By Todd Patrick Howell, MD — Founder & Medical Director, The Aesthetic Medicine and Anti-Aging Clinics of Louisiana. Member, American Academy of Cosmetic Surgery (AACS) · Member, American Academy of Anti-Aging Medicine (A4M) · LSU School of Medicine, New Orleans (Class of 2000) · 17+ years specializing in aesthetic and anti-aging medicine.
Testosterone replacement therapy, or TRT, is the medically supervised restoration of testosterone to optimal levels in men whose natural production has declined. For most men in their 40s and 50s, that decline is gradual, real, and usually mistaken for normal aging. The symptoms — flattening energy, eroding muscle, stubborn midsection fat, slower recovery from workouts, declining drive, and a kind of mental edge that has gone soft — get attributed to stress, sleep, age, or the wrong decade of life. What they often are, in plain clinical language, is low testosterone. And done correctly, TRT is one of the most reliable interventions in medicine.
At The Aesthetic Medicine and Anti-Aging Clinics of Louisiana, men account for roughly 60% of our patient base. We have spent more than 17 years building TRT protocols, refining them, and learning what works for the specific man sitting across from us. This guide is the conversation we have at first consultation, made available before you ever pick up the phone.
A note about how we practice. We are the only physician-led practice in Baton Rouge and Lafayette to combine nationally recognized aesthetic medicine, advanced hormone and longevity therapy, and surgeon-level body contouring under a single Medical Director. Founded in 2009 by Dr. Todd Howell and supported by an experienced team of nurse practitioners, master injectors, certified laser technicians, and medical aestheticians, the practice operates one of the deepest device and injectable suites in the state — built over 17+ years for patients who want every capability under one roof. For men in particular, that integrated structure matters. Optimizing testosterone often surfaces adjacent needs — peptide therapy for recovery, GLP-1 medical weight loss for stubborn fat, NAD+ IV for cognitive performance, and occasionally body contouring (VASERlipo Hi-Def) once weight is stabilized. Most TRT clinics offer TRT. We offer TRT inside the practice that earned the 2015 Best Male Patient Surgery award at THE Aesthetic Awards in Las Vegas — and the man who performed that procedure is the same physician writing your protocol.
What Is Testosterone Replacement Therapy?
TRT is the clinical practice of restoring testosterone to optimal physiologic levels in men whose natural production has fallen. Depending on the man, that may mean injectable testosterone cypionate or enanthate, hormone pellets, topical creams or gels, or — in specific cases — oral medications like enclomiphene that stimulate the body’s own testosterone production rather than replacing it directly.
The right protocol depends on the lab work, the symptoms, the lifestyle, the patient’s fertility considerations, and his preference for how he wants to manage the program day to day. A 44-year-old executive who travels two weeks a month needs a different protocol than a 56-year-old golfer who is home every day. A man who wants to preserve fertility needs a different protocol than a man whose family is complete. TRT is not a single product. It is a clinical strategy.
What we do not do, and what distinguishes our practice from online TRT services and chain clinics, is hand a man a bottle and a syringe and ask him to figure it out. Every TRT patient at our clinics is monitored — lab work at predictable intervals, dose adjustments based on what is happening in the body and how the man actually feels, and a relationship with the clinical team that lasts. The alternative is a generation of men medicated indifferently, which is what most chain TRT looks like.
The Symptoms of Low Testosterone Most Men Ignore
Low testosterone rarely announces itself. It accumulates. The man who used to recover from a workout in a day now needs three. The midsection that was always responsive to a week of clean eating no longer responds to a month of it. The libido that used to be a constant has become a sometimes. The mental edge — the kind that used to make 5 p.m. feel like an opportunity — now makes 5 p.m. feel like an obligation.
Most men are taught to ignore this. To work harder. To sleep more. To eat cleaner. Those things matter, and we will tell you so honestly. But after a certain age, no amount of discipline can compensate for testosterone that is no longer there. The men who recognize this earliest are the ones who benefit most from TRT.
The symptoms we see most often at consultation:
- Energy that flattens by mid-afternoon and never recovers
- Body composition shifts — particularly midsection fat that resists training
- Recovery time from workouts that has tripled or quadrupled
- Loss of mental sharpness, drive, ambition — what some call “the edge”
- Decline in libido or sexual function
- Sleep that has become lighter, less restorative, or interrupted
- Mood changes — irritability, low mood, or a flatness that is unlike you
- Loss of muscle mass despite continuing to train
- Slower thinking, forgetfulness, less verbal fluency
Why “Normal” Total Testosterone Isn’t Optimal
If you have asked your primary care doctor about testosterone, you have likely been told your levels are “in the normal range.” That may be technically true, and clinically misleading.
The standard reference range for total testosterone in most labs runs from approximately 250 to 1100 ng/dL. That range was constructed by averaging values across a very large population of men, many of whom were already symptomatic. A 50-year-old man with a total testosterone of 350 is “normal” — for a population of 50-year-old men, many of whom feel exactly the way he does. Normal is not the same as optimal. It is the same as common.
We look at the full picture. Total testosterone is one number. Free testosterone — the fraction actually available to your tissues — is another. SHBG (sex hormone-binding globulin), which determines how much of your testosterone is bound and therefore unavailable, is another. Estradiol, which is converted from testosterone and which matters enormously for mood, libido, and cardiovascular health, is another. We look at all of them, and we compare them to the levels associated with optimal function — not the levels averaged across symptomatic men.
Then we treat to optimal, not to normal. Done correctly, this is the difference between feeling like yourself again and being told to come back in a year.
TRT Delivery: Injections, Pellets, Creams, and Enclomiphene
How you receive your testosterone matters almost as much as which protocol you receive. The major options:
Injectable Testosterone
Testosterone cypionate or enanthate, injected once weekly or twice weekly. This is the most common TRT delivery method and the most well-studied. The advantages are precise dose control, steady blood levels (especially with twice-weekly dosing), and predictability. Most of our injection patients manage administration themselves at home after a brief in-office training.
Hormone Pellets
Bioidentical testosterone pellets are roughly the size of a grain of rice and are inserted under the skin (upper buttock area) in a 10-minute office procedure. They release testosterone at a steady rate over 4 to 6 months. Patients who travel frequently, who prefer not to think about weekly dosing, or who do not want syringes in the house gravitate toward pellets. The trade-off is that pellet levels cannot be adjusted mid-cycle.
Topical Creams and Gels
Transdermal testosterone is applied daily to the skin. It is the most easily adjustable option but requires consistent daily application and rotation of application sites. We use it less commonly than injections or pellets, but it has a specific role for men who cannot use injectable forms or who want maximum dosing flexibility.
Enclomiphene
Enclomiphene is not testosterone replacement — it is a medication that stimulates the body’s own natural testosterone production. We prescribe it primarily for men who want to preserve fertility or who have not yet committed to lifelong TRT. Most TRT clinics do not offer this option. We do, and for the right patient it can be a meaningful starting point.
The Anti-Aging Clinics TRT Protocol
Every TRT program at our practice begins the same way: a comprehensive baseline. That includes total and free testosterone, SHBG, estradiol, LH and FSH (the pituitary signals), DHEA-S, a full thyroid panel, complete blood count, comprehensive metabolic panel, lipid panel, PSA, and several other markers depending on your medical history. We are looking at the full endocrine and metabolic picture before we touch a dose.
From there, Dr. Howell and our clinical team build your protocol — typically with you in the room, explaining the rationale for each choice. You leave the consultation with a written plan, a clear understanding of what comes next, and a relationship with the team that will manage you for the long term.
Subsequent monitoring happens at structured intervals: 6 weeks, 3 months, 6 months, and then semi-annually once you are stable. We are looking for clinical response — how you feel, how you are performing, how you are sleeping — and for any lab values that need adjustment. TRT is not a set-it-and-forget-it medication. It is an ongoing relationship.
What Happens in Your First 90 Days
Most men want to know what to expect. Here is the honest answer.
Weeks 1 to 2
Early effects often include a subtle but real improvement in mood, mental clarity, and energy. Many men describe feeling more themselves before they can articulate why.
Weeks 3 to 6
Sleep usually improves. Libido begins to return. Mental edge — what feels like cognitive crispness — becomes noticeable. Some men report improvements in workout intensity and recovery as early as this phase, though the visible body composition changes lag behind.
Weeks 6 to 12
This is when body composition begins to shift. Strength returns, often beyond pre-TRT baselines. Visceral fat begins to respond. Recovery from workouts shortens. Mental and physical performance begin to compound.
Month 3 to 6 — Full Restoration
By month 6, most men report feeling fundamentally different. Body composition has shifted meaningfully. Energy, sleep, libido, and cognitive function are all operating at restored levels. This is also when we re-evaluate the protocol — and where adjustments often happen based on real-world response, not just lab numbers.
Side Effects, Monitoring, and Long-Term Safety
TRT, like any medical therapy, has potential side effects. The most common are elevated red blood cell counts (hematocrit), changes in estradiol levels, mild fluid retention in the first few weeks, and — in a subset of men with sensitive scalp follicles — acceleration of male-pattern hair loss. All of these are manageable with appropriate monitoring and, when needed, ancillary medications.
The more serious concerns — cardiovascular risk, prostate health, fertility — are real and we address them clinically. We monitor PSA. We screen for cardiovascular risk before and during treatment. We discuss fertility preservation openly and offer enclomiphene or HCG-supported protocols for men who want to maintain it. The decade-old concern that TRT causes prostate cancer has not held up under more recent research — but we still treat the prostate as a meaningful variable in every protocol.
What gets men into trouble with TRT is not testosterone itself. It is poor monitoring. Online clinics that mail testosterone with minimal labs and no follow-up are the source of most TRT complications we see in patients who come to us seeking better care. Done correctly, in a physician-led practice with structured monitoring, TRT has a strong long-term safety profile.
TRT Cost and Membership in Louisiana
TRT pricing depends on the protocol, the delivery method, the lab work required, and the level of monitoring. Most men find that physician-led TRT is more affordable than they expect — particularly when compared to the cumulative cost of treating the downstream consequences of untreated low T: sleep aids, antidepressants, energy supplements, weight-loss programs that do not work, and the compounding professional and personal cost of operating below your physical and mental capacity.
We offer financing through CareCredit, Cherry, and PatientFi. Our Longevity membership tier includes the labs, the protocol, and many adjacent services — and for most TRT patients, membership ends up being the most cost-effective long-term structure.
We provide a clear written cost estimate at your consultation. No surprises in billing.
Frequently Asked Questions
Will TRT cause hair loss?
Only in men who are genetically predisposed to male-pattern hair loss. TRT raises levels of dihydrotestosterone (DHT), the hormone responsible for follicle miniaturization in genetically susceptible men. If you have a family pattern of male-pattern hair loss, we can mitigate the risk with finasteride or topical anti-androgens, and we offer PRP and hair restoration services as part of the practice. If you do not have the genetic predisposition, TRT does not initiate hair loss.
Will I lose fertility on TRT?
External testosterone shuts down the body’s own production signal, which over time can reduce sperm production. For men who want to preserve fertility, we offer enclomiphene-based protocols or TRT combined with HCG to maintain testicular function. Tell us about your fertility goals at consultation — it is a routine conversation, not an awkward one.
Can I do TRT through telehealth?
Initial consultations are in-person at our Baton Rouge or Lafayette clinic — labs are drawn, the exam is done, and the protocol is built face-to-face. Follow-ups can be a mix of in-person and telehealth depending on the protocol and the visit.
Is TRT safe long-term?
Under proper physician supervision with structured monitoring, yes. The risks are well-characterized and manageable. The more important question is what the long-term cost is of NOT addressing low testosterone — and the answer to that is more concerning than the well-managed risks of treatment.
What if my partner is also interested in hormone therapy?
Many men come to us because their wife or partner is already a patient on HRT. We run a parallel Women’s HRT program — sometimes managed by the same provider, depending on the case. Couples consultations are common and welcomed.
How often will I need to come in once I am on TRT?
Initial protocol setup, then visits at 6 weeks, 3 months, 6 months, and then semi-annually once you are stable. For most men this is three to four office visits in the first year and twice yearly thereafter.
How discreet is this?
Very. Our practice was designed for patients who value privacy. The intake process, the consultation environment, the billing — everything is handled with the discretion you would expect.
Book a Consultation
If anything in this guide sounds like the season of life you are in, the next step is a consultation. We will spend an hour understanding where you are, where you want to be, and what an optimized protocol looks like for you. Initial consultations are complimentary. Call us at (225) 753-1234 (Baton Rouge) or (337) 484-1234 (Lafayette), or schedule online through the link below.
Where Luxury Meets Results. Because Confidence Is Always In Style.
