Testosterone replacement therapy

Our assessment

We have been hard on how testosterone gets sold, so it is worth leading with what this service gets right, because it is most of the list.

Bloods are required before anything is prescribed. That is the single most important thing a testosterone service can do and it is not universal — we have reviewed a product that puts testosterone in an on-demand lozenge and [publishes no strength at all](/defy-tadalafil-testosterone-troche-reviews). A 50-biomarker panel at $65 is a real workup at a fair price.

The consultation is a telehealth conversation with a physician rather than a form, and the described content — personal and family history, review of the labs, cause of the symptoms — is the right conversation to be having.

Most notably, fertility is addressed rather than avoided. Exogenous testosterone suppresses the body’s own production and with it sperm production, and that suppression is not reliably reversible. Offering clomiphene and enclomiphene as fertility-preserving alternatives is a mark of a service taking the actual clinical problem seriously, and it is the thing we would most want a man in his thirties to be told before he starts.

Now the caveats, and they are about what is not published rather than what is.

No eligibility threshold is stated. Guidelines generally want a diagnosis supported by two morning samples showing genuinely low testosterone, alongside symptoms — not one reading, not an afternoon draw, and not symptoms alone. The page describes thorough testing without saying what result would lead a physician to decline, and a service that never says no to anybody is a different product from one that treats a deficiency.

Ongoing monitoring is likewise not detailed. Men on testosterone need periodic checks of haematocrit — the therapy thickens the blood and that is the common, manageable, genuinely dangerous-if-ignored complication — along with PSA and repeat levels. The Premium tier includes regular retesting, which suggests this is handled; the page does not say what is measured or how often.

One inconsistency worth flagging in our own grading. Troches appear in the formulary here, and we criticised a competitor’s testosterone troche. The difference is context rather than format: there, a troche was sold as an on-demand sexual-performance product with no strengths published; here it is one dispensing option inside a service that tests first and prescribes deliberately. The format was never the objection — the absence of diagnosis was.

Finally, the framing point we make everywhere. If erectile dysfunction is what brought you here, testosterone is usually not the answer to it. Low testosterone causes low desire more reliably than it causes erectile failure, and the most common cause of erectile failure is vascular. Getting your testosterone measured is worth doing; expecting the result to explain the erections often is not.