Low testosterone — clinicians call it hypogonadism or testosterone deficiency — is a diagnosis, not a feeling. The symptoms men bring to us are real: flat energy, fading libido, softer erections, stubborn belly fat, poor sleep, a shorter fuse, a sense that the dial has been turned down. But none of those symptoms are specific to testosterone. Untreated sleep apnea, thyroid disease, depression, heavy alcohol use, opioid or steroid medications, and obesity itself can all produce the same picture, and some of them lower testosterone directly. Treating the hormone while missing the cause helps no one.
That is why the American Urological Association's testosterone deficiency guideline (published in 2018, with its validity reconfirmed in 2024) asks for two separate early-morning total testosterone measurements before a diagnosis is made, and uses a total testosterone below 300 ng/dL together with symptoms as the working definition. Testosterone swings through the day and across assays; a single afternoon draw is not enough to put a man on a controlled substance for years.
At Atlanta Medical Institute in Buckhead, that workup is the whole first phase. Dr. Elbridge Bills, Dr. Jeff Semel, and Dr. Leslye Pace review your history, symptoms, medications, and a full baseline lab panel before anyone discusses a prescription. Some men who walk in convinced they need testosterone turn out to need a sleep study, a thyroid workup, or a weight and metabolic plan instead — and some of them see their testosterone recover once that is addressed.
We also want you to know what testosterone therapy is and is not. The FDA-approved testosterone products are indicated for men with primary hypogonadism or hypogonadotropic hypogonadism from an established medical condition; the labels state plainly that safety and efficacy in men with age-related low testosterone have not been established. Testosterone is a Schedule III controlled substance. It can help the right patient meaningfully, and it can be the wrong choice for another man with identical symptoms. No one at AMI can promise you a particular result, and we will not try.
Program Benefits
- Two separate early-morning blood draws before any diagnosis is made, as the AUA guideline advises
- A baseline panel including total and free testosterone, LH, estradiol, hematocrit, lipids, and PSA for men over 40
- A deliberate search for reversible contributors — sleep apnea, thyroid disease, weight, alcohol, opioids, and other medications
- FDA-approved testosterone formulations (injection, topical, oral, nasal, or implanted pellet) selected by your physician for your situation
- A documented fertility conversation before you start, because exogenous testosterone suppresses sperm production
- Scheduled follow-up labs, blood pressure checks, and symptom review for as long as you remain on therapy
Is Low Testosterone Actually the Problem?
The symptoms below are the ones men most often describe. Read them as reasons to get tested, not as a diagnosis — every one of them has other common explanations, and the AUA guideline is explicit that testosterone deficiency requires both low measured levels and symptoms, not one or the other.
If your labs come back normal and your symptoms are real, that is useful information. We will keep looking rather than hand you a prescription you do not need.
- Persistent fatigue that sleep does not fix
- Reduced sex drive, or fewer spontaneous erections
- Loss of muscle mass and strength despite training
- Increased body fat, particularly around the abdomen
- Low mood, irritability, or difficulty concentrating
- Poor or fragmented sleep
- Reduced bone density found on a scan
Who Is a Candidate, and Who Is Not
Candidacy is a physician's decision made after evaluation and confirmed lab work — never something you can determine from a symptom quiz or an online questionnaire. In general, the men we consider for treatment have confirmed low morning testosterone on two occasions, symptoms that fit, and no condition that makes therapy unsafe.
Testosterone therapy is not appropriate for men with known or suspected prostate or male breast cancer, and the FDA labeling advises against its use in men with uncontrolled hypertension. We approach it cautiously — or decline it — when hematocrit is already elevated, when sleep apnea is untreated, or when an unexplained PSA elevation needs urologic evaluation first.
Fertility deserves its own paragraph. Exogenous testosterone suppresses the body's own production and, with it, sperm production. The AUA guideline states that testosterone therapy should not be prescribed to men who are currently trying to conceive, and that the long-term effect on sperm production must be discussed with any man interested in future fertility. If children are in your plans, tell us at the first visit; there are other approaches to discuss, and the order in which you do things matters.
What to Expect at Our Buckhead Office
Everything happens at our single office at 5009 Roswell Road NE, Suite 201 in Atlanta. Your first visit is a conversation and an examination, followed by lab orders. You return for the second morning draw, and then for a results visit where your physician walks you through the numbers, explains what they do and do not show, and — if therapy is appropriate — discusses the available FDA-approved delivery routes and their trade-offs.
Those routes include intramuscular and subcutaneous injections, topical gels and solutions, oral capsules, a nasal gel, and implanted pellets such as Testopel. They differ in how steady the levels are, how often you administer or return for them, cost, and side-effect profile. Your physician selects the formulation and the dose; we deliberately do not publish dosing guidance, because the right amount for one man is unsafe for another and it changes based on your follow-up labs.
Expect follow-up labs in the first few months and then on an ongoing schedule. Therapy is adjusted — and sometimes stopped — based on what those numbers and your symptoms show.
Safety, Side Effects, and Monitoring
The honest summary of the evidence is that testosterone therapy has real benefits in properly selected men and real risks that require monitoring. The AUA guideline tells clinicians to counsel patients that improvements may occur in erectile function, libido, anemia, and bone density, while the evidence for cognition, energy, diabetes, and general quality of life remains inconclusive. Averages from trials are not predictions about you.
On cardiovascular safety, the largest dedicated trial is TRAVERSE, published in the New England Journal of Medicine in 2023, which studied men with hypogonadism who already had or were at high risk for cardiovascular disease. Testosterone was noninferior to placebo for major adverse cardiac events. The same trial found higher rates of atrial fibrillation, acute kidney injury, and pulmonary embolism in the testosterone group — which is why your cardiac history is part of the candidacy conversation.
Current FDA labeling also warns that testosterone can raise blood pressure; the AndroGel 1.62% label, for example, reports a mean increase of roughly 1.9/1.3 mm Hg and states the product is not recommended in men with uncontrolled hypertension. Testosterone can raise hematocrit, which is why hemoglobin and hematocrit are checked before starting and periodically after. Topical gels carry a boxed warning about virilization in children who are secondarily exposed through skin contact, so if there are children in your home, that is a reason to discuss a different route.
- Blood pressure at every visit; therapy reconsidered if it rises
- Hematocrit before starting and on a recurring schedule
- PSA before starting in men over 40, then as your physician directs
- Estradiol, lipids, and symptom review at follow-up
- Immediate review of any leg swelling, chest pain, shortness of breath, or palpitations
How Low-T Care Fits With Our Other Men's Health Services
Low testosterone rarely arrives alone. If erectile difficulty is your main concern, testosterone is only one of several things worth evaluating — vascular health, blood pressure medications, diabetes, and anxiety all matter — and our erectile dysfunction program starts there rather than assuming a hormone is the answer. Premature ejaculation and Peyronie's disease are separate conditions with their own workups, and we treat them as such.
We offer GAINSWave and acoustic sound wave therapy, and we want you to have a clear picture of the evidence before you consider either. Acoustic wave therapy is not FDA-approved for erectile dysfunction, and the AUA's erectile dysfunction guideline classifies low-intensity shockwave therapy as investigational, meaning the published studies are small, varied in protocol, and not yet strong enough to establish it as standard care. Some men report improvement; we will not tell you it is proven, and it is not a substitute for evaluating and treating the underlying cause.
Weight is the other common thread. Obesity lowers testosterone through several mechanisms, and for some men, sustained weight loss improves hormone levels on its own. If that applies to you, our medical weight loss and obesity programs — including the physician-supervised GLP-1 options — may belong in the plan alongside, or instead of, hormone therapy. For men whose broader hormone picture needs attention, our hormone replacement and anti-aging services share the same lab-first, monitored approach.
Call (404) 341-4819 or use our contact page to schedule. We are open Monday through Thursday from 9 to 6 and Friday from 9 to 4.
Patient Reviews
"Dr. Semel and his team gave me my life back. TRT has restored my energy, focus, and confidence."
Frequently Asked Questions
Do I need two blood draws, or can you diagnose me from one?+
Two, taken in the early morning on separate days. Testosterone varies with the time of day and between lab assays, and the AUA guideline calls for two separate early-morning total testosterone measurements before a diagnosis of testosterone deficiency is made. We follow that.
My level came back low but I feel fine. Should I still treat it?+
Not necessarily. Testosterone deficiency is defined by low levels together with symptoms. A number on its own is not a reason to start a controlled substance you may take for years. Your physician will weigh the whole picture with you, including anything else the labs turned up.
Is testosterone therapy safe for my heart?+
The largest dedicated trial, TRAVERSE in the New England Journal of Medicine in 2023, found testosterone noninferior to placebo for major adverse cardiac events in men with hypogonadism and existing or high cardiovascular risk. That same trial found higher rates of atrial fibrillation, acute kidney injury, and pulmonary embolism with testosterone. It is not a blanket reassurance, and your cardiac history will shape whether therapy is appropriate for you.
Will testosterone therapy affect my fertility?+
Yes. Exogenous testosterone suppresses your body's own production, including sperm production. The AUA guideline states it should not be prescribed to men currently attempting conception. Tell your physician at the first visit if you want children, now or later, so the plan accounts for it.
Will I be on testosterone for life?+
Possibly, but not inevitably. When the cause is a permanent problem with the testes or pituitary, therapy is usually long term. When the cause is reversible — untreated sleep apnea, significant excess weight, a medication, heavy alcohol use — treating that cause can improve levels, and some men come off therapy. Your physician will tell you honestly which situation yours looks like.
Does GAINSWave or acoustic wave therapy raise testosterone?+
No. Acoustic wave therapy targets blood flow in penile tissue, not hormone production, so it does nothing for a testosterone level. It is also not FDA-approved for erectile dysfunction, and the AUA erectile dysfunction guideline considers low-intensity shockwave therapy investigational. If you are considering it, go in with realistic expectations.
Can you tell me what dose I would be on?+
Not in advance, and not on a web page. Dose depends on your baseline labs, the formulation chosen, your other conditions, and how you respond at follow-up testing. Your physician sets it after evaluation and adjusts it over time.
Do you have more than one location?+
No. Atlanta Medical Institute has one office, at 5009 Roswell Road NE, Suite 201, Atlanta, GA 30342, in Buckhead. We have been at this practice since 2010.
Costs and appointment planning
Review pricing questions, insurance and coverage information, and telehealth visit planning before booking. Confirm the costs and services that apply to your individual care.
Ready to Get Started?
Call us at (404) 341-4819 or book a telehealth consultation. New patients qualify for our 1st month Semaglutide special — $399 (regularly $450).