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 our list of 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?
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. For a more in-depth explanation, click here to read our ‘What is Testosterone’ article.
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
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.
This 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 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 thryoid 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!
Sex drive is an important part of feeling healthy and keeping a healthy relationship. It can also improve your confidence and make you feel more manly and energetic.
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.
It provides clarity and makes decision-making more assertive and natural. This can lead to really positive changes in a man’s work environment, where men on TRT often find that they suddenly become more productive and competitive. Many men find that TRT is the catalyst for them to start rising up the ranks at work.
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.
Over training or over working
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.
Use of SSRIs or other anti-depressants
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.
Primary hypogonadism (the body doesn’t produce enough 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)
Secondary hypogonadism (also called hypogonadotropic hypogonadism) – the most common type
- 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.