Starting TRT in Charleston: What Has to Happen First

Ashley Harwyn, PA-C  |  A4M Board Certified  |  Published September 2, 2026  |  10 min read

There are clinics in Charleston that will draw your blood, return the result, and hand you a testosterone protocol before you leave the building. That is a real convenience and I understand its appeal. It is also, by its own description, one blood sample.

The guideline asks for two. What follows is what the American Urological Association actually requires before anyone writes the first prescription, which is also what testosterone therapy at this practice is built around.

The four things that come before a prescription

The guideline is unusually concrete here, and each requirement carries a stated evidence grade rather than an opinion.

Two morning draws, on separate days

Testosterone follows a daily rhythm, and the reference ranges everyone quotes were built on morning values. An afternoon level will read lower than the same man's morning level. That is not a small technicality. It is the mechanism by which men with entirely normal testosterone end up on treatment they never needed.

Hemoglobin and hematocrit

Clinicians should measure hemoglobin and hematocrit before starting, and inform patients of the increased risk of polycythemia [1]. That is a strong recommendation at the guideline's highest evidence grade, and the reason is simple: testosterone raises red cell mass in everyone who takes it. The question is by how much, and you cannot answer that without knowing where you started. Those baselines are part of the full panel drawn here.

How much depends on the formulation, and the spread is wide. Intramuscular testosterone enanthate or cypionate raised hematocrit by about 4.0 percent, moving it from 42.7 to 46.6 percent in one comparison. Oral undecanoate was similar at 4.3 percent. Patch and nasal preparations produced much more modest increases [3]. Above a hematocrit of 52 percent, therapeutic phlebotomy is indicated [3].

None of that makes injections wrong. It makes them the option that earns closer monitoring, which is a different statement.

PSA, if you are over forty

Measuring PSA in men over 40 before starting is a clinical principle in the guideline [1]. Worth pairing with the statement immediately alongside it, which asks clinicians to inform patients of the absence of evidence linking testosterone therapy to the development of prostate cancer [1]. This is a baseline you will be measured against later, not a warning about what you are about to do.

A conversation about children

Exogenous testosterone suppresses your own production, and that includes sperm production. The guideline makes it a strong recommendation at Grade A that the long-term impact on spermatogenesis be discussed with any man interested in future fertility, and a separate strong recommendation at Grade A that testosterone not be prescribed to men currently trying to conceive [1].

What the treatment actually does

The guideline lists what therapy may improve: erectile function, low sex drive, anemia, bone mineral density, lean body mass, and depressive symptoms [1]. Erectile function is on that list and is worth reading about on its own, because it is a vascular finding before it is a sexual one. That is a genuine list and it is worth having.

It is also shorter than the advertising. Energy, focus, confidence and drive at work do not appear on it. I would rather you measured the treatment against what it was shown to do than against a version of yourself from fifteen years ago.

The honest answer on your heart

Two things are true and they need saying together. The guideline asks clinicians to state plainly that it cannot be said definitively whether testosterone therapy increases or decreases the risk of cardiovascular events [1]. Separately, low testosterone is itself described as a risk factor for cardiovascular disease [1].

Then TRAVERSE, a randomized trial in men with hypogonadism and existing cardiovascular risk, found testosterone noninferior to placebo for major adverse cardiac events [2]. Noninferior means it did not raise them. It does not mean it lowered them, and a clinic selling testosterone as heart protective has gone past what that trial found.

Monitoring, and where protocols quietly lapse

Testosterone levels should be measured every six to twelve months while on therapy [1], alongside the hematocrit you established at baseline. That interval is expert opinion in the guideline rather than trial evidence, so treat it as a floor rather than a target.

The failure mode here is undramatic. Nobody makes a decision to stop monitoring. The first follow-up slips, the refill arrives anyway, and eighteen months later there is no number to compare anything to. If you are already on therapy and cannot remember your last level, that is worth an appointment on its own.

The Charleston version of this conversation

The men's clinic model has arrived in Charleston in force, and the pitch is speed. Labs on the first visit, results the same day, a protocol before you leave. Read that sentence against the four requirements above and the arithmetic does not work, because two morning draws on separate days cannot happen in one appointment.

Solcara Health sees patients at two locations. The Mount Pleasant office is at 496 Bramson Ct, Ste 120, convenient to Old Village, I'On, Park West and Daniel Island. The downtown practice is at The Longevity Club, 163 Rutledge Ave, Ste 202, in the medical district near MUSC and easy to reach from Harleston Village, West Ashley, Sullivan's Island and Isle of Palms.

Ashley Harwyn, PA-C is board certified through the American Academy of Anti-Aging Medicine. Testosterone is assessed here against the diagnostic standard rather than a questionnaire, which sometimes means a second morning appointment before anything is prescribed. That is a slower answer than a Charleston shot clinic will give you, and it is more often the correct one.

What a first visit involves

A conversation about which symptoms you actually have and how long they have been there, your sleep, your medications, and whether children are in your plans. Then the first morning draw, with hematocrit and, if you are over forty, PSA. A second morning draw on a separate day confirms it. Only then is there a decision to make.

Questions men actually ask

Ashley Harwyn, PA-C A4M Board Certified · Founder, Solcara Health Online

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About the author

Ashley Harwyn, PA-C

Founder, Solcara Health · Board Certified in Anti-Aging and Functional Medicine (A4M)

Ashley has practiced medicine for more than fifteen years. Her path into it began at home, with a family member born with a congenital heart defect and a childhood spent watching how much the quality of a clinician's attention could change the shape of a life. She has since practiced across a range of settings, including medical mission work in Uganda, before founding Solcara to build the kind of practice she kept wishing existed, one that treats women as whole people and tells them the truth about what the evidence does and does not support.

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