For Men
Testosterone Replacement Therapy (TRT) for Men in St. Louis
Care provided by Judy Smart, RN, BSN, in collaboration with Jennifer McDonald, DO.
Testosterone plays a big role in how men feel day to day — energy, mood, muscle tone, and sex drive among them. Levels naturally decline with age, often starting in a man’s 50s, though it can happen earlier. When testosterone drops enough to cause symptoms, it is sometimes called “low T” or andropause. At Smart Age STL in Chesterfield, MO, we work with men throughout the St. Louis area to check hormone levels with lab work. When appropriate, we build an individualized testosterone replacement plan using pellet therapy.
Signs of Low Testosterone
Every man is different, and these symptoms can have other causes too — which is exactly why lab work comes before treatment. Symptoms commonly linked to low testosterone include:
- Ongoing fatigue or low energy
- Decreased sex drive
- Difficulty with erections or fewer morning erections
- Difficulty reaching climax
- Mood changes — irritability, low mood, or anxiety
- Brain fog or trouble concentrating
- Loss of muscle tone or strength
- Increased body fat, especially around the midsection
How TRT With Pellets Works
At Smart Age STL, testosterone replacement is most often delivered using hormone pellets — small, rice-grain-sized pellets of compounded bioidentical testosterone. They’re inserted just under the skin during a brief in-office visit. The area is numbed first, so most men feel pressure rather than sharp pain. Because the pellets release testosterone gradually, there is no daily gel to apply or injection to schedule between visits. Most men return for a new set of pellets roughly every three to six months, based on follow-up labs and how they are responding to treatment.
Why We Start With Labs
We do not recommend testosterone therapy based on symptoms alone. Before starting treatment, we check your hormone levels with lab work, along with a review of your health history. This helps confirm whether low testosterone is actually part of what you are experiencing, and it gives your provider a baseline to compare against as treatment continues. Follow-up labs continue throughout treatment, so your plan can be adjusted as needed rather than staying fixed at your starting dose indefinitely.
Important information
- Bioidentical hormone pellets are compounded — a licensed pharmacy prepares them to match an individual prescription. They are not a mass-manufactured, one-size-fits-all product.
- Compounded bioidentical hormone therapy (BHRT) is not FDA-approved. The FDA does not review the safety or effectiveness of compounded medications the same way it reviews FDA-approved drugs.
- Pellet therapy requires lab work and ongoing clinical supervision. It is not a one-time treatment — dosing is adjusted based on follow-up labs and how you are responding.
- Results and timelines vary by individual. What one patient experiences is not a guarantee of what you will experience.
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Frequently Asked Questions
What is testosterone replacement therapy (TRT)?
Testosterone replacement therapy is treatment designed to bring testosterone levels back toward a more typical range for men whose labs and symptoms point to a deficiency. At Smart Age STL, TRT is most often delivered through hormone pellets — small pellets of compounded bioidentical testosterone placed under the skin. They release hormone gradually over several months. Treatment always starts with lab work and a conversation about your symptoms and health history. Testosterone therapy is not appropriate for every man, so dosing has to be individualized rather than standardized. From there, your provider builds a plan and continues monitoring your levels with follow-up labs, adjusting your dose over time as needed based on how your body responds.
How long does it take to notice a difference?
It varies from patient to patient. Some men report noticing changes in energy or mood within the first several weeks. Other changes — like improvements in muscle tone — tend to take longer to become noticeable. Because the pellets release testosterone gradually rather than all at once, it typically takes time for levels to stabilize after your first insertion. We use follow-up labs to track how your levels are actually trending, rather than relying only on how you feel week to week. That matters because how you feel can shift for reasons unrelated to treatment. If you are not noticing much change after a cycle or two, let your provider know. That is useful information for adjusting your plan, not a sign that something has gone wrong.
Is TRT safe?
TRT at Smart Age STL is provided under clinical supervision, starting with lab work and a review of your health history before treatment begins. As with any hormone therapy, there are risks and possible side effects, which your provider will go over with you individually. What applies to one patient may not apply to another. Compounded bioidentical testosterone pellets are not FDA-approved; they are prepared by a licensed compounding pharmacy rather than manufactured as an FDA-approved drug. That is part of why ongoing supervision matters: follow-up labs let your provider watch how your body responds over time and make adjustments if something needs to change. If you have a health condition you are concerned about, bring it up during your consultation so it can be discussed before you start treatment.
What does TRT cost?
Cost depends on your individual dose, which is based on your labs and treatment plan, so it is different from patient to patient. Most insurance plans do not cover hormone pellet therapy, and most patients at Smart Age STL pay out of pocket for consultations, labs, and insertions. Because your actual cost depends on factors specific to your situation, the most accurate way to get real numbers is a consultation. There, we can walk through what a plan would likely look like for you before you commit to anything. A typical consultation includes a review of your symptoms and health history, plus baseline lab work to check your current testosterone level. That way, you leave with real numbers instead of a generic price list. Call (314) 619-8848 to ask about scheduling a consultation.
Do I need a referral to start TRT?
No — you can contact Smart Age STL directly to schedule a consultation; you do not need a referral from another doctor to get started. That said, we will ask about your health history and current medications. Depending on what comes up, your provider may recommend coordinating with your primary care doctor or a specialist as part of your care. Every new patient starts with lab work and a conversation about symptoms and goals, so we have a full picture before recommending any treatment plan. Your first visit typically includes baseline bloodwork alongside that conversation. That way, your provider is working from real lab values — not just a symptom checklist — before discussing whether TRT is the right next step for you.