Testosterone Therapy for Men in Chicago: What It Does, What It Risks, and the Fertility Question

Testosterone therapy is one of the most aggressively marketed treatments in men's health, and one of the most poorly explained. This guide covers how low testosterone is actually diagnosed, what treatment realistically does, where the heart-risk evidence now stands, and the option most clinics never mention: preserving fertility.

A note on why this is here. This is a women's health practice. This page exists because the question comes up — from partners weighing the decision together, from patients asking about hormones across a household, and from people who have found nothing but supplement advertising elsewhere. For diagnosis and ongoing management of male hypogonadism, a urologist or endocrinologist is the right specialist, and this article says so more than once.

Low testosterone is a diagnosis, not a feeling

Fatigue, low libido, low mood, and lost muscle are real symptoms — but they are also the symptoms of poor sleep, depression, thyroid disease, sleep apnea, anemia, and simply being busy and 45. None of that is settled by how you feel.

Proper diagnosis requires both:

1. Consistent symptoms, and
2. Two separate low morning total testosterone measurements, drawn before 10am when levels peak, on different days. A single low reading is not a diagnosis — levels swing substantially day to day and are suppressed by acute illness.

The commonly used threshold is around 300 ng/dL, though laboratories and guidelines differ. If total testosterone is borderline, free testosterone and SHBG help clarify it — particularly in men with obesity, where SHBG is often low and total testosterone reads misleadingly low.

Before starting anything, a proper workup also checks LH and FSH (to distinguish a testicular problem from a pituitary one), prolactin, and a baseline hematocrit and PSA. Testosterone prescribed without this workup can mask a pituitary tumour or an untreated thyroid problem.

Beware the direct-to-consumer clinics. A telehealth service that prescribes on one afternoon lab draw and a questionnaire has skipped every step above.

What therapy realistically does

Where levels are genuinely low and symptoms match, treatment helps — modestly, and over months rather than weeks.

• Sexual function and libido — the most consistent benefit, and usually the earliest, often within 3–6 weeks.
• Mood and energy — improvement in men with genuine deficiency. Testosterone is not a treatment for depression.
• Body composition — a few pounds of lean mass gained and fat mass lost over 6–12 months. Strength gains are real but modest.
• Bone density — improves over years.

What it does not do: turn a normal-testosterone man into a stronger one. In men whose levels are already normal, therapy produces no meaningful benefit and all of the risks. Nor does it replace training and protein intake — the body-composition changes above assume you are actually lifting and eating adequately. Therapy alone does very little for real-world strength.

The heart question, as it stands now

For a decade this was genuinely unresolved, and the internet still reflects the old uncertainty.

The TRAVERSE trial (published 2023) was the large randomised safety trial the field had been waiting for: middle-aged and older men with hypogonadism and existing cardiovascular disease or high risk. Testosterone gel was non-inferior to placebo for major adverse cardiac events — heart attack, stroke, and cardiovascular death. That is genuinely reassuring, and it is the reason older warnings have been revised.

But TRAVERSE also found higher rates of atrial fibrillation, pulmonary embolism, and acute kidney injury in the testosterone group. So the honest summary is: the feared heart-attack signal did not materialise, and a smaller set of real risks did.

Other risks that require monitoring regardless:

• Erythrocytosis — testosterone raises red cell mass. Hematocrit must be checked at baseline, 3–6 months, and annually. Rising above roughly 54% means dose reduction, therapeutic phlebotomy, or stopping.
• Blood pressure — testosterone products carry labelling about blood pressure increases; it should be monitored.
• Sleep apnea — can worsen. Treat it first if present.
• Prostate — testosterone does not appear to cause prostate cancer, but it can accelerate an existing one. PSA monitoring is standard.

The fertility problem nobody mentions

This is the most important thing on this page for any man who may want children.

Standard testosterone therapy suppresses sperm production, and can reduce sperm count to zero.

The mechanism is simple. Your brain monitors testosterone and adjusts its signals — LH and FSH — to the testes accordingly. Testosterone from outside the body raises blood levels without the testes doing anything, so the brain concludes no signal is needed and stops sending LH and FSH. Sperm production runs on those signals. Without them it stops.

Think of the brain as a thermostat and the testes as a furnace. Fill the room with heat from a space heater and the thermostat switches the furnace off — even though the furnace was doing a second job nobody accounted for.

Recovery after stopping is usual but not guaranteed, and can take 6 to 24 months. Some men never fully recover baseline sperm production. Duration of therapy and age both matter.

If there is any chance you want biological children, say so before starting, not after.

Fertility-preserving alternatives

These raise your own testosterone production instead of replacing it, so the LH/FSH signal — and sperm production — is maintained.

• Clomiphene citrate — blocks estrogen feedback at the brain, so LH and FSH rise and the testes make more testosterone. Used off-label for this purpose, oral, inexpensive, and generally well tolerated. The most common first choice.
• Enclomiphene — the isomer of clomiphene thought to carry most of the benefit with fewer side effects. Availability in the US is complicated: it is not an FDA-approved product, and compounded versions have been the subject of FDA attention. Ask specifically what you are being sold.
• hCG (human chorionic gonadotropin) — mimics LH directly, stimulating the testes. Used alone, or alongside testosterone therapy to preserve sperm production in men who need both.
• Anastrozole — an aromatase inhibitor, useful in a narrower group of men with a low testosterone-to-estradiol ratio. Not a first-line choice.
• Sperm banking before starting therapy — the simplest insurance, and frequently the best answer. Comparatively inexpensive against the cost of fertility treatment later.

The lifestyle factors that genuinely move testosterone

Not a substitute for treating real hypogonadism, but they are not nothing, and they are the reversible causes:

• Weight loss — adipose tissue converts testosterone to estradiol. Meaningful weight loss meaningfully raises testosterone.
• Sleep — testosterone is produced largely during sleep. Chronic short sleep suppresses it measurably.
• Untreated sleep apnea — a common and correctable cause. Worth testing for before starting therapy, not after.
• Resistance training, alcohol reduction, and reviewing medications — opioids and long-term glucocorticoids in particular suppress testosterone.

What ongoing treatment involves

Testosterone is delivered as injections, gels, patches, or pellets, each with different steadiness, cost, and convenience. Gels carry a real risk of transfer to a partner or child through skin contact — cover the site and wash your hands.

It is not a short course. Symptoms return when it stops, and monitoring — testosterone level, hematocrit, PSA, blood pressure — continues for as long as you are on it.

Where to go

For diagnosis and management of low testosterone, see a urologist or endocrinologist. If fertility is a consideration, see a reproductive urologist before starting anything.

For hormone therapy in women — a different set of hormones, a different evidence base, and what this practice actually does — see:

• Hormone replacement therapy in Chicago: a practical guide
• HRT and weight changes
• Menopause management

Medical disclaimer

This article is general health information, not medical advice for any individual, and it is not a recommendation to start or stop treatment. Testosterone is a controlled substance with real risks and requires diagnosis and monitoring by a qualified clinician. Do not obtain it without a prescription or from a source that has not properly evaluated you.