We need this to match you with a licensed provider in your state.
What sex were you assigned at birth?
We ask this to show you the correct safety and contraindication questions for your physiology. Your answer stays in your chart and only your prescribing provider sees it.
How long have you been experiencing these symptoms?
Less than 3 months
3-6 months
6-12 months
More than 1 year
Do you have recent bloodwork results?
Bloodwork is required before a physician can prescribe hormone replacement therapy. This ensures your treatment is safe and tailored to your body's needs.
Yes, I'll upload my labs (within past 60 days)
No — purchase the HRT Clearance Kit ($124.99, an at-home blood test shipped to your door so our doctors can evaluate and approve your hormone therapy)
Upload your recent lab results
We need: total testosterone, free testosterone, CBC, CMP, lipid panel, and PSA (if 40+)
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Click to upload your lab results (PDF, JPG, PNG, or HEIC)
Do any of these apply to you?
These conditions may affect your eligibility for testosterone therapy
None of the below
Prostate cancer (current or history)
Male breast cancer
Hematocrit above 54%
Untreated severe sleep apnea
Uncontrolled heart failure
Blood clots (DVT or PE)
Polycythemia (too many red blood cells)
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.
Do you plan to father children in the near future?
Important: Testosterone therapy significantly reduces sperm production
No, I do not plan to have children
Yes, I want to preserve fertility
I'm unsure
Do you have any cardiovascular conditions?
None
History of heart attack
History of stroke
High blood pressure
Heart failure
Have you used anabolic steroids or testosterone before?
No
Yes, prescribed by a doctor
Yes, self-administered
Describe your previous testosterone treatment
Include the form (injectable/cream/oral), dose, frequency, duration, and how you tolerated it.
What are your goals for testosterone therapy?
Free-text. Be specific — energy, libido, body composition, mood, athletic performance, etc.
Are you currently taking any medications?
No
Yes
Please list all current medications
Have you experienced any of the following?
This helps us monitor your care
None of the below
Depression requiring treatment
Anxiety requiring treatment
History of suicidal thoughts
Mood instability
Anything else you'd like your doctor to know?
Share any additional information, questions, or concerns.
This is optional - only include what you think is important
Upload a photo of the front of your government-issued ID.
Driver's license, state ID, or passport. Required for prescriber identity verification.
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Tap to take or upload a photo (JPG, PNG, WEBP, or PDF — HEIC not supported)
Upload a selfie holding your ID.
Hold your ID up next to your face so your prescriber can confirm the ID is yours.
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Tap to take or upload a photo (JPG, PNG, WEBP, or PDF — HEIC not supported)
