Physician-led · assessment first
Testosterone replacement therapy
For men with the symptoms of low testosterone — lower drive, loss of strength, poor energy and mood — and a level that is actually low when it is measured properly. Two early-morning blood tests come before any conversation about treatment.
- Early-morning blood tests
- 2
- Minute assessment
- 60
- Months to first review
- 3–6
What it is
Testosterone falls slowly with age in most men, and a lower number on its own is not a disease. What is treated is hypogonadism: symptoms that fit — lower sex drive, erectile problems, loss of muscle and strength, tiredness, low mood — together with a testosterone level that is low on repeated testing. Levels are highest in the morning and vary from day to day, which is why the test is done early, and done twice, before anything else is decided.
Many of the same symptoms have other causes: poor sleep and sleep apnoea, weight gain, diabetes, alcohol, some medications, depression and thyroid problems. Several of these also lower testosterone, and treating them can bring it back up without a prescription. The assessment looks for them first.
Where replacement is appropriate, testosterone is prescribed and then monitored — the level itself, the blood count, and prostate checks where your age calls for them. It is a long-term treatment that suppresses the body's own production and, importantly, sperm production. It is not a performance or body-building product, and it is not prescribed as one at our North Vancouver clinic.
Measured, not assumed
Two early-morning tests, and the reason behind a low result, before any treatment is discussed.
Other causes first
Sleep, weight, alcohol, medication and mood are looked at — some raise testosterone on their own once they are treated.
Fertility is discussed up front
Testosterone suppresses sperm production. If children are in your plans, that changes the conversation.
Monitored for as long as it continues
Levels, blood count and prostate checks on a schedule, with a decision each time about whether it is still worth it.
What gets checked first
Low energy and low drive in men have a long list of causes, and several are more common than low testosterone. They are worth excluding — some of them lower testosterone themselves.
- Sleep apnoea, and short or broken sleep
- Weight gain, especially around the abdomen, and type 2 diabetes
- Alcohol, opioid pain medication, steroids and some other medicines
- Depression, anxiety and prolonged stress
- Thyroid disease, iron overload or deficiency, and other hormonal conditions
Usually a good fit
- Symptoms that fit — lower sex drive, erectile problems, loss of strength, tiredness or low mood
- A testosterone level that is low on two separate early-morning tests
- Other causes have been looked for, and treated where found
- No plans to father children soon, or a plan to protect fertility
- You are willing to come back for monitoring for as long as treatment continues
Usually not
- You want to build muscle or improve athletic performance — it is not prescribed for that
- You are trying to conceive, or plan to soon
- Prostate or breast cancer, or an abnormal prostate test that has not yet been investigated
- A red blood cell count (haematocrit) that is already high
- Untreated severe sleep apnoea, or uncontrolled heart failure
- A recent heart attack or stroke — this needs a careful discussion first
- A single low result, or a test taken in the afternoon — that is a reason to repeat it, not to treat
Before
- If you have recent bloodwork, bring it — including the time of day it was drawn
- Blood tests for testosterone are booked early, roughly between 7 and 10 in the morning, when levels are highest
- Bring a list of every medication and supplement you take, including anything bought for training
- Think about whether children are in your plans; it changes what is suggested
- Tell us about snoring, daytime sleepiness or pauses in breathing at night — sleep apnoea is common and often missed
The assessment
- 01HistoryYour symptoms and how long they have been there, your sleep, weight, alcohol, medications and plans for a family.
- 02ExaminationBlood pressure, weight, and a focused examination guided by your history.
- 03BloodworkTestosterone on two early mornings, and the tests that explain a low result — the pituitary hormones that drive it, a blood count, and others as needed.
- 04A decision in writingWhether treatment is reasonable, what the alternatives are, how it would be monitored and what it would cost.
If treatment starts
- Bloodwork at about three to six months to check the level and the blood count, then usually once a year
- Prostate checks where your age and history call for them
- An honest review of whether your symptoms have changed — if they have not, stopping is discussed
- Do not share or change your prescription; it is individually dosed and monitored
- Tell us promptly about chest pain, breathlessness, leg pain or swelling, or new urinary symptoms
What can go wrong
Testosterone treatment is a long-term commitment with known effects on the blood, the prostate, fertility and sleep, and its long-term effect on the heart and circulation is still being studied. All of it is weighed against your own risk factors before anything is started.
- Reduced or absent sperm production and smaller testes — usually recovering after stopping, but not always quickly or fully
- A rise in red blood cell count, which thickens the blood and is the main reason for regular blood tests
- Acne, oily skin and fluid retention
- Breast tenderness or enlargement
- Worsening of untreated sleep apnoea
- Growth of an existing prostate cancer, which is why prostate checks are part of monitoring
Questions we get
My testosterone came back low once. Do I need treatment?
Not on one result. Levels vary through the day and from day to day, and a single low value — especially one drawn in the afternoon or during an illness — is a reason to repeat the test, not to treat.
Isn't lower testosterone just part of getting older?
A gradual decline is. Treatment is for symptoms that fit together with a level that is clearly low on repeated testing, not for age alone.
Will it affect my fertility?
Yes. Testosterone suppresses sperm production, sometimes completely. If you want children now or in the next few years, say so at the start — it changes what is recommended.
How long before I would notice anything?
Changes in drive and energy, where they come, can show within weeks to a few months; others take longer, and some men notice little. That is why the first review, at three to six months, includes an honest look at whether it is worth continuing.
Can I stop once I have started?
Yes, though your own production can take months to recover and the symptoms may return. Stopping is planned with the physician rather than done abruptly.
Do you prescribe testosterone for training or body-building?
No. It is prescribed for a diagnosed deficiency and monitored as a medical treatment. It will not be prescribed here for performance or appearance.
Is this covered by MSP?
The assessment here is self-pay; this clinic does not bill MSP. Your family doctor can also arrange testosterone testing, and treatment where it is indicated.
Request an assessment
Request an assessmentWho does this
Assessment, prescribing and follow-up for these programmes are by a licensed physician in British Columbia, at the Lonsdale Avenue clinic in North Vancouver. Nothing is prescribed without an assessment. Who the physician is, and who else you will meet, is on the team page.
Other programmes here
Everything listed here is offered at the Lonsdale Avenue address in North Vancouver. Names, durations and prices come from the clinic’s live schedule rather than from this page, so what you see is what is bookable today.
- Hormone Replacement Therapy (HRT) ConsultationPhysician assessment first
- Medical Weight Loss ConsultationPhysician assessment first
Other places people start
These are sorted by what is bothering you rather than by treatment name. Each page says what actually helps, what does not, and when the honest answer is that nothing here is needed.
- Loose Skin After Weight LossLosing the weight is the hard part and you have done it. What is left is usually a skin problem rather than a fat problem, and those have completely different answers.
- Fatigue & Low EnergyThis is the concern where we are least likely to sell you anything, and we would rather say that at the top of the page than at the end of a consultation.
- Dullness & Uneven ToneDullness and dehydration are a texture problem, not a shape problem. That distinction decides which half of the menu is even relevant.
- Volume Loss & HollowsVolume loss is the change people describe as looking tired or gaunt without being able to name a line. It is also the one where over-treatment is most visible from across a room.
- Forehead & Frown LinesForehead and frown lines are muscle before they are skin. The question that decides your result is not the dose — it is whether the line is still only there when you move.
- Hooded Upper LidsThe line where this stops being an injectable question and becomes a surgical one is unusually clear, and you are entitled to be told which side of it you are on.
- Jawline & Contour LossThe most common reason people book here, and the one where the honest answer changes most with age. In your forties a device usually does it. In your sixties it usually does not.
- Nasolabial FoldsNasolabial folds are usually a symptom. Filling the fold itself is the most common way to end up looking heavy in the lower face.
- Stubborn Body FatA pocket that stays the same size while the rest of you changes. Usually the flanks, the lower abdomen, or under the chin. The useful question is not which machine to use — it is whether what you are looking at is fat at all.
- Under-Eye Hollows & ShadowsThe most common request here, and the one where the answer is most often no. Under-eye shadow has at least four causes and filler helps exactly one of them.