Testosterone replacement therapy (TRT) has become increasingly accessible through telemedicine. Where patients once navigated weeks of appointments with multiple providers, many can now complete the entire process—from initial consultation through ongoing management—virtually. This guide explains exactly how TRT telemedicine works, what to expect, and how to identify legitimate providers.
Table of Contents
- What is TRT Telemedicine?
- The TRT Telemedicine Process (Step-by-Step)
- Lab Testing Requirements
- Treatment Options & Delivery Methods
- Cost Breakdown: What You'll Pay
- How to Choose a Legitimate TRT Telemedicine Provider
- Frequently Asked Questions
What is TRT Telemedicine?
TRT telemedicine allows men with clinically low testosterone (hypogonadism) to receive diagnosis, treatment, and ongoing monitoring through virtual consultations with licensed physicians. The entire process—from initial evaluation through prescription and follow-up—occurs remotely via video appointments and secure messaging.
What TRT telemedicine includes:
- Symptom assessment and medical history review via video consultation
- Comprehensive lab testing (you visit a local lab; results sent to provider)
- Diagnosis and treatment plan discussion
- Prescription for testosterone (injections, creams, or other formulations)
- Medication shipped to your home or sent to local pharmacy
- Regular follow-up labs and consultations to monitor response
- Dose adjustments as needed based on symptoms and lab results
The TRT Telemedicine Process (Step-by-Step)
Step 1: Initial Consultation (20-30 minutes)
Schedule a video appointment with a licensed physician. During this consultation, expect discussion of:
- Symptoms: Fatigue, decreased libido, erectile dysfunction, reduced motivation, difficulty building muscle, mood changes
- Medical history: Prior testosterone levels, treatments tried, cardiovascular health, prostate health
- Contraindications: Active prostate cancer, uncontrolled heart failure, severe sleep apnea, desire for fertility
- Goals: What you hope to achieve with TRT
Outcome: The physician determines whether lab testing is appropriate based on your symptoms and medical history.
Step 2: Laboratory Testing
If clinically indicated, the provider orders comprehensive labs. You'll visit a local lab (Quest Diagnostics, LabCorp, or similar) for blood draw, typically in the morning when testosterone levels are highest.
Standard TRT labs include:
- Total Testosterone
- Free Testosterone
- Estradiol (E2)
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (CMP)
- Lipid Panel
- PSA (Prostate-Specific Antigen)
- LH and FSH (if diagnosis is unclear)
Timeline: Results typically available in 2-5 business days.
Step 3: Results Review & Diagnosis
Your provider reviews lab results and determines whether you meet diagnostic criteria for hypogonadism (low testosterone).
Diagnostic thresholds:
- Total testosterone: Typically <300 ng/dL indicates low T
- Clinical symptoms: Lab values must correlate with symptoms
- Repeat testing: Responsible providers confirm low levels with a second test before initiating treatment
Outcome: If you qualify, the physician discusses treatment options and develops an individualized plan.
Step 4: Prescription & Medication Delivery
Your provider prescribes testosterone and any necessary ancillary medications (e.g., anastrozole for estrogen management if needed).
Delivery options:
- Shipped to home: Many telemedicine providers work with compounding pharmacies that ship directly
- Local pharmacy: Prescription sent to your preferred pharmacy for pickup
- Insurance vs. cash pay: Coverage varies; compounding pharmacies typically cash-pay only
Timeline: 3-7 days for delivery or pharmacy availability
Step 5: Treatment Initiation & Education
Before you begin treatment, quality providers ensure you understand:
- Administration technique: If injecting, proper injection protocol (many provide video tutorials)
- Expected timeline: Symptom improvement typically begins at 3-6 weeks, with maximal effects at 3-6 months
- Side effect monitoring: What to watch for and when to reach out
- Fertility impact: TRT suppresses natural testosterone production and sperm production
Support: Reputable providers offer unlimited messaging for questions during treatment initiation.
Step 6: Follow-Up Labs & Optimization
Initial follow-up (6-8 weeks): Repeat labs to assess response and adjust dosing. Key metrics:
- Testosterone levels (target range typically 600-1,100 ng/dL)
- Estradiol (ensuring not too high, which causes side effects)
- Hematocrit (TRT can increase red blood cell production)
- PSA monitoring (prostate health)
Ongoing monitoring: After stabilization, most patients need labs every 3-6 months and brief check-in consultations.
Dose adjustments: Based on symptoms and lab results, your provider fine-tunes your protocol to achieve optimal outcomes with minimal side effects.
Lab Testing Requirements
Legitimate TRT providers require comprehensive lab work both before initiating treatment and regularly during therapy. Beware of providers who prescribe without proper testing—this is medically inappropriate and potentially dangerous.
| Lab Test | Purpose | Frequency |
|---|---|---|
| Total & Free Testosterone | Diagnose low T and monitor treatment response | Baseline, 6-8 weeks, then every 3-6 months |
| Estradiol (E2) | Monitor estrogen (testosterone converts to estrogen) | Every lab draw |
| Complete Blood Count (CBC) | Monitor hematocrit (TRT can cause blood thickening) | Every lab draw |
| PSA (Prostate-Specific Antigen) | Screen for prostate issues | Baseline, then every 6-12 months |
| Lipid Panel | Monitor cholesterol (TRT can affect lipids) | Baseline, then annually |
Treatment Options & Delivery Methods
1. Testosterone Injections (Most Common)
Formulations: Testosterone cypionate or enanthate
Dosing: Typically 80-200mg injected subcutaneously or intramuscularly every 3.5-7 days
Pros: Most cost-effective, predictable levels, easy self-administration
Cons: Requires injections; some patients experience "peaks and valleys" in energy
2. Testosterone Cream/Gel
Application: Topical application to shoulders, upper arms, or abdomen daily
Pros: No injections; steady testosterone levels throughout the day
Cons: More expensive; risk of transfer to partners/children; less predictable absorption
3. Testosterone Pellets
Method: Small pellets implanted under skin every 3-6 months
Pros: Long-lasting; no daily or weekly administration
Cons: Requires in-person procedure (not purely telemedicine); expensive; difficult to adjust dose
4. Oral Testosterone (Newer Options)
Options: Jatenzo, Kyzatrex (not the old, liver-toxic formulations)
Pros: No injections or topical application
Cons: Very expensive; must be taken multiple times daily; insurance often doesn't cover
Most recommended for telemedicine: Injections (best balance of efficacy, cost, and convenience).
Cost Breakdown: What You'll Pay
Initial Costs
- Initial consultation: $100-$300 (varies by provider)
- Initial lab work: $150-$400 (if not covered by insurance)
Monthly Ongoing Costs
- Monthly membership/management fee: $100-$300 (covers physician consultations and care coordination)
- Testosterone medication:
- Generic injections: $30-$80/month (insurance may cover)
- Compounded injections: $80-$150/month (cash pay)
- Brand-name gels: $300-$500/month (before insurance)
- Ancillary medications (if needed): $20-$50/month (e.g., anastrozole, HCG)
- Follow-up labs: $100-$300 every 3-6 months
Total estimated monthly cost: $200-$600 depending on treatment complexity, medication choices, and insurance coverage.
Insurance Coverage Note
Many insurance plans cover testosterone medications when medically necessary (documented low testosterone with symptoms). However, most telemedicine TRT providers operate on a membership model outside of insurance for the clinical management fees. Some will help coordinate insurance authorization for the medications themselves.
How to Choose a Legitimate TRT Telemedicine Provider
The explosion of online TRT clinics has created a landscape with both excellent and questionable providers. Look for these markers of quality:
✅ Green Flags (Good Signs)
- Licensed physicians: Verify the provider is a real MD or DO licensed in your state
- Comprehensive lab requirements: Requires baseline labs before prescribing and regular monitoring
- Video consultations: Conducts actual video appointments, not just online questionnaires
- Conservative prescribing: Starts with physiologic doses, not "bodybuilder" doses
- Transparent pricing: Clear about all costs upfront
- Physician accessibility: Offers direct communication with your physician between appointments
- Evidence-based protocols: Follows endocrinology society guidelines
🚩 Red Flags (Warning Signs)
- No lab requirements: Prescribes without comprehensive testing
- Guaranteed prescriptions: Promises everyone will qualify for TRT
- Supraphysiologic doses: Starts new patients at high doses (>200mg/week)
- No follow-up monitoring: Doesn't require regular labs during treatment
- Aggressive marketing: Focuses more on "alpha male" marketing than medical appropriateness
- Unclear licensing: Can't easily verify physician credentials or state licensure
- Hidden costs: Unclear about medication and lab pricing
Frequently Asked Questions
Can I get TRT prescribed entirely online without ever meeting a doctor in person?
Yes. As long as you have a video consultation with a physician licensed in your state and complete the required lab testing, TRT can be initiated and managed entirely via telemedicine. You will need to visit a local lab for blood draws, but all physician interactions can occur virtually.
What testosterone level qualifies me for TRT?
Most providers use <300 ng/dL as the threshold for low testosterone, though some consider treatment for symptomatic men in the 300-400 ng/dL range. However, lab values alone don't qualify you—you must have both low levels AND clinical symptoms (fatigue, low libido, erectile dysfunction, etc.). Legitimate providers won't prescribe to asymptomatic men with normal-low testosterone.
How quickly will I see results from TRT?
Timeline varies by symptom: Libido and mood improvements may begin at 3-4 weeks. Energy and cognitive benefits typically emerge at 4-8 weeks. Body composition changes (increased muscle, decreased fat) become noticeable at 3-6 months. Full benefits may take 6-12 months.
Will TRT affect my fertility?
Yes. TRT suppresses your body's natural testosterone production and sperm production. If you're planning to father children in the near future, discuss fertility preservation options with your provider. Some men take HCG alongside TRT to maintain fertility, though this adds cost and complexity.
Is TRT safe long-term?
When properly monitored by a physician, TRT has a good long-term safety profile for men with genuine hypogonadism. The key is regular lab monitoring (especially hematocrit, PSA, and cardiovascular markers) and dose adjustments as needed. Poor candidates include men with active prostate cancer, severe untreated sleep apnea, or uncontrolled heart failure.
Can I stop TRT if I don't like it?
Yes, but understand that once you start TRT, your body's natural testosterone production decreases. If you stop, it may take several months for natural production to recover (if it recovers fully at all, depending on age and baseline function). Work with your provider to taper appropriately if you decide to discontinue.
Considering TRT?
Bonsai Health provides evidence-based TRT via telemedicine to patients in Florida, Virginia, and Maryland. Licensed physician management starting at $295/month.