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
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
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.
19 LESSONS · 5+ HOURS
Male Hormone Replacement Therapy
Male Hormone Replacement Therapy
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.
7 LESSONS · 2+ HOURS
The Metabolic Foundation
The Metabolic Foundation
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.
17 LESSONS · 3+ HOURS
Thyroid Optimization
Thyroid Optimization
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.
5 LESSONS · 1+ HOUR
Adjunct Hormones
Adjunct Hormones
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.
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
Men's TRT certificate and training: which providers benefit
The HRTU Master Course is built for licensed providers who prescribe: nurse practitioners, physician assistants, and physicians (MDs and DOs)
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.
ACCREDITATION
Jointly accredited through Pinnacle Conference, LLC
(ACCME, ACPE, and ANCC). 30 CE hours, including 12 hours of pharmacology. Meets credentialing standards for nurse practitioners, physicians, and physician assistants
What providers say after the Master Course
Clinicians who came in collecting certificates and left actually treating patients.
Meet your instructor
Nico Misleh
MSN
FNP-C
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
Men's TRT course
frequently asked questions
Who should take a men's TRT or testosterone replacement therapy course?
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.
What does the HRTU Male HRT module cover?
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.
How is HRTU different from other TRT training programs?
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.
Can nurse practitioners prescribe testosterone replacement therapy?
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.
Can physician assistants prescribe TRT?
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.
Does the course cover male fertility and TRT?
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
Does the course address erythrocytosis and hematocrit management?
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.
Is the course available online, and how long does it take?
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.
What is included beyond the video instruction?
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