Persistent Fatigue
Tiredness that doesn't resolve with adequate sleep. One of the most common presentations.
Medical · Men's Hormone Health
Testosterone Therapy (TRT) in Troy, Michigan
In-person testosterone replacement therapy for men with clinically low testosterone. Lab-based, physician-overseen.
- Lab-based diagnosis, not a symptom-only checklist.
- Injections, pellets, or topical options based on your preference.
- In-person quarterly monitoring with comprehensive labs.
- Honest care, we tell you if TRT isn't right for you yet.
The Approach
Testosterone therapy at Rêve
Testosterone declines gradually with age, typically about 1% per year after 30. For most men, this is asymptomatic and doesn't require treatment. For others, the decline produces real symptoms: persistent fatigue despite adequate sleep, reduced muscle mass despite training, decreased libido, mood changes, brain fog, increased abdominal fat. When these symptoms are accompanied by documented low testosterone on lab work, testosterone replacement therapy can produce significant improvement in quality of life.
The key word is "documented." Many telehealth services prescribe testosterone based on a symptom checklist alone, sometimes to men with normal labs. That's not medicine, it's commerce. At Rêve, we require comprehensive lab work showing actual deficiency before initiating TRT. We confirm with a second test. And we monitor regularly to ensure your testosterone stays in physiological range, not pushed into bodybuilder territory.
If your labs come back normal and your symptoms are real, we'll look elsewhere, sleep, thyroid, stress, body composition, sometimes hormone therapy in different forms. The goal is to fix what's actually wrong, not sell you a prescription.
Low testosterone is also cumulative when it's real. The fatigue is what you notice; the muscle, bone density and drive erode quietly underneath it, year over year, while you tell yourself it's just age or work. A lab panel settles the question in one visit. Men drive to us for that answer from Troy, Birmingham, Bloomfield Hills, Rochester Hills and across Metro Detroit.
Low testosterone is also cumulative when it's real. The fatigue is what you notice; the muscle, bone density and drive erode quietly underneath it, year over year, while you tell yourself it's just age or work. A lab panel settles the question in one visit. Men drive to us for that answer from Troy, Birmingham, Bloomfield Hills, Rochester Hills and across Metro Detroit.
Symptoms & Diagnosis
Symptoms of low testosterone
These symptoms can suggest low testosterone, but they can also be caused by many other things. Lab work confirms the diagnosis.
Reduced Libido
Decreased sexual interest, drive, or function. Can also be psychological, we discuss.
Loss of Muscle Mass
Difficulty maintaining or building muscle despite training and protein intake.
Mood Changes
Irritability, low mood, motivation loss, or depression-like symptoms.
Brain Fog
Reduced cognitive sharpness, difficulty focusing, memory complaints.
Increased Abdominal Fat
Particularly visceral fat that doesn't respond to diet and exercise.
Your Journey
How the program works
01
Initial consultation
60-minute in-person consultation with our medical team. Medical history, symptom review, lifestyle factors, goals.
02
Comprehensive labs
Total testosterone, free testosterone, SHBG, estradiol, LH, FSH, prolactin, PSA, CBC, lipids, metabolic panel. Drawn morning (testosterone is highest then). Repeated to confirm low levels.
03
Diagnosis & protocol design
Lab review. If TRT is right, we design a protocol, delivery method, dose, ancillary medications if needed. If TRT isn't right, we explain why and recommend alternatives.
04
First 6 weeks
Begin protocol. Self-administer injections (we teach you) or schedule pellet insertion. Most men feel meaningful improvement within 4-6 weeks. Lab follow-up at week 6.
05
Ongoing monitoring
Quarterly labs and in-person visits during the first year. After stabilization, twice-yearly. We monitor testosterone, estradiol, hematocrit, PSA, and clinical response.
Delivery Methods
How testosterone can be delivered
| Frequency | Pros | Cons | |
|---|---|---|---|
| Injections (intramuscular) | Weekly to bi-weekly | Precise dosing, lowest cost, most common protocol | Self-injection required, occasional level fluctuations |
| Injections (subcutaneous) | Twice weekly | Smaller needle, more stable levels | More frequent injections |
| Pellets | Every 4-6 months | Hands-off, steady levels | In-office procedure, higher upfront cost |
| Topical Cream / Gel | Daily | No injections | Transfer risk to others (especially women, children), absorption variability |
Investment
Pricing
Pricing is personal, it depends on your goals and the plan we build together. We share exact pricing at your complimentary consultation, transparently and before anything begins.
Book a Consultationor call (248) 817-6704
Safety
Safety considerations
Common side effects
- Mild acne, particularly during initiation
- Increased hematocrit (red blood cell count)
- Mild estradiol elevation (managed if needed)
- Testicular size reduction (testes naturally decrease production when supplemented)
- Reduced fertility (important if planning family)
- Sleep apnea worsening in susceptible men
Not appropriate if you have
- Active prostate or breast cancer
- Severe untreated sleep apnea
- Hematocrit above 54% at baseline
- Severe heart failure
- Planning to start a family (TRT can suppress fertility)
- Untreated polycythemia
Questions
Frequently asked questions
Candidacy requires both clinical symptoms AND documented low testosterone on lab work. If your labs show low levels and you have appropriate symptoms, and you have no contraindications, yes. If your labs are normal (even with symptoms) TRT isn't the right answer, and we'll look at other causes.
Labs typically report total testosterone reference ranges of 300-1000 ng/dL. Many men feel optimal at 600-900. Below 300 is generally considered low. Below 200 is significantly low. Symptoms can occur at any level, we look at the full picture, not just the number.
Many men notice mood and energy improvements within 2-3 weeks. Libido changes in 3-6 weeks. Body composition shifts over 3-6 months. Full effect takes about 6 months.
TRT usually suppresses sperm production significantly. If fertility matters now or in the future, we discuss alternatives (enclomiphene, HCG protocols, or fertility-preserving combinations) before starting.
No, you can stop anytime. Your body's natural production has been suppressed, so there's a transition period when stopping. We taper gradually and can use ancillary medications to support recovery.
Many men do, particularly when combined with resistance training and adequate protein. TRT optimizes your body's ability to build muscle, but you still need to do the training.
In men genetically predisposed to male pattern baldness, TRT can accelerate the process. We can discuss preventive measures if this is a concern.
Long-term data has been mixed historically, but recent large studies have been reassuring. Properly monitored TRT in men with documented low testosterone is generally considered safe cardiovascularly. We monitor labs regularly to maintain physiological levels.
Some testosterone converts to estradiol, this is normal and necessary. We monitor estradiol levels and manage if they go too high or too low.
TRT requires careful monitoring of testosterone, estradiol, hematocrit, PSA, and clinical response. Telehealth services that prescribe without proper labs or that operate at high volume miss things. We do this carefully because the consequences of getting it wrong matter.
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Lab-based diagnosis. In-person care. Real medical oversight.
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