive assay), SHBG, LH, FSH, Prolactin, CBC with Hematocrit, CMP, Lipid Panel, and PSA for men over 40.
Why this matters: Insufficient lab work leads to inaccurate diagnoses and missed contraindications. A provider testing only Total Testosterone may overlook secondary hypogonadism (caused by pituitary issues), elevated prolactin (requiring further evaluation), or pre-existing polycythemia that makes TRT dangerous.
Providers that skip comprehensive baseline labs are cutting clinical corners. Learn what a proper panel includes in our complete telehealth TRT guide.
2. How Often Will Labs Be Monitored?
Follow-up labs should occur at 6–8 weeks after starting TRT, then every 3–6 months once stable. The monitoring panel should include Total T, Free T, Estradiol, Hematocrit, and CMP at minimum.
Why this matters: TRT affects multiple body systems. Without regular monitoring, dangerous conditions like polycythemia (hematocrit above 54%) can develop silently. Estradiol may climb too high, causing water retention and gynecomastia. Dose optimization also requires data—guessing isn't medicine.
A provider who doesn't schedule regular follow-up labs is not providing adequate medical oversight.
3. Do You Prescribe HCG or Enclomiphene?
HCG (human chorionic gonadotropin) and enclomiphene are important adjunct therapies that address key limitations of testosterone-only TRT. A quality provider should offer both when clinically appropriate.
Why this matters: Exogenous testosterone suppresses LH and FSH, leading to testicular atrophy and reduced sperm production. HCG maintains testicular function by mimicking LH. Enclomiphene stimulates the body's own testosterone production and may be preferable for younger men or those planning families.
Read more about these options in our TRT and fertility guide and TRT vs Clomid comparison.
4. How Do You Manage Estradiol?
Testosterone converts to estradiol through the aromatase enzyme. Elevated estradiol (E2) can cause water retention, mood changes, gynecomastia, and reduced libido—the very symptoms TRT is meant to treat.
Why this matters: A knowledgeable provider will monitor estradiol with the sensitive assay (not the standard assay, which is less accurate in men) and manage it appropriately. Management options include dose adjustment, injection frequency changes (more frequent = more stable levels), or, when necessary, a low-dose aromatase inhibitor (AI).
Providers who ignore estradiol or reflexively prescribe AI without monitoring are both problematic approaches. Balance is key.
5. What Happens If Hematocrit Rises?
TRT stimulates red blood cell production (erythropoiesis), which can increase hematocrit—the percentage of blood volume occupied by red blood cells. Hematocrit above 54% increases the risk of blood clots, stroke, and cardiovascular events.
Why this matters: A responsible provider should have a clear protocol for managing elevated hematocrit. Options include reducing the TRT dose, switching delivery methods (creams typically raise hematocrit less than injections), increasing injection frequency, therapeutic phlebotomy (blood donation), or temporarily pausing treatment.
If a provider doesn't monitor hematocrit or lacks a management protocol, that's a significant safety concern. Learn more about TRT safety in our side effects guide.
6. Is This Legal in My State?
Telehealth TRT is legal in all 50 states, but specific regulations vary. The prescribing physician must be licensed in your state, and both federal and state telemedicine laws must be followed.
Why this matters: Some states have additional requirements for controlled substance prescribing via telemedicine, including specific informed consent documentation, in-person follow-up requirements, or prescription monitoring program (PMP) checks. A reputable provider will be transparent about their compliance with your state's laws.
Read our full breakdown of TRT legality and prescription requirements.
7. What Are Total Monthly Costs?
Ask for a complete cost breakdown that includes every expense. Don't accept vague "starting at" pricing. A transparent provider will itemize:
- Monthly subscription or consultation fee
- Medication costs (testosterone, HCG, enclomiphene, AI if needed)
- Lab work costs and frequency
- Shipping fees
- Supplies (syringes, needles, alcohol swabs)
- Any enrollment or initial setup fees
Why this matters: Hidden fees are common in the telehealth TRT space. Some providers advertise low monthly rates but charge separately for labs, shipping, supplies, and follow-up consultations—doubling the effective cost. Compare total annual costs, not just monthly subscription rates.
See our detailed TRT cost breakdown and compare providers side-by-side.