Testosterone Replacement Therapy (TRT) in the UK

Testosterone replacement therapy TRT in the UK

Testosterone Replacement Therapy (TRT) in the UK

Testosterone replacement therapy (also known as TRT) is an extremely effective service and medical treatment for men who are suffering from low testosterone levels and its symptoms.

Low testosterone is a common condition that men can be born with, or may develop with age, stress or unhealthy lifestyle factors.

Despite its sometimes bad reputation, the benefits of optimising testosterone are becoming better known and more widely talked about.

At Optimale we improve men’s testosterone levels by using an individual approach with the best medications, supplements and lifestyle advice available to remove symptoms and improve your quality of life.

Blood Test

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What is TRT?

TRT is the replacement of a man’s natural testosterone production when it is lower than it should be and causing symptoms of low testosterone.

Replacement usually occurs through the use of testosterone medication (exogenous testosterone) that is provided through either injections, pellets, patches, or gel. It can also include non-medical treatments such as lifestyle advice, supplements and other non-prescription options to optimise and replace testosterone levels.

In TRT clinics there are usually several different options that you can choose from. Nowadays it is also common to have other medications such as HCG included in TRT to fully optimise the treatment by preserving your fertility and natural testosterone production.

Other hormones such as oestrogen may need to be managed further with the use of other medications or protocols.

The use of other medications including HCG to maintain natural testosterone levels, has led some to rename the treatment Testosterone Optimisation Therapy, as natural production remains present and isn’t being replaced.

This is the safest and most effective way of using TRT.

TRT UK man on beach

How to get TRT in the UK?

There are two main ways to legally get TRT in the UK:

1. Through a private clinic such as Optimale – a good private clinic should provide cutting edge treatment options, remote consultations and a UK-wide, reliable service.

Clinics should offer a combination of medications, lifestyle advice, and supplementation, including injections, HCG (very important for all men on TRT), creams, or gels, to provide a tailored and personal approach to your care.

Treatments should be personalised to your individual situation. There is no one size fits all treatment plan, whether that be traditional gels or daily injections, no one person is the same in their lifestyle requirements or how they respond to medications!

2. The NHS via your GP – this can be a long-winded and frustrating process, but it is low cost. Most men find they cannot get treatment unless levels are very low (below 8nmol/l in most men).

The medication options are usually restricted to gels (that lose effectiveness over time in a lot of men), and doctors aim for a low-medium level of testosterone (around 15nmol/l). This is one of many reasons why a lot of doctors think that TRT does not work – their protocols don’t give the results that men expect.

Side effects are often badly managed as off-license medications such as HCG and aromatase inhibitors are unavailable to men who need them. This can result in treatment being ineffective with lots of men suffering from high oestrogen and infertility.

Because fertility medications such as HCG are not available, younger men usually can’t start treatment if they want children at a later stage in life.

In most cases, the process can be quite long. This usually includes extra blood tests with an endocrinologist after a long wait after seeing a GP for tests. In most areas for the UK, this can take as long as 9 months to a year, and treatment is not guaranteed.

Optimale TRT clipboard

ADAM Questionnaire

Low Testosterone Test

The ADAM questionnaire has been shown to have 88% sensitivity in testing for low testosterone.

Why get TRT with Optimale?

1. Optimale provides remote clinic services UK wide and posts the medication directly to your door for safe and convenient care. Careful monitoring is part of the treatment and ensures you are getting the best out of your TRT.

2. Our clinic is the top-rated clinic in the UK with the most 5 star reviews of any clinic.

3. We use the best medication options (Cypionate injections, HCG, and Versa-base creams), advice and supplements with flexible protocols to meet your needs.

4. Our doctors can increase your testosterone to high-normal levels, whilst avoiding a lot of the side effects that men often experience when getting TRT through the NHS or other clinics.

5. Our pioneering doctor-led approach and technology-driven service is the reason for our high rating, unlike other clinics and the NHS.

How easy is it to get TRT in the UK?

Testosterone Replacement Therapy (TRT) is a fantastic treatment option, but we are very careful in assessing suitability. If you are interested in treatment, we are required by regulations to complete the following steps:

1. Check that you have low testosterone symptoms through our ADAM questionnaire.

2. A first low testosterone result – You can either get a blood test here  for £33.95 or send over previous results (e.g. from your GP or another provider) showing low total or free testosterone levels (free testosterone levels are often low despite a more normal total testosterone level).

3. An enhanced blood test (£64.95 plus cost of clinic visit which varies between £20-£40 depending on your preferred clinic location/provider). This checks 43 biomarkers (39 more than the finger prick test) to ensure you are otherwise healthy and suitable for TRT. It is a venous test and needs to be administered by a nurse. You can visit one of our partner clinics (Superdrug, Randox or Goodbody) to do this, or if you know a nurse you can ask them to do it for you.

Depending on your blood test results and medical history, in some cases further tests or investigation with us or your GP may be required, prior to consultation or potential treatment.

4. If levels are low on two tests (a regulatory requirement in the UK) then you can move to a consultation with a TRT-specialist doctor (£79.95 for a remote consultation). During your consultation, the doctor will discuss your symptoms, medical history and treatment options. The consultation can be done remotely in most men. Some men may still need a prostate exam before starting treatment, at the doctor’s discretion.

5. If you are approved for treatment, they will arrange a prescription and we can then set you up on a monthly subscription of testosterone medication. You can read more about the cost of TRT here.

Start with the ADAM questionnaire test below to check your symptoms:

Blood Test

Testosterone test kits

Order an at-home test kit to get started.

What are the benefits of TRT?

• Improved mood and reduced anxiety

• Increased muscle mass

• Harder erections and reduced erectile dysfunction

• Improved libido/sex drive

• More drive and competitiveness

• More confidence and assertiveness

• Better sleep quality

• Better gut health/ reduced IBS and Crohn’s disease symptoms

• Improved mental clarity

• Deeper and more stable voice

• Beard hair growth

• Reduced all-cause mortality

Benefits of TRT

Testosterone replacement therapy is a very effective treatment for men with low testosterone symptoms.

The main benefits of taking TRT are that it improves the symptoms seen in men with testosterone deficiency. However, some men notice further improvements that go beyond how they felt with natural levels.

Read more about the benefits of TRT.

How do I know I need TRT? Low testosterone symptoms.

• Low sex drive/libido and erectile dysfunction

• Poor cognition/ brain fog

• Fatigue/ low energy

• Anxiety and depression

• Loss of muscle mass/physical performance

• Reduced drive/competitiveness

• Poor sleep/insomnia

• Shrunken testicles

These are the most common signs of low testosterone, but there are more.

Optimale TRT clipboard

ADAM Questionnaire

Low Testosterone Test

The ADAM questionnaire has been shown to have 88% sensitivity in testing for low testosterone.

Why do some men need TRT?

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 one, or most likely a combination of several factors:

Environmental factors – such as plastics and fertilisers leaching chemicals into the water supply/food

Hormones – the contraceptive pill contains hormones which can disrupt the male hormonal system

Anabolic steroid use – often a full recovery of the HPTA does not occur after the shutdown of natural production

• Soy consumption – phytoestrogens from some foods such as soy and mint can reduce T levels

• Stress – chronically increased cortisol production may reduce T levels

• Congenital disposition – genetic conditions can lead to low levels

• Age-related decline/andropause – testosterone levels may decrease with age

• Pesticide exposure – pesticides and other chemicals can reduce hormone production

• Obesity – increased body fat can lead to higher conversion of testosterone into oestrogen which reduces levels and suppresses testosterone production

• Lack of hormetic stress (low level stress such as cold, heat and low calories)

Many of these factors are present in a lot of men today.

Although some of the factors above are more controversial than others, it is likely that most of these factors can lead to suppressed hormone levels and symptoms of low testosterone. The gradual reduction in male testosterone levels over the years in western societies is likely linked to factors from the list above.

Which blood tests do I need before starting TRT in the UK?

Have you already had your blood tests done? Check below if you have everything you need.

UK regulations state that you need to have two results showing low total testosterone and/or free testosterone before starting TRT 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 less available to the body. If you have a raised SHBG level, you could suffer from the symptoms of low testosterone despite good total testosterone levels.

NHS GPs rarely test for this and therefore cannot accurately tell if low 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 gynaecomastia, or ‘man boobs’!) This is extremely important to test before and during treatment for low testosterone!

TRT UK Blood Test

• Follicle Stimulating Hormone (FSH) – A hormone produced by the pituitary gland that stimulates the testes to produce sperm and testosterone.

• Luteinising Hormone (LH) – A hormone produced by the pituitary gland that stimulates the production of testosterone in the testicles. Luteinising Hormone and FSH are important for understanding why you have low testosterone.

• Prolactin – If your levels are high 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. If over a certain range then the doctor may recommend that you have an MRI scan before starting treatment.

• Prostate-Specific Antigen (PSA) – This can indicate prostate health. The most recent research suggests that TRT does not 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 doctor.
This is required for all men over the age of 45 as well as a prostate examination or scan.

• 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.

• Lipids – Certain medications can make your cholesterol, LDLs and HDLs worse. If these are particularly bad before treatment then you may need to talk to your GP before starting.

These are also reviewed whilst on treatment to ensure you are healthy.

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.

• Liver function tests – Certain medications can make these worse, they can also indicate other issues.

• Renal (kidney) function – Certain medications can make these worse, they can also indicate other issues.

• Iron studies – These can indicate certain issues such as haemochromatosis, which may need further investigation before starting testosterone replacement therapy.

• HbA1C – This checks for signs of prediabetes or diabetes.

All of these Blood tests serve certain purposes and may be requested before starting treatment, depending on your medical and medication history.
If your doctor or pharmacy is trying to provide treatment based on just one testosterone result, then it may be worth looking for a different clinic with more thorough testing and your health as its priority.

Blood Test

Testosterone test kits

Order an at-home test kit to get started.

How much does TRT Cost with Optimale?

Our initial consultation is now only 79.95 and can be done remotely for most men. If, like many men, you are transferring from the NHS or another clinic the consultation is only £59.95.

Medicated TRT plans in the UK can cost as little as £59.99 per month for medication, advice, postage and support with Optimale. Cypionate subscriptions are more at £109.99 per month. HCG as an add-on to a TRT plan is £35 per vial which lasts from 4 to 10 weeks depending on your dosage.

A Sustanon subscription is now only £59.99 per month including full support.

HCG monotherapy (on its own without TRT) is £79.99 per month including support.

Supplements start from £59.99 per month.

Injection supplies are not included in the subscription cost, we provide roughly a year’s supply for £59.99 or you can buy these elsewhere.

We don’t have any hidden costs for postage, letters, consultation reviews or medication changes, unlike most other clinics!

You can read more about costs on our Costs of TRT page.

What is the best type of TRT treatment in the UK?

The most popular and most effective form of TRT in the UK is via injections of testosterone. 95% of our patients prefer this route, and we specialise in providing this treatment effectively and safely.

TRT-UK-Testosterone-Cyp

Testosterone is injected with an ester attached to slow its release into the body and reduce the number of injections that are required each week.

HCG is also important to maintain fertility and natural testosterone production as well as to regulate other hormonal pathways.

However, we understand that some men don’t get on with injections. For these men, there are several options for the administration of TRT, some of which have either reduced injection frequency or none at all:

• Testosterone gels or creams – these can have absorption issues for some men, but in general the creams are effective. There is however a risk of transmission of testosterone to women and children.

• Monthly or Quarterly testosterone injections,

• Weekly testosterone injections, typically Testosterone Enanth or Cyp. Testosterone Enanth and Cyp are the preferred treatment options for most men and are best taken twice or three times weekly. Sustanon is the most commonly provided injectable in the UK and comes in 1ml ampoules.

• Pellets which are inserted every 6 months – these may have issues with side effects and it is difficult to adjust the dose, it is also a very expensive option as it requires minor surgery for initial insertion and adjustments, as well as replacement. We don’t provide this option.

You can read more on the different options and preferred approaches in our article ‘What is the Best TRT protocol?’

Conclusion

Testosterone replacement therapy in the UK is a growing area of interest for many men. Whilst the UK has been behind other countries in providing this treatment, it is now starting to bring more modern treatment approaches to the UK through private clinics.

TRT is a long term treatment that requires careful consideration before starting. Other potential causes should be identified and treated before treatment is considered. There are some risks to testosterone replacement therapy, especially if the treatment is not carefully monitored and managed by a specialist clinic, such as Optimale.

TRT is an extremely effective treatment for many men and can improve a man’s quality of life exponentially, if you think that low testosterone is an issue for you then a testosterone blood test is the best first step to diagnosing this condition.

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References
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