Testosterone replacement: a urologist’s framework.

Testosterone replacement therapy is heavily marketed and frequently misunderstood. A urologist’s framework starts not with the prescription but with the diagnosis.

Start with whether it is actually indicated

TRT is appropriate for men with genuine, diagnosed testosterone deficiency — confirmed with proper testing and correlated with symptoms. It is not a general-purpose enhancement, and a single borderline lab value is not a diagnosis. Step one is establishing whether a real deficiency exists.

Symptoms matter alongside numbers

Testosterone deficiency is a clinical picture: laboratory values and symptoms — energy, mood, libido, body composition, cognition. Numbers without symptoms, or symptoms without confirmatory numbers, both warrant caution and further thought.

Benefits and considerations

For appropriately selected men, TRT can meaningfully improve quality of life. It also carries real considerations — effects on fertility, the need for monitoring, and individual factors — that must be weighed honestly. As a urologist, Dr. Shusterman brings particular attention to the fertility and prostate dimensions that a non-specialist may underweight.