38 year old recently started trt cream. im concerned about my psa levels baseline may 3 2021 .64 6/12/2021 .70 8/4/2021 3.94 9/9/2021 1.83 12/4/2021 2.9 what are your thoughts?

That is very concerning. PSA is certainly not a perfect test, and there are many complexities to testing. PSA levels can fluctuate, which is why serial tests are done. The concepts of PSA density (your PSA level relative to prostate size) and PSA velocity (how fast PSA changes), are also important. But, in general, a PSA velocity (change in level) like you have is concerning.

TRT replacement therapy does increase PSA level and risk of prostate cancer. By UPTODATE: a patient should be referred for urologic consultation if a prostate nodule is palpated or the serum PSA concentration (confirmed by a repeat value) rises by more than 1.4 ng/mL in any one-year period or to above 4 ng/mL.