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Men’s TRT Course

MEN'S TRT & HORMONE THERAPY TRAINING

Men's TRT training built on physiology, not protocols

Learn to treat the symptomatic man insurance calls “normal.” A physiology-first testosterone replacement therapy course that trains you to restore energy, drive, and clarity, not just refill a prescription

TRT
Hypogonadism
Estradiol & DHT
Erythrocytosis
Fertility
Thyroid
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What this training covers
30 CME Hrs
12 Pharmacology Hrs
Self-Paced & Online
97+ Lessons
6 Modules
Joint Accreditation
Self-Paced & Online

Why men's hormone therapy demands deeper training than a protocol sheet

Male hormone physiology is not a single-variable system. Testosterone interacts with estradiol, DHT, thyroid, cortisol, insulin, and SHBG. When one shifts, the others respond. When a man presents with symptoms that cross several systems at once (as they almost always do) the clinical picture becomes something a dosing chart alone cannot navigate

A COMMON PRESENTATION

A man in his early 40s presents with fatigue, brain fog, declining libido, and 20 pounds gained around his midsection. His total testosterone comes back at 380 ng/dL. His provider is not sure whether that warrants treatment. His thyroid was never checked. His SHBG was not ordered. His free testosterone was never calculated.
This is the case that exposes the gap, not because the provider is careless, but because the training they received was never designed to connect testosterone to thyroid function, metabolic health, and estrogen metabolism, the downstream systems that determine whether a man actually improves on therapy

Comprehensive men’s HRT and TRT training needs to cover how the hypothalamic-pituitary-gonadal axis regulates testosterone production, how primary and secondary hypogonadism produce different clinical pictures, how estradiol and DHT account for roughly half of testosterone’s clinical benefits rather than being side effects to suppress, and why erythrocytosis on TRT is usually a physiological adaptation rather than a pathological emergency

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MEN'S HRT & TRT CURRICULUM

What a complete men's TRT course should cover

The HRTU Master Course addresses both men’s and womens hormone therapy. Below is an indepth look at the topics covered around the male hormone therapy module, plus the supporting systems (metabolic, thyroid, adjunct) that determine whether testosterone treatment actually works.
The core men’s hormone module. Structured diagnosis and long-term management across eight clinical sections.
HPG AXIS
HYPOGONADISM
ANDROGEN DYSREGULATION
LAB INTERPRETATION
ERYTHROCYTOSIS
ESTRADIOL & DHT
DOSING PROTOCOLS
FERTILITY
TRT MYTHS

HPG axis physiology and the HRT vs TRT distinction

GnRH to LH and FSH, Leydig cell stimulation, Sertoli cell function, inhibin feedback, and what happens to this axis when exogenous testosterone is introduced.

Hypogonadism: diagnosis and differential

Primary, secondary, and mixed hypogonadism as distinct clinical entities. Klinefelter syndrome, orchitis, trauma, radiation, opioid-induced hypogonadism, TBI, and metabolic and environmental factors.

Androgen Dysregulation Syndrome

The male analog of PCOS: fluctuating testosterone, low SHBG driven by elevated insulin, and a cluster of metabolic disturbances. A clinical entity most programs do not name, let alone teach.

Lab interpretation with optimal ranges

Full male hormone panel: CBC, CMP, LH, FSH, total and free testosterone, SHBG, PSA, prolactin, DHEA, TSH, free T3, free T4, with specific clinical thresholds rather than lab reference ranges.

Erythrocytosis: physiology, not pathology

Secondary erythrocytosis on TRT is a physiological adaptation, not polycythemia vera. Elevated hematocrit alone does not correlate with thrombosis risk. Management through dosing frequency, transdermal delivery, hydration, and resolving OSA.

Estradiol and DHT metabolism

Roughly 50% of testosterone's clinical benefits come from its metabolites. Why not to block estradiol with aromatase inhibitors or DHT with finasteride. Management through dosing frequency, fat loss, and xenoestrogen mitigation.

Treatment options and dosing protocols

Testosterone cypionate injections, compounded cream, pellets (with critique), intranasal, oral. Real starting doses, application guidance, blood work timing, and follow-up protocols.

Male fertility preservation and TRT myths

HCG protocols for fertility preservation and enclomiphene as an alternative. Evidence-based rebuttal of the prostate cancer, cardiovascular risk, and VTE claims, plus clear contraindications.

Every clinical concept in the course traces back to energy metabolism. Oxidative phosphorylation versus glycolysis, mitochondrial function, and the five metabolic disruptors (estrogen as a class, serotonin, cortisol, polyunsaturated fatty acids, and endotoxin). This is the reasoning engine that makes every later module make sense. Without it, testosterone prescribing is guesswork.
Hypothyroidism reduces BMR by 30-40%, impairs steroidogenesis, and disrupts spermatogenesis. Optimal TSH is under 1.0, not “under 4.5.” Covers desiccated thyroid extract, T3/T4 combination therapy, Hashimoto’s patterns, and why many men with “adequate” testosterone still present with fatigue. If thyroid is not addressed, TRT optimization is incomplete.
Progesterone in men (anxiety, OCD, poor sleep, BPH). DHEA (neuroprotective, anti-cortisol). Pregnenolone (anti-stress, pro-cognitive, TBI). Oxytocin (sexual function, PTSD, chronic pain). Melatonin (master antioxidant, promitochondrial). The tools that complete the picture when testosterone and thyroid are not enough on their own.
See curriculum details and tuition

LEARN TO PRACTICE THE MEDICINE SCHOOL WON'T

Insurance-driven care tells a symptomatic man his labs are “normal” and sends him home. A total testosterone of 380 is “in range.” A TSH of 3.8 is “fine.” He is told to sleep more, lose weight, and manage his stress, while the fatigue, the weight gain, and the loss of drive go untreated.
Done well, men’s hormone therapy is the medicine the conventional system is not built to deliver: treating to optimal rather than merely normal, treating the person rather than the reference range, and restoring the energy, clarity, and vitality a man had quietly written off as aging
This course trains you to be the provider who can actually do that — to give patients the outcome they came looking for instead of one more referral and a shrug. That is the work most providers got into medicine to do, and it is the work this training is built around

Why physiology-first TRT training changes how you practice

Protocol-based programs teach what to prescribe. They work until the patient does not respond the way the protocol predicted, until the hematocrit rises and the guideline says stop but the clinical picture says otherwise, until the total testosterone looks fine and the patient feels worse than before treatment.
That is the difference between training that gives you confidence for a month and training that changes how you practice. It is also why the men’s content is not sold as a standalone TRT course: testosterone interacts with thyroid, cortisol, and insulin, so the metabolic, thyroid, and adjunct modules make the men’s content work, not pad it out
Physiology-first training builds a framework for clinical reasoning instead of a library of protocols to memorize. When you understand why testosterone, estradiol, and DHT behave the way they do at the cellular level, and how thyroid and insulin interact with them, you can reason through novel presentations instead of freezing when the case gets complicated.

Nico built this course because he kept watching providers suffer the same way he once did: caring deeply, practicing carefully, and still feeling unsure

The teaching starts with the patient, names the clinical tension, introduces the mechanism, then goes one layer deeper than you expected. Every concept traces back to energy metabolism. Module 02 (19 lessons, 5+ hours) is the second-largest module in the course, and every other module makes it more useful
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ACCREDITATION

Men's TRT certificate and training. Jointly accredited through Pinnacle Conference, LLC

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The HRTU Master Course is built for licensed providers who prescribe: nurse practitioners, physician assistants, and physicians (MDs and DOs) (ACCME, ACPE, and ANCC). 30 CE hours, including 12 hours of pharmacology. Meets credentialing standards for nurse practitioners, physicians, and physician assistants

01

Providers newer to TRT

The Master Course starts with metabolic foundations and builds from there. You do not need prior hormone training, but you do need clinical experience. The Male HRT module takes you from HPG axis physiology through treatment initiation, dose adjustment, side effect management, and long-term monitoring

02

Providers with some TRT experience

Many arrive after another program and still feel uncertain. A hematocrit that keeps climbing. A patient whose mood worsened after starting therapy. That uncertainty is a signal that protocol-based training left gaps. HRTU fills them by teaching the reasoning underneath.

03

Experienced TRT providers going deeper

The metabolic foundation, thyroid optimization, and adjunct hormone modules take you beyond testosterone prescribing: Androgen Dysregulation Syndrome, thyroid insufficiency that sabotages TRT outcomes, and adjunct hormones for patients who do not fully respond to testosterone alone.

04

Nurse practitioners adding TRT

NPs who add men’s HRT can build meaningful, independent patient relationships. In most U.S. states, NPs with full practice authority can prescribe both compounded and FDA-approved testosterone without physician oversight. The course is ANCC-accredited.

05

Physician assistants and physicians

PAs and physicians bring strong diagnostic foundations. The Master Course adds the metabolic reasoning, dosing philosophy, and clinical nuance that medical school and PA training were never designed to cover. Most residency and PA programs dedicate little to no curriculum time to TRT; this course fills that gap, backed by joint accreditation.

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What Your Three Years Includes

The Curriculum

  • 6 clinical modules: metabolic foundations, male HRT, female HRT,
    advanced female endocrinology, thyroid optimization, adjunct hormones
  • 97+ structured lessons, 24+ hours of on demand instruction
  • Case based teaching that shows the reasoning, not only the protocol

Clinical Tools

  • Lab interpretation and dosing reference guides
  • Liability documentation frameworks for male and female HRT
  • 14+ customizable consent forms and patient handouts
    Complete HRT troubleshooting and signs and symptoms guide

Three Years Of Access

  • Revisit every module and lesson as often as you need; 3 year access.
  • Curriculum updates and material included.
  • Forms and handouts download once and stay yours to use in practice
  • CE certificate issued on completion, yours permanently
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Accreditation

In support of improving patient care, this activity has been planned and implemented by HRT University. Pinnacle Conference, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Earn 30 CEU hours, including 12 hours of pharmacology, as you advance your knowledge in hormone replacement therapy and patient care.

PAYMENT PLAN

Choose a Klarna payment plan at the checkout
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7 DAY REFUND

Refundable within 7 days, provided you have not
moved past the first section.

AFTER YOUR 3 YEARS

Membership carries your access and updates past year three. Optional, and never required to
finish the course.

What providers say after the Master Course

Clinicians who came in collecting certificates and left actually treating patients.

A professional portrait of a male healthcare provider Nico Misleh looking confident and approachab
Meet your instructor

Nico Misleh

MSN
FNP-C
Host, The HRT University® PodcasT
Nico is a board-certified Family Nurse Practitioner and the founder of HRT University. He built the Master Course after years of treating hormone patients and watching capable, careful providers stay stuck on protocols that fell apart the moment a patient didn’t respond.
He now teaches the same physiology-first framework to thousands of clinicians, on the HRT University Podcast, in his daily writing, and inside the course, so providers can reason through hormone cases instead of memorizing dosing charts
More about Nico
Men's TRT course

frequently asked questions

Any licensed provider who sees male patients with hormone-related complaints: NPs, PAs, and physicians (MDs and DOs). If your patients present with fatigue, weight gain, declining libido, brain fog, or mood changes and you do not have a clear clinical framework for evaluation and treatment, this training closes that gap.
Module 02 includes 19 lessons and 5+ hours across eight clinical sections: HPG axis physiology, hypogonadism differential, Androgen Dysregulation Syndrome, lab interpretation with optimal ranges, erythrocytosis management, estradiol and DHT as metabolites, treatment options with dosing protocols, side effect management, male fertility preservation, and evidence-based myth rebuttal. Built on the metabolic foundation in Module 01.
Most programs teach protocols. HRTU teaches the physiology and clinical reasoning underneath the protocols. Built on a metabolic foundation, with an integrated curriculum (male, female, thyroid, adjuncts), jointly accredited for 30 CE hours including 12 pharmacology, plus post-course support through Pearl, community, and continued learning.
In most U.S. states, yes. NPs with full practice authority can prescribe both compounded and FDA-approved testosterone, including testosterone cypionate (Schedule III), without physician oversight. Some states require a collaborative practice agreement. The HRTU Master Course is ANCC-accredited, so CE hours count toward NP credentialing.
Yes. PAs can prescribe testosterone in all 50 states, though requirements for physician supervision or collaborative agreements vary. The HRTU Master Course is jointly accredited through ACCME, so CE hours apply to PA continuing education requirements.
Yes. Exogenous testosterone suppresses the HPG axis and reduces sperm production, so fertility preservation is a core clinical concern. The course covers HCG protocols and enclomiphene as an alternative. Any provider initiating TRT in a man of reproductive age must understand this before writing the first prescription
Yes. The course teaches that secondary erythrocytosis on TRT is a physiological adaptation, not polycythemia vera. It challenges the reflex to phlebotomize at a fixed threshold and teaches management through dosing frequency, transdermal delivery, hydration, and sleep apnea resolution.
Fully online and self-paced. Six modules, 97+ lessons, 24+ hours of instruction, 30 CE hours including 12 pharmacology. Most students complete it over several weeks alongside their clinical schedule, and there is no expiration on access. The Male HRT module alone is 5+ hours.
Lab reference and dosing guides, liability documentation frameworks, 14+ customizable consent forms and patient handouts, and a complete HRT troubleshooting guide, everything you need to start treating, not just studying. An optional monthly membership ($49/mo) adds community, live case discussions, and continued learning.
BUILT ON A BODY OF WORK

The thinking behind the course

This course did not appear out of nowhere. It is the same physiology-first reasoning Nico teaches every week on the podcast and in writing, refined with thousands of providers. A sample before you enroll.
READ · FROM THE BLOG

Keep reading

One clinical insight per week.

The physiology that changes how you practice. No hype. No spam. Just the cases and questions most courses skip.

Go Deeper

Close the gap between knowing and treating

The HRT University Master Course is a comprehensive, jointly accredited men’s HRT and TRT training program built for licensed providers who want more than protocols. See the full curriculum, accreditation, tuition, and provider reviews

Explore The Master Course