The energy, the libido, the workouts, the edge — the parts of you that quietly went missing. We bring testosterone back into range using a full panel, not a questionnaire, and we follow the numbers that actually matter on therapy — free T, estradiol, hematocrit, PSA. Weekly injection, EvexiPEL® pellet, or compounded cream.
You came in because something is off. Energy that used to be reliable isn't. Morning erections faded. The gym stopped giving back what you put in. Belly fat that won't move and motivation that won't show up. We draw a real panel — not just total testosterone — sit down with the numbers, and build a plan that brings testosterone back into the range a healthy version of you would live in, while monitoring the markers that actually matter on therapy: free testosterone, SHBG, estradiol, hematocrit, PSA, lipids, and a metabolic panel.
Weekly injection — the precision route. A small subcutaneous or intramuscular dose, self-administered at home once a week. Smooth, level chemistry — no peaks and valleys, no missed window. It's the route most men land on long-term because the dose is the most adjustable.
EvexiPEL® pellet — the set-it-and-forget-it route. A small pellet placed under the skin in a five-minute office visit, under local. It dissolves quietly over four to five months, so your levels stay even with nothing to remember and no weekly task.
Compounded cream — the gentle starting route. A daily transdermal cream made for your exact dose. Easy to start, easy to adjust, easy to stop. A good first step if you'd like to feel the change before committing to longer-acting delivery, or if injections aren't where you want to begin.
When clinically indicated, we add HCG to preserve testicular function and fertility, anastrozole to manage estradiol if it climbs, or pair therapy with peptides, weight-loss support, or sexual-wellness regenerative work. Compounded preparations are individually formulated and are not FDA-approved finished drug products; brand-name FDA-approved options are offered when clinically appropriate. The agent, the route, and the dose follow your diagnostics — never the other way around.
Who it helps.
You're not chasing a number on a chart — you're chasing how you feel. The labs are how we know we're getting there, and how we keep getting there. Learn about our diagnostics →
The 2 p.m. wall thins. The drive to get after the day comes back. Most men feel it in the first month.
Morning erections come back first; libido follows. We address the vascular and psychological pieces alongside the chemistry.
Lean mass goes up, visceral fat comes down — particularly when training and protein move with the medication.
Deeper sleep, fewer 3 a.m. wakeups, mornings that feel like mornings used to feel.
The flatness lifts. Frustration tolerance comes back. The dial on motivation rotates the right direction.
Soreness clears in a day instead of three. Workouts compound again instead of accumulating damage.
The arc is the same for most men — sleep and morning energy first, libido and recovery next, body composition and the strength curve after that. Here is what a real first half-year of TRT looks like at Bespoke.
Comprehensive lab draw — total & free T, SHBG, E2, hematocrit, PSA, lipids, metabolic, thyroid. Your provider sits with the data and recommends a route (injection, cream, or pellet) and a starting dose.
Repeat panel at trough. We adjust the dose to your numbers — not a generic protocol. HCG added if fertility matters; anastrozole only if E2 is genuinely climbing. Sleep and morning energy usually moving by now.
Visit with full safety labs — hematocrit and PSA in particular. Libido and recovery are typically settling; body-composition work begins to compound if training and protein are in range.
Full lab redraw against baseline. Strength and composition reviewed honestly. Maintenance plan set — quarterly visits, not yearly, with peptides or sexual-wellness work layered in if your goals call for them.
The honest versions of the questions that come up in every TRT consult. If yours isn't here, bring it — we'd rather work through it in person than guess on a webpage.
Not by default. Many men stay on therapy because they prefer how they feel on it, but it's a decision you keep making. If you stop, your levels return to where they were and the symptoms tend to follow. Injection and cream taper cleanly; pellets simply finish dissolving over four to five months. A door you keep choosing to walk through, not one that closes behind you.
Exogenous testosterone suppresses your own LH and FSH signaling, which reduces testicular production and can reduce fertility while you're on therapy. If fertility matters to you now — or might in the next few years — we typically add HCG to preserve testicular function and sperm production. We have that conversation at the consult, not after the script is written.
TRT can accelerate male-pattern hair loss in men who are genetically predisposed — by raising DHT, the androgen most associated with follicle miniaturization. It does not cause balding in men who weren't going to lose hair. If you're concerned, we screen for the pattern at consult and can layer in finasteride, topical anti-androgens, or PRP/exosome scalp therapy alongside the TRT plan.
The TRAVERSE trial (2023), the largest randomized cardiovascular safety study to date on TRT, found testosterone therapy in men with documented hypogonadism was non-inferior to placebo on major cardiovascular events. Risk is still real and individual, particularly for men with uncontrolled blood pressure, untreated sleep apnea, or rising hematocrit on therapy — which is exactly why we monitor those markers every quarter.
Sleep, mood, and morning energy often shift in the first two to four weeks. Libido and erectile quality typically follow in weeks four to eight. Body composition, strength, and recovery move slower — meaningful change shows up between months three and six, which is also when we re-test and tune the dose. A curve, not a switch.
We're a cash-pay clinic — labs, the consult, and medication are billed transparently up front, with no surprise fees. Many patients submit the lab work to their insurance for reimbursement; we provide the documentation. Cherry financing and our membership plans are available if you'd like to spread the cost.
If you choose the injection route, yes — most men self-administer a small subcutaneous or intramuscular dose once a week at home. The needles are short and thin and the technique is easy to learn; we walk you through the first one in clinic. If needles aren't for you, the EvexiPEL pellet (every four to five months) and the compounded cream (daily transdermal) are equally valid routes.
Urology is excellent for a focused workup of erectile or prostate disease. We're built differently — testosterone as part of a longer arc that includes sleep, body composition, metabolic health, peptides, and sexual wellness regenerative work. If something in your panel suggests a urologic question (a rising PSA, an exam finding), we refer cleanly. You don't have to choose between specialties; you choose the entry point.
No testosterone is prescribed before diagnostics. Your first visit is a structured clinical interview and a full blood draw — total and free testosterone, SHBG, estradiol, hematocrit, PSA, lipids, and metabolic markers. The plan that follows is built on what we find, not on what you typed into a form.
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