Frequently Asked Questions
The questions men actually ask before they call. Plain answers.
The questions that come up most before a first visit. If yours isn't here, the office is the fastest place to ask — Dr. Castellano or the front desk handles it directly.
Cost + Insurance
What it costs and what insurance does.
How much does TRT cost at Castellano Health Institute?
$250 per month, flat. The number includes the medication, lab work (initial panel + 6-week recheck + quarterly labs after), monthly follow-up visits, and refills. There's no separate consult fee, no per-script charge, and no long-term contract. Patients cancel any month. Most TRT clinics structure their pricing to leave the all-in monthly figure unclear; the practice runs it the other way on purpose. Full TRT page: /trt.
Does insurance cover TRT?
Most major insurance plans cover TRT when it's medically necessary — i.e., labs document low testosterone and a physician documents the clinical justification. The practice runs cash-pay for TRT visits to keep pricing flat and avoid prior-authorization delays. Patients with HSA / FSA cards can usually pay with those, and the front desk hands over receipts for any patient who wants to submit them to insurance for partial reimbursement.
Does insurance cover hormone support therapy or anti-aging visits?
Hormone support and anti-aging visits often fall outside the medical-necessity threshold most insurance plans use, even when the underlying lab work would be covered. The practice runs these visits cash-pay to keep the pricing predictable. The same HSA / FSA + receipt-for-submission pattern applies — the front desk can walk patients through it.
Process + What to Expect
What the first visit looks like, what to bring, when to expect change.
What happens at the first visit?
The first visit runs about an hour, one-on-one with Dr. Castellano — that's the sit-down, where he walks through your history, the symptom picture, and what's been tried before. If recent bloodwork is on file (within the last 6 months), bring it and Dr. Castellano reads it with you in the visit. If labs aren't current, the order goes out from the sit-down for a full hormone + thyroid + adrenal + metabolic panel, and results get reviewed together at the next touch (~1-2 weeks). Either way, the first visit ends with a real diagnostic conversation, not a sales pitch.
What should you bring to the first visit?
Three things, if available: any recent bloodwork (within 6 months), a list of current medications and supplements, and any prior-clinic records that include hormone or thyroid panels. None of that is required — Dr. Castellano can order everything fresh — but bringing it cuts time off the diagnostic loop and avoids redundant lab work.
How long does it take TRT to start working?
Many appropriately diagnosed patients begin noticing changes in energy or sleep within the first several weeks, while libido, strength, and body-composition changes often take longer. Response varies, which is why labs and symptoms are rechecked at 6 weeks and then monitored over time. Discuss your specific situation with Dr. Castellano in your initial visit for guidance tailored to your panel.
How often do you have to come in once on TRT?
Monthly follow-up for the first 6 months — short visits (15-20 minutes) that can be in-office or telehealth depending on what fits the patient's schedule. After 6 months, the cadence drops to quarterly check-ins as long as labs and how the patient feels are tracking together. Refills get coordinated with the visit cadence so no separate trips for prescriptions.
Safety + Side Effects
The questions about hair loss, weight, long-term safety, and stopping TRT.
Does TRT cause prostate cancer? Should I be monitored?
Current clinical evidence has established that physiologic testosterone replacement does not increase prostate cancer risk in clinically appropriate patients. That said, TRT decisions include prostate history and PSA monitoring where appropriate. Men with prostate cancer history, elevated PSA, or active prostate symptoms need individualized review and/or urology coordination before treatment. Dr. Castellano monitors PSA as part of standard TRT follow-up.
Does TRT cause hair loss?
Testosterone itself doesn't cause hair loss; the conversion to dihydrotestosterone (DHT) is what affects hair follicles in genetically predisposed men. TRT can accelerate male-pattern hair loss in patients who already carry the genetic susceptibility. Dr. Castellano discusses this trade-off during the initial visit — for some patients it's not a meaningful concern, for others it changes the protocol decision. Hair-protective adjuncts and dose adjustments are part of the conversation when relevant.
Does TRT make you gain weight?
TRT generally shifts body composition toward more muscle and less fat, which can increase total weight on the scale even when body fat percentage drops. Some patients also see water retention in the first 4-6 weeks that resolves as the protocol stabilizes. If a patient is gaining fat (not muscle) on TRT, the protocol or the underlying metabolic picture needs a closer look — that's what the 6-week recheck catches.
Is TRT safe long term?
When properly monitored, the long-term safety data on TRT is favorable for most men with documented low testosterone. Dr. Castellano runs quarterly labs after the first 6 months specifically to track the markers that matter for long-term safety: hematocrit (red blood cell count), PSA (prostate marker, where applicable), estradiol, and cardiovascular markers. The risk profile of unmonitored or under-monitored TRT is materially different from properly-monitored TRT, which is part of why the protocol is built around the lab cadence.
Can you stop TRT once you start?
Yes. There's no medical requirement to continue TRT indefinitely. Stopping cold-turkey isn't recommended — testosterone production at the testicular level shuts down or downregulates during TRT, and an abrupt stop can leave the patient at lower-than-baseline testosterone for several months. A taper protocol or a hCG-based recovery plan handles the off-ramp cleanly. The practice walks any patient who wants to stop through the right way to do it.
TRT vs. Other Options
TRT vs. HRT, online clinics, and how to find a real TRT doctor.
What's the difference between TRT and HRT?
TRT (testosterone replacement therapy) is specifically about replacing testosterone in men with documented low T. HRT (hormone replacement therapy) is the broader umbrella — can apply to men or women, and covers any hormone including thyroid, estrogen (women), or testosterone (men). At Castellano Health Institute, TRT is the focused men's-low-T protocol; hormone support therapy is the broader-panel men's-hormone-optimization service that covers thyroid, cortisol, estradiol, and metabolic markers alongside testosterone.
Do you need a doctor for TRT, or can you do it through an online clinic?
TRT is a controlled-substance protocol that requires physician prescription and ongoing lab monitoring. Online clinics fill that legal requirement, but the depth of clinical oversight varies widely. Things that get lost in a high-throughput online model: same-doctor continuity for trend reading, patient-specific dose adjustment based on the wider panel, in-person evaluation of side-effect signals, and the conversation when the labs say TRT isn't actually the right call. The practice's model is built around the trade-off — slower throughput, deeper oversight.
How do you find a good TRT doctor?
Three things to look for: physician credentials (board-certification in family medicine or endocrinology, plus ideally additional training in hormone medicine — ABAARM or similar); transparent pricing including labs and follow-ups (no "starts at" trick pricing); and willingness to say no to TRT if the labs don't justify it. The honest test: ask the clinic what percentage of evaluated patients they DON'T put on TRT. A clinic that puts everyone on TRT isn't running a real diagnostic process.
Privacy + Scheduling
Records, confidentiality, scheduling, and how the practice serves the wider OC.
Is the visit and the protocol confidential?
Yes. The practice operates under HIPAA. Records are not shared with employers, insurance carriers (unless the patient submits for reimbursement themselves), or any outside party without written patient authorization. The practice also doesn't market the patient list or sell contact information. Some patients ask whether TRT can be handled discreetly given workplace or insurance considerations — yes, and the practice walks through the options at the first visit.
How do you schedule a first visit?
The fastest path is a phone call to the office: (714) 530-2183. Front-desk hours are Monday through Friday, 9 AM to 5 PM. New-patient slots are typically open within 1-2 weeks. For non-urgent questions or scheduling, email at info@castellanomd.com works (note: the practice's mailbox is being provisioned through the website launch — bounce-back is possible in the first few weeks, so the phone is the more reliable channel until then). Full contact info: /contact.
Does the practice serve patients outside Garden Grove?
Yes — the practice serves the full Orange County corridor. Most patients drive in from Anaheim, Westminster, Santa Ana, Stanton, Cypress, Buena Park, Orange, and Fountain Valley; the wider radius pulls from Huntington Beach, Costa Mesa, Tustin, Fullerton, and as far as Long Beach and the LA edge. The clinic sits right off the 22 freeway with free on-site parking. For follow-up visits where in-person isn't necessary, telehealth is available within California.
When NOT TRT
What happens when the labs don't say TRT.
What if your labs come back normal but you still feel off?
That's one of the more common patterns the practice sees, and it's exactly what the broader hormone support therapy workup is for. Standard primary-care labs often check TSH and total testosterone and stop there. The wider panel — free testosterone, full thyroid (T3, T4 in addition to TSH), morning cortisol, estradiol, vitamin D, metabolic markers — frequently reveals what the narrow panel missed. Symptoms that don't track to a single marker often track to a pattern across the panel; that's the diagnostic work.
Ready when you are
One conversation tells you whether this is the right fit.
Call the office to set up a 1-hour consult with Dr. Castellano. Bring whatever bloodwork you have on file — or fresh labs get ordered up front. Either way, you’ll leave with a real read on what’s going on.
Calling after hours? Leave a message — we’ll get back to you the next business day.