Dr. Jeremy GoodmanBoard-certified urologist
Testosterone therapy from a urologist in Los Angeles
A lot of the testosterone clinics in LA are TRT mills. A nurse practitioner starts you on hormones, and when something comes up beyond that, they can’t handle it. I’m a urologist. I confirm the diagnosis before I prescribe anything, and I look after what testosterone touches, including your fertility, your prostate, your blood count and your erections.
Written and medically reviewed by Jeremy Goodman, MD, board-certified urologist. Last reviewed .
Why a urologist should be the one running your testosterone
Most testosterone clinics in Los Angeles are built to start testosterone and keep you on it. Many are run by nurse practitioners who can write the prescription but can’t handle much beyond it. If the cause turns out to be your sleep or the blood flow behind your erections, a clinic like that isn’t set up to see it.
So when you come in tired and flat, or with a sex drive that’s gone quiet, I look at all of it. Sometimes the answer is testosterone. Other times it’s sleep apnea, a medication, drinking, or a blood vessel problem that needs to be dealt with first, and I can treat those too.
Urology covers the whole male reproductive system. That means the testicles, which make testosterone and sperm, the prostate, which testosterone affects, and the vessels and nerves behind erections. I trained at UCSF, did my urology residency at the University of Wisconsin, and spent two years in South Georgia doing bread and butter urology, kidney stone surgery and cancer surgery, with a focus on men’s health.
| Topic | Typical TRT clinic | With me |
|---|---|---|
| Who you see | Often a nurse practitioner, and not always the same one | Me, at every visit. I’m a board-certified urologist. |
| First visit | A short intake built around starting a prescription | A full hour on your symptoms, sleep, training, sex life and plans for kids |
| Diagnosis | Labs drawn so treatment can start | Your symptoms plus two early-morning blood tests, and a look for the cause |
| Forms of testosterone | Usually injections, the form the clinic makes money on | Injections, gels, creams, nasal spray, pills or pellets, picked with you |
| Fertility | Often an afterthought | I ask at the first visit, and I offer fertility-sparing options if you want kids |
| Anything beyond hormones | Referred out, or missed | Erections, prostate, testicles and fertility, all handled by me |
Who needs testosterone therapy
Low testosterone is a medical diagnosis, and one blood test isn’t enough to make it. The American Urological Association guideline asks for two things together. You need symptoms or signs of low testosterone, and you need low levels on two blood tests drawn early in the morning on different days.1 The guideline uses a total testosterone below 300 ng/dL as a reasonable cutoff.2
Symptoms that point to low testosterone
- Low sex drive, or erections that aren’t what they were
- Feeling tired even after a full night’s sleep
- Losing muscle and strength even though you’re training
- More belly fat and a flatter mood
- Trouble concentrating, or a short fuse
None of these points to testosterone on its own. Take a 45-year-old executive who sleeps five hours a night and drinks most evenings. He’ll feel most of that list whatever his testosterone is. That’s why I want the labs, and it’s why the first visit runs a full hour.
When it’s something else
Testosterone falls for a reason, and some of the reasons can be fixed without a prescription. Untreated sleep apnea, extra body fat, heavy drinking, some medications, or a problem with the pituitary gland that signals the testicles can all bring it down. Part of the workup is finding out which one you’re dealing with.
The AUA guideline also tells doctors to explain that losing weight and exercising can raise testosterone.1 I competed as a bodybuilder and worked as a personal trainer, so I can help you with that part too.
The labs I run, and what each one tells me
This is the workup the AUA guideline describes, plus the metabolic labs that show what your hormones are doing to the rest of you.1 I go through every number with you in plain English.
Starting with labs only
If you’d like your numbers first, you can start with a lab panel that I read, and decide from there. Price set at launch.
| Test | What it tells me |
|---|---|
| Total testosterone, two early-morning draws | Confirms the diagnosis. Levels peak in the morning, so the timing counts. |
| Free testosterone and SHBG | Shows how much testosterone your body can use when the total is borderline. |
| LH, plus prolactin when LH is low | Tells me whether the cause is in the testicles or the pituitary. |
| Hemoglobin and hematocrit | A baseline before treatment, since testosterone can thicken the blood. |
| PSA, in men over 40 | Checks the prostate before testosterone starts and while you’re on it. |
| Estradiol | If you have breast symptoms, or once you’re on therapy. |
| Kidney and liver panel, lipids, HbA1c | Low testosterone tends to show up alongside metabolic disease, so I check for it. |
| Semen analysis | For men who want children, before we decide on any treatment. |
Statement 23 of the AUA guideline, a strong recommendation, says “Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive.”1
If you want kids, tell me at the first visit.
Most testosterone clinics don’t explain this part. When testosterone comes from outside, your brain sees plenty in the blood and stops sending the signal that tells your testicles to work. Testosterone inside the testicles drops, and so does sperm production. In some men it goes to zero.3 Sperm usually comes back after you stop, but nobody can tell you how long that will take.
Most of the men I see are in their 40s and 50s, and plenty of them are still planning a family or haven’t ruled it out. So I ask up front. If kids are on the table, I start with treatments that raise your own testosterone and keep the testicles working. A semen analysis before we decide anything tells you where you stand.
Fertility-sparing options
- hCG
- Acts like the signal from your pituitary, so the testicles keep making their own testosterone and sperm.
- SERMs
- Clomiphene or enclomiphene. Pills that turn up your body’s own signal to make more testosterone.
- Aromatase inhibitors
- Lower how much testosterone turns into estrogen. I use them selectively, sometimes in combination.
These options are named in the AUA guideline and in the male infertility literature.1 3
How I treat low testosterone
There’s no single TRT program. What you get depends on your labs, your goals, whether you want children and how you live. I lay out the options and we decide together.
| Option | How it works | Fertility |
|---|---|---|
| Testosterone injections | Testosterone given by injection on a regular schedule. It’s easy to adjust. | Fertility: Suppresses sperm production |
| Gels and creams | Rubbed into the skin every day. Gel is the form used in the TRAVERSE trial. | Fertility: Suppresses sperm production |
| Nasal spray | A short-acting spray used two or three times a day, with no needles. | Fertility: Suppresses sperm production |
| Pills | Testosterone undecanoate capsules, taken twice a day with food. | Fertility: Suppresses sperm production |
| Pellets | Small pellets placed under the skin in a quick office procedure. Each round lasts about three to six months. | Fertility: Suppresses sperm production |
| Fertility-sparing treatment | hCG, clomiphene or enclomiphene raise your own production. | Fertility: Designed to preserve it |
| Lifestyle | Sleep, body composition, training and alcohol, worked on first and alongside everything else. | Fertility: Can only help |
A lot of TRT clinics offer injections and nothing else. I can prescribe every form, and the right one depends on your life, like how you feel about needles and whether you want kids.
How monitoring works
- Before you start
- Two morning testosterone levels, the cause workup, hematocrit, and PSA if you’re over 40. A semen analysis if you want children.
- Starting out
- I aim for the upper part of the normal range, around 750 to 1,000 ng/dL, then adjust the form and the dose to how you feel. I don’t copy doses from forums.
- The first months
- We recheck your levels and symptoms. If your levels are normal and you don’t feel better within 3 to 6 months, the guideline says to talk about stopping and look for another cause.1 I’ll have that conversation with you.
- For as long as you’re on it
- Testosterone, hematocrit and PSA on a schedule, every 6 to 12 months once you’re stable, and I read the results myself.
Testosterone and your heart, prostate and blood
For years the worry was the heart. Then came TRAVERSE, the largest randomized trial of testosterone therapy so far, published in the New England Journal of Medicine in 2023.4 It followed 5,246 men aged 45 to 80 with low testosterone and existing heart disease or high heart risk, for an average of 33 months. Major heart events happened in 7.0% of the men on testosterone and 7.3% of the men on placebo, so testosterone did not raise the rate of heart attacks or strokes.
The same trial found more atrial fibrillation, acute kidney injury and blood clots in the lungs in the testosterone group. Testosterone turned out safer for the heart than people feared, and it still carries some risk. That’s why I’m careful about diagnosis and monitoring.
What the FDA and HHS have changed
Regulators have moved with the evidence. In February 2025 the FDA ordered class-wide label changes. It added a blood pressure warning and the TRAVERSE results, and took out the boxed-warning language about increased cardiovascular risk.5 In June 2026, HHS asked for more updates, including removing the limitation on age-related low testosterone and contraindicating testosterone only in metastatic prostate cancer.6
Your prostate and your blood count
The prostate and the blood are a urologist’s territory. I check your PSA before you start and while you’re on treatment, and I watch your hematocrit because testosterone can thicken the blood. If either one moves, I’m already the doctor reading it.
| PSA | Your prostate |
|---|---|
| Hematocrit | How thick your blood is |
| Blood pressure | Now on the FDA label |
| Kidney function | Flagged in TRAVERSE |
| Testosterone | Keeps your dose right |
I know the gym side of testosterone
I competed as a bodybuilder and worked as a personal trainer before medicine. I know how men talk about testosterone in the gym, and the shortcuts they take, because I spent years in that world.
Bringing a low level back to normal can help your energy, strength, body composition and drive, and your training goes better when your hormones aren’t working against you. Pushing levels far past normal is a cycle, and it comes with its own consequences for your blood count and your fertility. I’ll tell you plainly which one you’re asking for.
What testosterone therapy costs
Goodman Longevity is cash pay, and I don’t bill insurance. That’s how visits can run a full hour while I keep the number of patients small. Financing is available through CareCredit and Cherry.
| Who treats you | Dr. Jeremy Goodman |
|---|---|
| First visit | A full hour, by telehealth or in person |
| Diagnosis | Symptoms plus two morning blood tests |
| Fertility | Fertility-sparing options if you want children |
| Consult fee | Set at launch |
| Labs only | Set at launch |
| Membership | $300–500 a month |
| Insurance | Cash pay, no insurance billing |
Telehealth in California and Georgia, in person in Los Angeles
Consults open by telehealth for patients in California and Georgia in late November 2026, and in-person visits in Los Angeles start in December. Testosterone is a Schedule III controlled substance. Under the current federal rules it can be started by telehealth through the end of 2026, and from 2027 new prescriptions may need an in-person visit.7 Seeing me in person in Los Angeles covers that either way.
Testosterone is often one part of a bigger picture. If you want the rest of it, read about men’s longevity medicine or penile filler from a urologist.
Concierge membership
$300–500a month
Testosterone is a long-term thing, so it fits best inside the membership. It covers direct access to me and my team by text and hormone management with labs I review. It also covers sexual health, longevity planning, other labs and the everyday medical questions that come up between visits.
Founding member spots are limited. Tiers are set at launch.
Questions men ask me about testosterone
If yours isn’t here, text it to my team and we’ll get back to you.
How do I know if I need testosterone therapy?
You need two things together. The first is symptoms. The second is low numbers on two early-morning blood tests taken on different days. The American Urological Association uses a total testosterone below 300 ng/dL as a reasonable cutoff. One low reading, or symptoms without the labs, isn’t enough reason to start a man on treatment for life.
Will testosterone therapy affect my fertility?
Yes, and most clinics skip this question. Testosterone from outside the body tells your testicles to stop making their own testosterone and sperm, and it can drop your sperm count to zero. Sperm usually comes back after you stop, but nobody can predict how long that takes. If you want children now or soon, I use fertility-sparing options like hCG or clomiphene.
Do your testicles shrink on TRT?
Often, yes. When outside testosterone shuts down your own production, the testicles have less to do, and many men notice they get smaller. How much varies. Treatments that keep the testicles working, like hCG, are one way I plan around it.
Do I have to inject testosterone?
No. Testosterone comes as injections, gels and creams, a nasal spray, pills, and small pellets placed under the skin. Many TRT clinics only offer injections. I go through every form with you, and we pick the one that fits your life and your plans for kids.
How much does testosterone therapy cost?
Goodman Longevity is cash pay, so you know the price up front. The concierge membership is $300 to $500 a month and covers ongoing hormone management with direct access to me. I confirm consult and lab prices with you before you book. Financing is available through CareCredit and Cherry. See the concierge membership.
Is TRT covered by insurance?
I don’t bill insurance. Staying cash pay is what lets every visit run a full hour. Financing is available through CareCredit and Cherry.
Can I get testosterone without seeing a doctor?
Not legally. Testosterone is a Schedule III controlled substance, so you need a prescription from a licensed clinician. Gym and online “research” products skip the diagnosis and the monitoring, and you have no idea what’s in the vial.
Why are some doctors reluctant to prescribe testosterone?
Mostly because of old worries about the heart and the prostate. In 2023 the large TRAVERSE trial found that testosterone didn’t increase heart attacks or strokes in properly diagnosed men, and the FDA has since updated the testosterone labels. My answer is to diagnose properly and monitor well.
Should a 70-year-old man take testosterone?
Age alone doesn’t rule it out. TRAVERSE enrolled men up to 80, and in 2026 HHS asked the FDA to remove the label’s limitation on age-related low testosterone. I use the same rules at 70 as at 40. I confirm the diagnosis and check the prostate and the heart before you start, and I keep a close eye on things after.
Can you build muscle on TRT?
If you’re low, bringing testosterone back into the normal range can help your energy, strength, body composition and drive, and training goes better when your hormones aren’t working against you. TRT and a steroid cycle are two different things. I competed as a bodybuilder, so I know that world, and I’ll tell you straight where medicine ends.
I’m already on testosterone. Can I switch my care to Dr. Goodman?
Yes. Bring your recent labs, your current dose and how you take it. I’ll look at how you were diagnosed, what’s been monitored, and whether the plan still fits your goals, including fertility. Sometimes a small change is enough, and sometimes it’s better to start over and do it properly.
Can I get penile filler if I’m on testosterone?
Yes. Many of the men I see for penile filler are already on testosterone or thinking about it. Tell me at your free filler consult and I can plan your hormones and the filler together. Read the penile filler guide.
What should I look for in a TRT clinic?
Look for a physician who confirms the diagnosis with two morning tests and asks about kids before prescribing. They should check PSA and hematocrit on a schedule, and they should be able to handle what else comes up, like erection problems or the prostate. That’s how I run my own practice.
Written and medically reviewed by Jeremy Goodman, MD, board-certified urologist. Last reviewed .
References
7 sources
- 1.American Urological Association. Evaluation and Management of Testosterone Deficiency. AUA guideline, 2018; reviewed and validity confirmed 2024. www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline
- 2.Testosterone deficiency: FAQs from the AUA guideline. Urology Times, July 30, 2026. www.urologytimes.com/view/testosterone-deficiency-faqs-from-the-aua-guideline
- 3.Ring JD, Lwin AA, Köhler TS. Current medical management of endocrine-related male infertility. Asian J Androl. 2016;18(3):357-63. pmc.ncbi.nlm.nih.gov/articles/PMC4854080/
- 4.Lincoff AM, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023;389:107-17. pubmed.ncbi.nlm.nih.gov/37326322/
- 5.U.S. Food and Drug Administration. FDA issues class-wide labeling changes for testosterone products. February 28, 2025. www.fda.gov/drugs/drug-alerts-and-statements/fda-issues-class-wide-labeling-changes-testosterone-products
- 6.HHS requests testosterone therapy label updates, citing new safety data. Urology Times, June 19, 2026. www.urologytimes.com/view/hhs-requests-testosterone-therapy-label-updates-citing-new-safety-data
- 7.McDermott Will & Schulte. DEA extends telemedicine flexibilities for controlled substance prescribing for 2026. www.mcdermottlaw.com/insights/dea-telemedicine-flexibilities-for-controlled-substances-2026/
Let’s find out what’s going on before you start anything.
A full hour with me, going through your symptoms and your labs. Telehealth in California and Georgia from late November. In person in Los Angeles from December.