Male Testosterone Therapy Consent Form

Purpose of Treatment

I understand that testosterone replacement therapy (TRT) is being prescribed to treat symptoms of low testosterone including low energy, decreased libido, erectile dysfunction, reduced muscle mass, and overall decreased well-being.

Risks & Potential Side Effects

I understand that possible risks and side effects include:

• Acne or oily skin
• Increased red blood cell count (polycythemia)
• Fluid retention
• Mood changes
• Testicular atrophy
• Suppression of natural testosterone production
• Infertility or decreased sperm production

Monitoring & Compliance

I agree to complete all recommended lab work and follow-up visits. I understand that ongoing monitoring is required to ensure safe and effective treatment.

Financial Responsibility

I understand that testosterone injections are $45 per visit. Additional labs or services may incur separate costs.

Patient Acknowledgment

I acknowledge that I have discussed this treatment with my provider, understand the risks and benefits, and consent to proceed with testosterone therapy.