TRT UK FAQ - Testosterone Replacement Therapy in the UK
TRT UK FAQ – Testosterone Replacement Therapy in the UK
Unsure about testosterone replacement therapy?
Want to know if it is available in the UK?
Perhaps you like the sound of it but you are worried about the potential side effects?
Or did you try and approach your GP to ask if some your symptoms might be related to low testosterone, only to get an unsympathetic response?
If so, or even if you just want to learn what all the fuss is about, then read on for the answers to some of the main questions people have about UK TRT (Testosterone Replacement Therapy). If you have any further questions please contact one of our advisors who will be happy to help.
- What is TRT?
- What is Testosterone?
- Why is Testosterone Replacement Therapy necessary?
- Will TRT make me infertile?
- Do I have to inject on TRT in the UK?
- How much does TRT cost in the UK?
- Will TRT shrink my testicles (balls)?
- Is TRT linked to prostate cancer?
- Is TRT linked to heart attacks or strokes?
- Will Testosterone Replacement Therapy make my penis shrink?
- Which tests do I need before TRT in the UK?
- What are common signs of low testosterone which may require TRT?
- What could have caused or triggered my low testosterone?
- What types of low testosterone are there?
- Should I get TRT with the NHS or through a TRT UK clinic?
- UK BSSM guidelines on testosterone deficiency and TRT
- What side effects, if any, should I worry about?
TRT stands for Testosterone Replacement Therapy. The replacement of a man’s natural testosterone production when it is lower than it should be. Mainly this occurs through the use of testosterone medication (exogenous testosterone) that is usually provided through injections, patches, or gel. In TRT UK clinics there are usually several different options that you can choose from. Nowadays it is also common to have other medications such as HCG and anastrozole included in TRT to optimise function.
Testosterone is the male sex hormone responsible for male characteristics and health. It is important for sexual function, muscle building, cognitive function, fertility and mood enhancement amongst other complex roles within the male body. It occurs naturally to a lesser extent in females.
It is extremely important for good health and general well-being in all men but is often ostracised in the media and by many doctors for its connections to violence, aggression and ‘toxic masculinity’ amongst other things.
For a more in-depth explanation, click here to read our ‘What is Testosterone’ article.
Think you might have low testosterone?
Testosterone levels can become low for many reasons, some of which are still not fully understood. We know that the modern man’s testosterone levels are on average 20% less than they were 20 years ago. This may be due to a combination of several factors:
- Environmental factors such as plastics and fertilisers leaching chemicals into the water supply/food
- Hormones from the contraceptive pill disrupting the male hormonal system
- Anabolic steroid use – often a full recovery of the HPTA does not occur after shutdown of natural production
- Soy consumption – phytoestrogens from some foods such as soy can reduce T levels
- Stress – chronically increased cortisol production may reduce T levels
- Congenital disposition
- Age related decline/andropause
- Pesticide exposure
- Obesity – increased body fat can lead to higher conversion of testosterone into oestrogen.
Many of these factors are at play in the men of today. These can lead to suppressed hormone function and symptoms of low testosterone. If you notice these factors in your life then it may be time to get a test, or talk to one of our advisors today who can help you to further identify any symptoms of low testosterone.
The addition of exogenous (not from the body’s natural production) testosterone can reduce sperm production in men. Luckily our TRT programs are designed with the option of medications to stimulate the natural production of sperm by the testes. This medication (hCG) has been shown to improve fertility in men.
No. There are several options for the administration of TRT, some of which have either reduced injection frequency or none at all:
- Testosterone gels
- Monthly testosterone injections
- Weekly testosterone injections
However, self-injections are a good option for TRT in the UK. We can provide help with injection advice and videos such as this one.
You may be surprised at how reasonable the cost of TRT in the UK can be. Prices start as low as £90 a month for testosterone replacement therapy treatment. An initial testosterone blood test costs as little as £59.99. These prices may be higher if you require fertility or sexual function enhancing medications. Most patients find these can be added and removed as required, for example if you are trying for a child then you might be prescribed hCG in addition to testosterone replacement therapy. After the first few months of treatment and regular blood tests, bi-yearly blood tests are recommended to ensure good health and effective treatment.
Increasing the amount of testosterone in the body from outside sources, for example through Testosterone Replacement Therapy, can cause the testicles to shrink to around 75% of their normal volume. Luckily medications like hCG (Human Chorionic Gonadotropin) can be used to effectively improve testicle size back to normal whilst stimulating further production of your natural testosterone levels. Many men also notice improvements in mood when starting hCG.
The most recent available evidence suggests that there is no correlation between cardiovascular risk and TRT. Recent studies even find that men with high testosterone are at a lower risk of heart attacks and strokes. If this is a concern for you, please read our detailed and well researched article on Testosterone Replacement Therapy and the risk of Hearts Attacks and Strokes.
Before starting TRT you should have certain blood results tested.
You need to have two results showing low total and/or free testosterone before starting Testosterone Replacement Therapy.
Alongside this, your doctor should make sure that you have the following values tested to ensure your safe treatment:
• Sex Hormone Binding Globulin (SHBG) – This protein binds to your total testosterone making it useless to the body.
If you have a raised SHBG level, you could suffer from the symptoms of low testosterone despite ‘normal’ total testosterone levels.
NHS GPs rarely test for this and therefore cannot accurately tell if testosterone is causing your symptoms. This value is also used to calculate your free testosterone level.
• Oestradiol (Oestrogen) – Oestradiol is the main active part of oestrogen. It is produced in the male body from testosterone when it is converted by aromatase (an enzyme).
If Oestradiol is too high, or too low, it can affect male libido, erection quality, emotions, fat accumulation and growth of breast tissue (which can lead to gynecomastia, or ‘man boobs’!)
This is extremely important to test before and during treatment for low testosterone!
• Follicle Stimulating Hormone (FSH) – A hormone produced by the pituitary gland that stimulates the testes to produce sperm and testosterone.
• Lutenising Hormone (LH) – A hormone produced by the pituitary gland that stimulates production of testosterone in the testicles.
Lutenising Hormone and FSH are important for understanding why you have low testosterone.
• Prolactin – If your levels are low it can affect your mood and sexual health.
High levels can reduce testosterone production. If your Prolactin level is very high, it may be associated with a prolactinoma, a tumour in the pituitary gland that can lower your testosterone levels.
• Prostate Specific Antigen (PSA) – This can indicate prostate health. Testosterone Replacement Therapy has been shown not to increase the risk of Prostate Cancer, but it can increase Lower Urinary Tract Symptoms and potentially make prostate cancer worse if you already have it.
If this value comes back high, you may need further tests before starting TRT, including a physical examination by a nurse or doctor.
• Full Blood Count – TRT increases the production of red blood cells. This can increase the thickness of the blood and the chances of clotting. If this is high or increases during TRT you may need to have some blood let to reduce your levels.
Things we may also look at:
Thyroid hormones – some thyroid problems present with the same symptoms as testosterone deficiency. Your doctor should check these to ensure you are not suffering from thyroid issues before starting TRT.
If your clinic has not looked at these tests before starting you on TRT in the UK you should be questioning their motivations. Your health and safety should always come above everything else!
Poor cognition/poor arithmetic/brain fog
Often one of the first benefits men who start Testosterone Replacement Therapy realise is improved clarity of thought! TRT has been shown to improve the IQ and cognition of older men and allows many to think straight again.
Men with low testosterone often complain of low energy levels and feeling tired all the time. Falling asleep after dinner is another big indicator that you may have testosterone deficiency. TRT can have a rapid impact in improving this situation, giving you the energy of your younger self and allowing you to get more done!
Loss of muscle mass/sports performance
Testosterone is a performance enhancing drug. It is sometimes used illegally by athletes to get a competitive advantage over their peers.
In sport and fitness, testosterone has many useful effects including: muscle mass building, strength improvements, improving joint health and reducing body fat levels! It is truely the magic ingredient for improving your physique and your sports performance.
TRT will also improve your energy levels allowing you to work harder and see more gains. You will be amazed at the effect TRT can have on your performance and physique.
Testosterone is always associated with competition, and for good reason! Men and women with more testosterone are more competitive, and tend to win more as a result! Without testosterone, competing and improving yourself can feel close to impossible. If you have low testosterone, starting TRT will make you better at sports, in competition and at work.
There are many other symptoms that you might have noticed, which may not be directly associated with low testosterone – you may have increased body fat around your waist, excessive sweating and/or night sweats (often caused by oestrogen levels), reduced or absent body and facial hair, increased breast tissue (gynaecomastia), insulin resistance, and particularly in older men: loss of bone mass (osteoporosis), reduced circulation (cold hands and feet!)
Men get low testosterone for many reasons but there are some triggers that are known to cause low testosterone. These include:
Anabolic steroid use
After taking anabolic steroids, many men’s natural production of testosterone can be reduced or even permanently damaged. The testosterone then needs to be replaced using testosterone replacement therapy, or production needs to be stimulated using other medications like HCG or Clomid.
Many men have worked out or worked in a high stress environment for too many hours over too many years. These same men who used to have good testosterone levels now have much lower levels than they are used to. They may have low normal testosterone levels but for their body it is very, very low and the symptoms are hard to deal with, because they know how they ‘used’ to feel.
Use of certain pain killers
Opioid based pain killers can reduce testosterone levels. Combined with high stress after an accident or even PTSD, and your testosterone levels can be reduced significantly.
Many men who become depressed are put on anti-depressants. Some think that this can reduce testosterone levels. Many of these men actually have low testosterone in the first place, which is wrongly diagnosed by their GP, leading to them being prescribed anti-depressants to improve their mood.
Think you might have low testosterone?
Primary hypogonadism (the testicles don’t produce enough testosterone) (hypergonadotropic hygonadism)
In primary hypogonadism the gonads (testicles in men) don’t respond to the hormones released by the pituitary (in the brain) LH and FSH. Basically the testicles can’t produce enough testosterone. Often LH and FSH are raised as the body produces more to try to stimulate the testes to produce testosterone.
- Damage to the testicles/trauma
- Radiation / Chemotherapy used when treating cancer (usually of the testicles)
- Castration (removal of the testicles, often due to cancer of other issues)
- Klinefelter syndrome (a genetic issue that means a man does not have the same chromosomes as other men)
In secondary hypogonadism the gonads (testes) are working but the release of LH and FSH is affected. Basically the brain isn’t telling the testes to produce enough testosterone.
- Pituitary tumours or disease (prolactinomas – this is why your doctor should test prolactin)
- Traumatic brain injury – damage to the pituitary can affect the production of hormones
- Damage or trauma to the testicles
- Radiation / Chemotherapy used when treating cancer
- Other chronic diseases like liver or kidney disease
- Nutritional deficiencies
A qualified and experienced testosterone replacement therapy doctor will be able to tell you which type of testosterone deficiency you most likely have and possibly even why. LH and FSH are important to help with this diagnosis.
NHS / GP
If you are lucky enough to get a good GP who can provide you with effective TRT in the NHS then you will pay for your prescriptions only.
This is great but only if you are receiving the medications and support you need from a doctor who knows what they are doing. Usually it takes a few weeks to see a GP, another month to get a blood test, then you are referred to an endocrinologist (if you are lucky) which means another 3 month wait.
Many men are put on medications such as Testogel or Nebido and left to get on with it. These men often suffer from oestrogen issues, poor absorption from the Testogel and fertility issues which are poorly managed by the NHS. These men often stop TRT thinking that it isn’t working for them when actually the treatment isn’t being provided correctly! Very few NHS providers follow up with adequate blood tests. And seeing an endocrinologist for changes to your management can take months!
Harley Street / Private TRT UK clinics
This is the most expensive option. You visit a snazzy clinic on Harley Street in London and pay around £300 for the initial consultation. You then usually have to return and pay another £300 three months later, and for all follow up appointments.
The quality of the care and the surroundings is normally very good. However the service is arguably less convenient than a good online provider who can communicate with you and provide a service remotely.
The monthly cost is often very high following the start of treatment and blood tests routinely cost over £250 whereas OptiMale can provide a similar test for £59.99.
(At OptiMale we do provide a face-to-face consultation option which is similar to the Harley Street clinics but better value)
Online medical facilitators
These are companies that work in a grey area in the TRT UK market. They avoid being called private medical clinics by claiming that they don’t actually provide treatment, they just facilitate treatment by doctors. This is technically incorrect as they are responsible for ordering and sending medication to patients as well as dealing with patient’s concerns.
Being in this grey area also means that they are not regulated by the CQC and often do not have any valid medical or indemnity insurance. The big risk with using a company like this is that if something goes wrong you will be out of pocket with no treatment available.
The service provided by these companies is often poor, mainly due to an explosion in the number of patients they try to manage. This means that they struggle to respond to queries and provide proper support nor do they screen adequately for medical issues before starting TRT. Also watch out for hidden charges – doctor’s fees and postage costs!
Online TRT UK Clinic – OptiMale
OptiMale falls within this category. Our highly experienced doctors provide consultations across the UK and organised by us, this allows us to keep costs down and still provide safe, effective treatment. We have extremely quick response times to your issues, usually within a few hours for most calls or emails, to ensure you get quick answers and advice. We are regulated by the CQC which is required by law in the UK. We can support you throughout your TRT experience without the need for costly follow up consultations. All doctor advice and support after the initial consultation is included in the monthly cost.
The monthly cost is roughly £89.99, this is cheaper for some options and sometimes slightly more if you require extra medications. For less than a pint of beer or a cup of coffee a day you can be back to normal and feeling great again. Contact us for more information.
The Black Market
Not having a valid prescription leaves you open to legal issues with your employment and particularly when travelling. As the details of your treatment are not shared with your doctor or on your medical records there are dangers involved if you are ever taken in to care and don’t have this information available to services treating you.
You will not have proper follow ups in place to ensure you are receiving the proper treatment throughout your life. This leaves you open to medical problems which have not been properly identified and addressed by a registered doctor.
This is a risky alternative to receiving proper medical care for your condition through a valid TRT UK clinic and it is highly inadvisable – your health is too important to risk messing around with dodgy steroids.
Should I pay for a ‘consultation’ for advice on TRT?
Beware that these seemingly impartial middle men are usually being paid commission by certain companies to send patients their way…
The UK BSSM guidelines on testosterone deficiency are the gold standard for how to assess and treat testosterone deficiency in the UK. If your endocrinologist or GP don’t know about them and aren’t referring to them then you need to find another TRT UK specialist. They contain some extremely interesting information and research.
You can find the guidelines here:
They provide a framework for how to assess for and treat testosterone deficiency. They key points from the guidelines (they are worth a read in full!) are:
- Testosterone deficiency is more common in older men with comorbidities (other medical problems) who are overweight
- The CAG DNA segment can affect not only how sensitive an individual is to testosterone levels but also how the body reacts to the testosterone in its receptors (e.g. how much muscle growth is stimulated from the amount of testosterone present).
- Testosterone has lots of different physical and psychological effects: increased libido and aggression, it aids cognition and memory, supports collagen and red blood cell production as well as muscle and bone growth, sex organ growth, increases the output of the heart and how it contracts (in a beneficial way), and erection strength and frequency.
- Gonadotropins (LH and FSH) should be tested before starting TRT to find the cause of the low testosterone.
- 80% of men maintain normal testosterone levels into old age (but 20% don’t!)
- Lifestyle changes alone are not supported as a means of treating low testosterone – only when combined with TRT are symptoms reduced.
- The three most common symptoms of low testosterone are erectile dysfunction, low sexual desire and reduced early morning erections.
- A minimum of a 6 month trial of TRT is recommended.
- TRT has many health benefits! (too many to list here supported by evidence).
- Having a testosterone level below 8nmol/l protects against prostate cancer but raising it from above 8nmol/l to a higher level doesn’t increase the risk of prostate cancer!
- There is no compelling evidence that TRT increases the risk of prostate cancer or the progression of prostate cancer.
- Men younger than 40 should have their testosterone tested before 11am as this is when it is mostly released in younger men.
- Total testosterone below 12 nmol/l should be trialled on TRT.
- Free testosterone below 0.225 nmol/l should be trialled on TRT.
- A raised LH level with normal Total Testosterone level may have testosterone deficiency.
Cardiovascular (heart and blood vessel) issues.
Contrary to popular belief, well controlled TRT (particularly well monitored haematocrit) is not damaging to the cardiovascular system. In fact recent research indicates that it has a beneficial effect.
Men who were at risk of cardiovascular events when starting TRT, had less heart attacks than men at similar risk who weren’t on TRT.
Additionally, men with low testosterone appear to be at higher risk of cardiovascular issues.
Low endogenous (naturally produced) testosterone levels have been shown to be associated with higher rates of all-cause and cardiovascular-related deaths in men.
Raised oestrogen/oestradiol levels
In men testosterone is converted by aromatase into oestrogen. Most men do not require medication to control oestrogen as there levels remain normal as conversion remains at the same rate.
In some men the conversion is higher than others and the higher testosterone can lead to increased oestrogen. In these men an aromatase inhibitor is often prescribed to reduce this conversion and control levels back to normal. This is rare in TRT but happens more frequently in men treated with Clomifene.
These symptoms can indicate high oestrogen:
- gynecomastia (breast tissue growth)
- itchy nipples
- reduced libido
- hot flushes
We can provide advice and guidance on how to get NHS treatment, the best tests for you as well as options for TRT UK treatment.
Our highly experienced medical team will be happy to work with you if you are just starting your TRT journey, if you already have blood test results or even if you are unhappy with your current TRT UK provider and want to transfer to a more professional service.