How to Find a Clinician Who Will Evaluate You Properly

Most readers of this site are not in San Diego. This page is for you, and it is meant to send you somewhere else.

What a proper evaluation looks like

Whoever you see, the sequence should look roughly like this. If it doesn't, that is worth noticing.

Symptoms are taken seriously and taken apart. Sexual symptoms carry more diagnostic weight than fatigue, because they are the ones that actually track testosterone.
Testosterone is measured in the early morning, fasting. Between roughly 7am and 10am, on an empty stomach.
The low result is confirmed on a second sample. Around 30% of initially low results are normal on repeat. One test is not a diagnosis.
LH and FSH are measured. This is what tells you whether the problem is in the testes or upstream, and it is the step most often skipped.
Someone asks why. Medication review, weight, sleep, alcohol, thyroid, prolactin, chronic illness.
Fertility is discussed before the first dose, not after.
There is a plan for what happens next — what is being monitored, and what would count as this not working.

Who to look for

An endocrinologist for the hormonal workup, particularly where the cause is unclear or the pituitary may be involved. A urologist or andrologist, especially one who does male fertility, where sexual function or conception is central. A primary care physician who is willing to do the full workup is entirely adequate for straightforward cases — the discipline matters more than the specialty.

Questions worth asking

Was my testosterone drawn in the morning, fasting?
Has the low result been confirmed on a second sample?
What were my LH and FSH, and what do they suggest about the cause?
Is there a reversible cause we haven't addressed?
What does this mean for my fertility?
What are the alternatives, including doing nothing for now?
How will we know whether this is working, and when do we stop if it isn't?

A good clinician will welcome these. The full version is atshould you start testosterone?

Warning signs

None of these is proof of bad practice on its own. Several together mean the decision was made before you arrived.

A symptom quiz is the front door. These have high sensitivity and poor specificity — one validated version flagged roughly half the men who did not have low testosterone. They are built to qualify you, not to diagnose you.
One blood test, then a prescription.
LH and FSH were never measured.
Nobody asked about children.
The word "optimization" is doing a lot of work, particularly if your testosterone is not actually low.
An aromatase inhibitor is prescribed routinely alongside testosterone, without a specific reason.
The clinic dispenses what it prescribes and the consultation is free or nominal. That is not disqualifying, but it is an incentive worth seeing.
You were never told you might not need this.

If you have already started

It is not too late to ask the questions. A second opinion on an existing prescription is a normal thing to seek, and a reasonable clinician will not be offended by it. Bear in mind that testosterone suppresses LH and FSH, so evaluating the original cause after the fact usually means stopping and waiting for the axis to recover — which is exactly why the workup is supposed to come first.

If you are in San Diego County