Testosterone Therapy in Arizona: Labs, Risks, and TRT Telehealth

Testosterone therapy in Arizona is easy to find and harder to find done well. Between Phoenix billboards and online offers that ship a prescription in days, many men over 40 are told their fatigue, low drive, or stubborn belly fat must be “low T.”

Sometimes it is. Often it is not, or not only. This guide explains how low testosterone is actually defined, which labs a careful workup includes, what the newest cardiovascular research and FDA labeling changes say, how testosterone is used for women, and how telehealth prescribing of testosterone works in Arizona today.

What is low testosterone, and what are the symptoms in men over 40?

Low testosterone (testosterone deficiency or hypogonadism) is a combination of symptoms plus consistently low blood levels. The American Urological Association (AUA) guideline supports a total testosterone below 300 ng/dL as a reasonable cut-off, and says the diagnosis should be made only after two measurements taken on separate occasions, both in the early morning.

The AUA guideline was first published in 2018 and remains the current guideline (the AUA reconfirmed its validity in 2024), though testosterone standards are under active discussion. A single low number is not a diagnosis. Testosterone varies through the day and drops with acute illness, poor sleep, and heavy training. Common symptoms include:

• Low libido, weaker erections, or fewer morning erections
• Persistent fatigue and lower motivation
• Loss of muscle mass and strength, or rising body fat, especially around the waist
• Low mood, irritability, or trouble concentrating
• Reduced body hair, hot flashes, or breast tenderness in some men

Many of these symptoms overlap with sleep apnea, depression, thyroid disease, insulin resistance, and medication side effects. That overlap is exactly why labs and a full history matter.

How common is low testosterone, and how fast does it decline with age?

Low testosterone becomes more common with each decade. A 2024 StatPearls clinical review reports that approximately 40% of men older than 45 and 50% of men in their 80s are hypogonadal, and that testosterone levels have been found to decrease by about 100 ng/dL every 10 years.

The same review links morbid obesity (a BMI above 40) to hypothalamic hypogonadism, in which the brain sends weaker signals to the testes.

The takeaway: a low number is common, especially with excess weight, but a low number plus real symptoms is what warrants a treatment conversation.

What labs should be checked before starting testosterone therapy?

A proper workup uses repeated early-morning testing, a hormone panel that explains why testosterone is low, and safety labs before any prescription. The Endocrine Society’s current guideline (2018), which is under active discussion, recommends morning fasting measurements confirmed with repeat testing.

At Amsara Health, the starting lab panel for men includes:

Lab	Why it matters
Total testosterone and free testosterone	Confirms the deficiency, using the AUA cut-off of 300 ng/dL for total testosterone
SHBG (sex hormone-binding globulin)	Shows how much testosterone is bound and unavailable, which helps interpret borderline results
LH and FSH	Distinguish a testicular cause from a pituitary or brain signaling cause; the AUA recommends measuring LH
Estradiol	Testosterone converts partly to estradiol; the AUA recommends testing when there are breast symptoms
CBC, including hematocrit	Testosterone can raise red blood cell counts; the AUA calls for baseline hemoglobin and hematocrit
Electrolytes	Baseline kidney and fluid balance, relevant given the kidney findings in TRAVERSE
PSA	The AUA recommends PSA in men over 40 before starting therapy
Lipids and hemoglobin A1c	Screen cardiometabolic health, since low testosterone and insulin resistance often travel together
TSH	Thyroid problems can mimic low-testosterone symptoms
Vitamin D, CRP, and DHEA	Round out the picture of inflammation, overall hormone balance, and nutrient status

Depending on your history, your provider may also look at prolactin, iron studies, or a sleep apnea screen.

What testosterone therapy options are available, and what about fertility?

FDA-approved testosterone for men comes in several forms, including injections, topical gels, and implanted pellets. At Amsara Health, testosterone therapy for men is prescribed as injections, when appropriate. For men who want to protect fertility, medications that stimulate the body’s own production may be used instead of or alongside testosterone.

Option	How it works	Considerations
Injections (for example, testosterone cypionate)	Intramuscular or subcutaneous doses on a set schedule	Flexible dosing; levels rise and fall between doses; hematocrit needs monitoring
Topical gels	Applied to the skin daily	Steadier levels; risk of transferring testosterone to partners or children through skin contact
Pellets	Implanted under the skin every few months	Dose cannot be quickly adjusted once placed; requires an in-office procedure
Clomiphene or enclomiphene	Signals the pituitary to increase LH and FSH, so the testes make more testosterone	Clomiphene is FDA-approved only for ovulation induction in women, so use in men is off-label; enclomiphene has not been FDA-approved for any use
hCG	Mimics LH to stimulate the testes	FDA-approved for selected cases of hypogonadotropic hypogonadism in males; use alongside testosterone to preserve fertility is off-label

Fertility deserves a direct conversation. Testosterone therapy signals the brain to shut down the hormones that drive sperm production, and the AUA states that exogenous testosterone should not be prescribed to men currently trying to conceive. For men who want to maintain fertility, the AUA says clinicians may use hCG, selective estrogen receptor modulators, aromatase inhibitors, or a combination.

Amsara providers ask every man about his fertility plans before discussing testosterone. When appropriate, Amsara offers clomiphene, enclomiphene, and hCG for fertility preservation. Compounded versions of any of these medications are not FDA-approved.

Can women use testosterone therapy in Arizona?

Yes, for selected women, but it is prescribed off-label. According to a March 2025 VA clinical summary, there are no FDA-approved testosterone products indicated for women in the U.S., and the best-supported use is low sexual desire that causes distress (hypoactive sexual desire disorder) after menopause.

The same summary prefers transdermal testosterone over injections, pellets, or oral forms, at roughly one-tenth of a daily men’s dose, with testosterone levels checked after starting to keep them in a normal female range. At Amsara Health, testosterone for women is prescribed as a gel, when appropriate. Read more about the FDA’s recent discussion of testosterone for menopausal women.

Is testosterone therapy safe for your heart? What the TRAVERSE trial and FDA found

For men with confirmed deficiency, the best current evidence shows testosterone therapy did not increase major heart attacks or strokes. The TRAVERSE trial, published in the New England Journal of Medicine in 2023, randomized 5,204 men ages 45 to 80 with hypogonadism and existing or high cardiovascular risk to testosterone gel or placebo.

According to a Cleveland Clinic summary, major cardiovascular events occurred in 7.0% of the testosterone group and 7.3% of the placebo group (hazard ratio 0.96). However, some risks were higher with testosterone:

• Atrial fibrillation: 3.5% versus 2.4%
• Acute kidney injury: 2.3% versus 1.5%
• Pulmonary embolism: 0.9% versus 0.5%

In February 2025, the FDA announced class-wide labeling changes for testosterone products. The agency removed boxed-warning language about an increased risk of adverse cardiovascular outcomes, added the TRAVERSE results, and required a warning about increased blood pressure. The FDA kept the Limitation of Use language for age-related hypogonadism, meaning approval still centers on men with a clear medical cause of low testosterone.

Potential benefits in men with true deficiency can include improved libido, energy, mood, and body composition, but responses vary and no result is guaranteed. Other risks include acne, elevated hematocrit, worsening untreated sleep apnea, and testicular shrinkage.

How often should testosterone therapy be monitored?

Monitoring is part of the treatment. The Endocrine Society recommends evaluating men at baseline, again at 3 to 6 months after starting, and then annually, and the AUA recommends checking testosterone levels every 6 to 12 months while on therapy.

• Testosterone levels, to confirm the dose lands in a healthy range
• Hematocrit, since the Endocrine Society treats a hematocrit above 54% as a reason to pause or adjust
• PSA, with urology referral if PSA rises more than 1.4 ng/mL over baseline or exceeds 4.0 ng/mL in the first year
• Blood pressure, lipids, and A1c, reflecting the updated FDA blood pressure warning

Can lifestyle changes raise testosterone naturally?

For some men, yes, and they are often the first step. Weight in particular matters. In a study presented at the Endocrine Society’s 2025 annual meeting, 110 men with obesity or type 2 diabetes treated with GLP-1 medications lost about 10% of their body weight, and the share with normal total and free testosterone rose from 53% to 77%.

Sleep matters too. A 2021 meta-analysis in Sleep Medicine of 18 studies in 252 healthy men found that total sleep deprivation of 24 hours or longer significantly lowered testosterone, while short-term partial sleep loss did not show a significant effect.

Practical levers include consistent sleep, screening for sleep apnea, strength training, reducing alcohol, and addressing insulin resistance. For men with obesity, supervised metabolic care may be part of the plan.

Can you get testosterone therapy through telehealth in Arizona?

Yes. Arizona law permits telehealth care and prescribing without a prior in-person exam for most medications. Under A.R.S. 36-3602, Arizona health regulatory boards generally may not require an in-person examination before a prescription; the statute carves out Schedule II drugs, which require an in-person or audio-visual examination.

Testosterone is classified by the DEA as a Schedule III controlled substance, so the prescriber must hold a DEA registration that covers Schedule III. Normally, the federal Ryan Haight Act requires an in-person evaluation before controlled substances are prescribed via telemedicine. The fourth temporary extension allows DEA-registered practitioners to prescribe Schedule II through V medications via telemedicine without a prior in-person visit through December 31, 2026. Rules after that date may change.

Convenient access is not the same as careful care. When evaluating any provider, ask whether they confirm low levels on two early-morning tests, check LH, hematocrit, and PSA, discuss fertility before prescribing, and schedule monitoring labs.

How does Amsara Health approach testosterone therapy in Arizona?

Amsara Health is a concierge integrative telehealth practice based in Scottsdale, serving adults across Arizona. We look at testosterone as one part of a larger picture that includes metabolic health, sleep, stress, and cardiovascular risk. Testosterone at Amsara is prescribed by Dr. Mia Chorney, DNP, FNP-BC, MSCP, who holds an active DEA registration for Schedule III medications.

Your first visit is a consultation and full history. Labs are ordered afterward through Sonora Quest or Quest, and your follow-up visit reviews results and builds a plan. If testosterone therapy is appropriate for you, your provider will discuss options (injections for men, gel for women), fertility goals, and a monitoring schedule. If it is not, we look at the other drivers of how you feel.

Amsara is direct-pay and does not bill commercial insurance, though insurance may still cover prescriptions and some labs. An initial visit is $275, follow-ups are $175, and the prescription refill service is $15 (free for members). Membership is $1,999 per year or $799 per quarter and includes 20% off non-insurable tests, free prescription renewals, priority booking, and weekday provider messaging.

Learn more about men’s health at Amsara, women’s health at Amsara, our providers, our lab and testing options, pricing and membership, or insulin resistance labs.

Frequently asked questions

If weight and blood sugar are part of your picture, our guide to GLP-1 weight loss in Arizona explains how metabolic care and hormone care can work together. When you are ready, you can become a patient.

Sources

• American Urological Association. Evaluation and Management of Testosterone Deficiency (AUA Guideline). AUA, 2018; validity reconfirmed 2024. Current guideline; standards under active discussion.
• Endocrine Society. Testosterone Therapy for Hypogonadism Guideline Resources. Endocrine Society, 2018. Current guideline; standards under active discussion.
• U.S. Food and Drug Administration. FDA Issues Class-Wide Labeling Changes for Testosterone Products. FDA, 2025.
• Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. New England Journal of Medicine, 2023.
• Cleveland Clinic. TRAVERSE Study Supports Cardiovascular Safety of Testosterone Therapy When Used as Indicated. Consult QD, 2023.
• Sizar O, Leslie SW, Schwartz J. Male Hypogonadism. StatPearls, updated 2024.
• VA Pharmacy Benefits Management Services. Transdermal Testosterone (Off-Label) for Hypoactive Sexual Desire Disorder in Postmenopausal Females: Summary Guidance. U.S. Department of Veterans Affairs, 2025.
• Endocrine Society. Anti-Obesity Medications Can Normalize Testosterone Levels in Men (ENDO 2025). Endocrine Society, 2025.
• Su L, et al. Effect of Partial and Total Sleep Deprivation on Serum Testosterone in Healthy Males: A Systematic Review and Meta-Analysis. Sleep Medicine, 2021.
• Operation Supplement Safety, U.S. Department of Defense. Clomiphene and Enclomiphene: Drugs, Not Dietary Supplements. OPSS, 2026.
• U.S. Food and Drug Administration. Pregnyl (chorionic gonadotropin for injection) Prescribing Information. FDA, 2023.
• Drug Enforcement Administration. Drug Scheduling. DEA.gov.
• Drug Enforcement Administration and HHS. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Federal Register, 2025.
• Arizona State Legislature. A.R.S. 36-3602, Delivery of Health Care Through Telehealth; Requirements; Exceptions. azleg.gov.

This article is for educational purposes and is not a substitute for individual medical advice. Talk with a licensed provider about your specific situation.

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