Testosterone Replacement Therapy: A Practical 2026 Guide

What TRT actually is

Testosterone replacement therapy is exactly what the name says: a man's own testosterone has dropped below what his physiology needs, and an exogenous form is introduced to restore it. The two delivery methods Selvara prescribes are intramuscular or subcutaneous testosterone cypionate and a daily testosterone cream.

TRT is the most studied hormone therapy in modern men's medicine. There is no ambiguity about what it does. The conversation worth having is whether you actually need it, what dose, what delivery, and how to manage the secondary hormones that move when testosterone moves.

When TRT is the right answer

A licensed practitioner generally reaches for TRT when two things are true: total testosterone is consistently in the low range (often below 300 ng/dL on a morning lab), and the symptoms align. Fatigue not explained by sleep, libido decline, loss of morning erections, depressed mood, slow recovery, brain fog.

TRT is also the right answer for primary hypogonadism, where the testes themselves cannot make enough testosterone regardless of how much LH the brain sends. Enclomiphene will not work in that case.

Cypionate vs cream

Testosterone cypionate is an injectable ester. It is the most widely used form of TRT globally. Selvara prescribes it as a once- or twice-weekly subcutaneous or intramuscular injection. It produces stable levels, is the cheapest delivery, and is the most predictable.

Testosterone cream is a daily transdermal. Applied to the scrotum or upper inner thigh, it bypasses needles entirely. Some men prefer it for that reason alone. Absorption is more variable, and partner transfer is a real concern, but the cream is the right answer for men who will not stay on a weekly injection schedule.

What HCG and anastrozole are for

When testosterone is replaced from outside, the brain stops asking the testes to make their own. The testes shrink, fertility usually stops, and the man's own LH falls to near-zero. HCG mimics LH and keeps the testes working alongside TRT. Selvara prescribes HCG for men who want to preserve testicular size and fertility while on therapy.

Anastrozole is an aromatase inhibitor. When testosterone is high, some of it converts to estradiol. Most men do not need anastrozole. A subset, especially men with higher body fat, convert enough to feel symptomatic. Nipple sensitivity, water retention, mood instability. A small dose corrects it. The aim is not to crush estradiol; estradiol is essential for bone, libido, and mood.

The bloodwork that matters

Selvara's initial panel covers total testosterone, free testosterone, LH, FSH, SHBG, estradiol (sensitive assay), CBC + hematocrit, lipid panel, PSA, and metabolic markers. The follow-up panel narrows to total testosterone, free testosterone, estradiol, and hematocrit.

What matters is not a single number but the trajectory. A practitioner reads three months of trend lines and the man's report of how he feels.

Side effects worth taking seriously

The two side effects to actually watch: rising hematocrit and rising estradiol. Both are correctable with dose, frequency, and (if needed) anastrozole. Acne and water retention are common at the start and usually settle.

PSA does not rise as much on TRT as the older literature suggested. A practitioner still tracks it. Sleep apnea can worsen on testosterone; men who already snore heavily should be screened.

Cost

Selvara prices testosterone cypionate at $169/mo, testosterone cream at $189/mo, HCG at $349/mo, and anastrozole at $39/mo. Initial bloodwork is $89, follow-up bloodwork is $79. No subscription. No card on file until you approve a protocol.

Frequently asked questions

Do I have to inject for the rest of my life?

TRT is typically a long-term protocol if the underlying cause of low testosterone does not change. Many men stay on it indefinitely. Some come off and try enclomiphene as a maintenance route.

Will TRT make me infertile?

Almost always, yes, TRT alone suppresses sperm production. HCG alongside TRT preserves fertility in most men. If pregnancy is on the horizon, the practitioner adjusts.

How fast does TRT work?

Energy and mood often shift in two to three weeks. Libido in three to six. Body composition in three to six months.

Is the cream as effective as injections?

When applied correctly and absorbed well, yes, but absorption is more variable. Some men test fine on cream; some find injections more reliable.

1. Bhasin S et al., "Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline," J Clin Endocrinol Metab, 2018.
2. Mulhall JP et al., "Evaluation and Management of Testosterone Deficiency: AUA Guideline," J Urol, 2018.