Testosterone deficiency requires: total T <300 ng/dL on two morning fasting draws + hypogonadal symptoms. Seomyeon L runs a 6-marker panel distinguishing primary from secondary hypogonadism and screening TRT contraindications (PSA, hematocrit, fertility desire). Nebido long-acting injectable (every 10–14 weeks) is preferred for foreign patients — first injection in Busan, subsequent injections at home GP using our English protocol letter.
The 6-Marker Diagnostic Panel
Total testosterone alone is insufficient to correctly diagnose and manage hypogonadism. Dr. Kim's panel identifies the type of hypogonadism, screens for treatable underlying causes, and checks for TRT contraindications before any treatment is initiated.
| Marker | Purpose | Normal Range |
|---|---|---|
| Total Testosterone | Screening (morning fasting 8–10AM draw) | 300–1,000 ng/dL |
| Free Testosterone | Biologically active fraction — can be low even when total T is normal | >65 pg/mL |
| LH + FSH | High → primary (testicular). Low/normal → secondary (pituitary) | LH 1.5–9.3 IU/L |
| Prolactin | Elevated prolactin suppresses T — rules out pituitary adenoma | <20 ng/mL |
| PSA | TRT contraindicated if PSA suggests active prostate cancer | <3.0 ng/mL (age-adjusted) |
| Hematocrit | TRT raises RBC count — baseline required for safety monitoring | 38.3–48.6% |
TRT Options for Foreign Patients
Nebido (Testosterone Undecanoate) — Preferred
IM injection every 10–14 weeks. First injection at Seomyeon L Urology in Busan; subsequent injections at your home GP or local clinic using our English protocol letter. Stable testosterone levels with minimal peak-trough fluctuation. The best TRT option for patients who cannot return to Korea frequently.
Cost: $180–$220/injection + written protocol letter for home-country GP
Testosterone Cypionate / Sustanon — Shorter-Acting
Injection every 2–3 weeks. More cost-effective per injection but requires more frequent administration. Self-injection training + English protocol provided. Korean generics available at pharmacy.
Cost: $40–$80 per injection + supplies
Topical Testosterone Gel (AndroGel)
Daily application. Flexible dosing; flexible interruption. Risk of transdermal transfer to female partner or children — apply after showering, cover site. Less suitable for patients with young children.
Cost: $90–$130/month prescription
TRT Side Effects & Monitoring
| Side Effect | Rate | Monitoring |
|---|---|---|
| Erythrocytosis (Hct rise) | 12–24% | 3mo, 6mo, annually |
| Testicular atrophy | ~100% on TRT | Expected; hCG if fertility desired |
| Acne / oily skin | 15–20% | First 3 months |
| Mood changes | 8% | Dose timing adjustment |
| PSA elevation | 2–3% | 3mo, 6mo, annually |
- PSA >3.0 ng/mL untreated or active prostate cancer suspicion
- Active desire for biological paternity — TRT suppresses spermatogenesis
- Hematocrit >52% at baseline
- Severe uncontrolled obstructive sleep apnoea
- Active breast cancer
Dr. Kim will counsel you directly if any of these apply and suggest alternatives (clomiphene for secondary hypogonadism, hCG for fertility preservation).