TRT UK FAQ - Testosterone Replacement Therapy in the UK

Are you unsure about TRT in the UK?

Want to know if it is available near you?

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 of 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 TRT in the UK (Testosterone Replacement Therapy).

If you have any further questions please contact one of our advisors who will be happy to help.

What is TRT?

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 UK 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 and aromatase inhibitors included in TRT to fully optimise the treatment by preserving the patient’s fertility and managing the levels of other hormones like Estradiol (Oestrogen).

What is testosterone?

Testosterone is the male sex hormone responsible for male characteristics and health.

It is important for various functions in the human body, in both men and women!

Testosterone improves sexual function, mainly through changes to sexual drive (libido) which can also impact erectile function.

Muscle growth is improved by increased testosterone levels, which also improves general strength. This occurs through ramping up of both protein synthesis, tendon strength and neurological changes that affect force production.

Cognitive function, including memory, mood and mental agility, are all heavily influenced by testosterone. Men with low levels of testosterone often report reduced short term memory and ‘brain fog’ which makes thinking difficult. Men will comment that mental arithmetic is harder than usual.

TRT UK what is testosterone?

Fertility is controlled by various factors including the testosterone level inside the testicles. If testosterone is very low (usually due to genetic or pituitary issues) then men may have reduced sperm count and quality.

Testosterone is also involved in lesser-known roles such as ensuring normal bone density, producing body hair and increasing the cardiac output of the heart.

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 some doctors for its connections to violence, aggression and ‘toxic masculinity’ as well as certain health issues.

If used safely, TRT in the UK under the supervision of one of our specialist doctors can be a very effective and safe treatment.

For a more in-depth explanation, click here to read our ‘What is Testosterone’ article.

Why is Testosterone Replacement Therapy necessary?

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 a combination of several factors:

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.

Do I have to inject on TRT in the UK?

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 or Quarterly testosterone injections, including Nebido
  • Patches
  • Weekly testosterone injections, typically Testosterone Enanthate, Cypionate or Sustanon.

Discuss the best TRT UK option for you with one of our advisors today.

However, self-injections are the best option for TRT in the UK. We can provide help with injection advice and videos such as this one.

Testosterone Replacement Therapy UK - Sustanon 250
Testosterone Cypionate in the UK

How to get TRT in the UK?

Until recently getting TRT in the UK was quite a difficult journey. Most men would need to go to their GP and convince them to test them for testosterone levels. Often GPs are not keen on testing for testosterone or they will convince men to take SSRIs (antidepressants) instead as it is easier, cheaper and seen as less risky by some GPs.

Bear in mind that most GPs are hugely overworked and have very little time to spend diagnosing the route cause of issues. Add to this that total testosterone is usually only tested and your chance of getting treated is even slimmer.

On top of this, a lot of NHS guidelines are based on the ‘normal values’ of testosterone which do not correspond with the levels at which men get symptoms. This means that a lot of men are refused treatment or told they are normal when their results are low based on the BSSM (British Society of Sexual Medicine) guidelines. You can read more on normal male testosterone levels here.

Luckily, nowadays clinics like Optimale provide effective testing and treatment using the most recent, pioneering treatment protocols which keep men safe and provide brilliant results.

How much does TRT cost in the UK?

You may be surprised at how reasonable the cost of TRT in the UK can be.

An initial testosterone blood test costs as little as £44.99.

This is followed by a second, more comprehensive, blood test costing £79.99 so that our doctors can ensure you are safe to start therapy. Our blood tests are the best price you will find anywhere for the wide range of important values that they test. If you find a better price anywhere, we will promise to match it!

Prices start as low as £90 a month for Testosterone Replacement Therapy treatment.

Medications for fertility or sexual function are additional to the price, but charged at competitive prices. For most patients hCG is recommended to maintain fertility, this is £35 every 4 to 10 weeks depending on dosage. Medications like hCG can be added as required, although long-term use is recommended.

If you are trying for a child (or will be in the future) then you will be encouraged to take 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.

Will TRT make me infertile?

The addition of exogenous (not from the body’s natural production) testosterone can reduce sperm production in men.

Traditionally this meant that TRT could only be used by men who weren’t interested in fertility, or who were suffering so much that they had no choice but to be infertile for life.

Luckily our clinic has access to TRT programs which are designed to include medications to stimulate the natural production of sperm by the testes. The medication which our doctors recommend to maintain the fertility of our patients is called HCG, and has been shown to improve fertility in men.

HCG is used in women to improve their fertility when undergoing IVF to increase their chances of pregnancy. It is used in smaller, more frequent doses in men to improve their testicular function. The byproduct of this is that the testicles remain a normal size and continue to produce testosterone in most men. This can add to the testosterone levels from TRT and also allows the production of other hormones which are usually ‘knocked out’ by exogenous testosterone use.

You can read more on TRT and fertility here.

HCG should be used by most men on TRT. Our medical director Dr Chris Airey encourages all men to use this medication alongside TRT as it improves fertility, maintains testicular function and stimulates other hormonal pathways important for well-being in men.

Will TRT shrink my testicles (balls)?

Increasing the amount of testosterone in the body from outside sources, for example through Testosterone Replacement Therapy, can cause the testicles to shrink in size by around 75%.

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 as it maintains a downstream of other hormones such as pregnenolone which is important for wellbeing and libido.

Is TRT linked to prostate cancer?

No, recent research suggests there is no link. A recent study observing 1,500 patients concluded that higher testosterone levels may even reduce the risk of prostate cancer, and that low testosterone may increase your risk of prostate cancer. You can read more about this on the prostate cancer UK website here.

However, if you already have prostate cancer then starting TRT is not advised. Men over 45 require a clear prostate exam and PSA blood test reviewed by our doctors before starting TRT in the UK as there is some evidence that higher androgen (male hormone) levels can increase the growth of prostate cancers which are already there.

You can read more on this here.

Will TRT improve my Sleep/Help me to Sleep better?

Yes there is lots of anecdotal evidence to support this as well as some studies that show normal testosterone levels improving sleep quality.

Sleep cycles are separated into two different main types Non-rapid eye movements (NREM) and Rapid eye movements (REM). NREM amounts to 75-80% of sleep duration whereas REM amounts to 20-25% of total sleep duration.

Not only does poor sleep reduce testosterone levels, but low testosterone can reduce sleep quality. Men with low testosterone have decreased sleep efficiency, increased number of night time awakenings and reduced deep sleep times.

Does TRT cause other prostate issues?.

When men start TRT there is a phenomenon which results in a raised PSA (prostate specific antigen) – this usually reduces within a few months of starting.

If the dose is too high and too much testosterone is converted into DHT, then some men may get Benign Prostatic Hypertrophy – growth of the prostate which isn’t linked to cancer.

This can cause some issues with urination. It is usually treatable and may reduce with a reduced dose.

Is TRT linked to heart attacks or strokes?

The most recent available evidence is mixed regarding cardiovascular risk and TRT. Recent studies show that men with high testosterone are at a lower risk of heart attacks and strokes.

Whereas there are other new studies which show a 20% increased risk of cardiovascular events for men over 45 in the first 2 years of TRT. This risk level then returns to normal. This same study also shows that men on TRT had less overall mortality than the group with low testosterone who did not have TRT.

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.

As with everything, taking too much testosterone and not following the doctor’s advice on dosage, may increase your risk of certain issues. A high testosterone level over time can increase the thickness of the blood. This may lead to an increased risk of a heart attack or stroke. This is why follow up blood testing and monitoring by our specialist doctors is so important to effective and safe TRT.

TRT UK prostate health BPH
TRT UK blood pressure

Can TRT help with anti-ageing?

Yes, it can based on new research in this area. New research from an Autralian study of 2913 men shows that men with higher levels of oestradiol (which is produced from testosterone in men) had longer telomeres which can lead to an increased life span. They also found that higher SHBG (sex hormone binding globulin) levels reduced telomere length. Testosterone reduces SHBG levels so it may also increase telomere length indirectly.

Anti-ageing is now big business with new compounds and treatments becoming available by the day.  TRT is often used by Longevity or Anti-ageing companies in the US. Testosterone is used alongside Human Growth Hormone (HGH) to improve general health and energy levels. Many of our patients see improved energy and vitality which can lead to better lifestyle choices and healthier living.

Can I cycle TRT on and off?

No, it isn’t advisable. Testosterone replacement therapy is meant to replace your low natural production so that you have high normal levels to relieve your symptoms. It isn’t effective if you stop.

TRT UK Cycling-min

If you ‘cycle off’ (a term used by AAS users to describe the way they take steroids on and off for short ‘cycles’ of a few weeks) TRT then your levels will drop down to below what they were whilst they recover back to pre-TRT levels.

This leaves men with low testosterone and a return of symptoms. Levels do not stay at the same point whilst off TRT and you do not keep the symptomatic relief.

Unlike ‘cycles’ of AAS which are used to increase muscle mass and allow the body to recover its natural levels, TRT is meant to be used longterm to reduce symptoms by bringing testosterone levels into the top of the normal range and avoid side effects.

Is TRT for life?

In most cases men will take TRT for life. This is because it has great benefits to symptom relief, longevity, vitality and health.

Occasionally men may develop another condition which means that TRT should be stopped either temporarily or permanently. Others may not be able to get rid of certain side effects and decide not to continue treatment. Often these same men will return as they realise the low testosterone symptoms were worse than the side effect they had.

By taking TRT with HCG alongside it, men are more able to stop TRT if they have health or other issues which force it. This means that natural testosterone production remains and men aren’t left with no ability to produce testosterone after stopping treatment.

Will Testosterone Replacement Therapy make my penis shrink?

No. Testosterone will not make your penis shrink!

If anything it may improve the size, hardness and endurance of your erections for men who are having issues with Erectile Dysfunction.

In addition TRT also has a positive effect on morning erections and increased sexual interest/libido in men. In the event that our patients continue to have issues with Erectile Dysfunction and lack of sexual desire/libido, there are other medications that our doctors can prescribe, including Cialis and Viagra.

Can TRT Help to Build Muscle?

Yes, if you have low testosterone levels then your muscle growth will be reduced as testosterone is an important compound for increasing protein synthesis and muscle growth.

When men go through puberty they develop more muscle mass. Testosterone is also used by bodybuilders to increase muscle mass. It is now a widely accepted fact that testosterone helps with muscle mass and therefore muscle strength development.

In one study men who were on testosterone developed more muscle not training than men who trained but without testosterone.

This is especially important for older men who are more likely to suffer serious injuries or death from frailty. Frailty is one of the biggest indirect killers of men and women. Older men are much more likely to have low testosterone which in turn can reduce their muscle strength. Muscle strength is indirectly correlated with the chance of falls and fractures in the elderly population.

Testosterone injections have been shown to be more effective at assisting muscle growth than gel forms of TRT.

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

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 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!

•  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!

UK TRT Blood Test

What are common signs of low testosterone which may require TRT?

Low sex drive/libido and/or erectile dysfunction

Many men (but not all) with low testosterone suffer from erectile dysfunction. Others will notice that their sex drive has dropped.

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 energetic.

TRT UK libido

Poor cognition/poor arithmetic/brain fog

Often one of the first benefits men who start Testosterone Replacement Therapy realise is improved clarity of thought and reduced brain fog.

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. TRT is not allowed in most competitions in the UK or internationally.

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 truly 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 replacement therapy, competing and improving yourself can feel like a constant challenge. If you have low testosterone, starting TRT will increase your performance in sports, in competition and at work.

TRT UK business

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) and reduced circulation (cold hands and feet!)

What could have caused or triggered my low testosterone?

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. We can provide all of these medications through our UK TRT treatment plans.

Over training or over working

Many men have worked out or worked in a high stress environment for too long. These same men who used to have good testosterone levels now have much lower levels than they are used to.

There is some evidence that chronically high cortisol can lead to reduced testosterone levels.

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.

man stressed work TRT UK

Use of SSRIs or other anti-depressants

Many men who become depressed are put on anti-depressants.

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. Unfortunately there is also evidence that certain anti-depressants lower testosterone further.

What types of low testosterone are there?

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)
TRT UK primary vs secondary hypogonadism
Secondary hypogonadism (also called hypogonadotropic hypogonadism) – the most common type

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
  • Obesity
  • Nutritional deficiencies

Often there does not appear to be a reason for men having low testosterone. Many people think that it is caused by certain environmental factors in modern day life, such as hormones in the water and the widespread use of plastic containers for storing food and drinks.

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. Our doctors specialise in TRT UK wide and can help with your diagnosis and treatment.

Where to get TRT in the UK? Should I get it with the NHS or through a TRT UK Clinic?

Getting TRT in the UK is often a difficult process. Unfortunately the NHS is not always the best means for getting TRT. For men that are refused TRT through the NHS there are several other TRT UK options.

Read more about getting TRT here.

NHS/GP Services

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, with very little monitoring and management of their treatment. These men often suffer from high 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 can visit a 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 experience and surroundings is normally very good.

However, the service is much less convenient than a more modern clinic like our own. We can communicate with you and provide the same service with less hassle and faster response times for reviews of your treatment if something needs to be changed.

Additionally, our doctors are on the cutting edge of new developments in this field, whereas some of the Harley Street Clinics have a cookie-cutter approach to treatment which hasn’t changed much in the last decade, with reliance on less modern approaches and medications.

The monthly cost is often very high following the start of treatment and blood tests routinely cost over £250 whereas OptiMale can provide similar blood tests for competitive prices.

(At OptiMale we do provide a face-to-face consultations as well as remote consultations, which are 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 a large number of patients they try to manage with inadquate support. This means that they struggle to respond to patient queries and provide proper follow up support, nor do they screen adequately for medical issues before starting TRT. Also watch out for hidden charges – doctor’s fees, credit card fees passed onto the customer at inflated mark-up and inflated postage costs!

Modern 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 endeavour to provide quick response times to your issues, usually within a few hours for most calls or emails, to ensure you get quick answers and advice.

OptiMale logo

We are regulated by the CQC which is required by law in the UK.

We can support you throughout your TRT experience with follow up consultations included in the monthly cost. All doctors advice and support after the initial consultation is included in our monthly plan fee.

The monthly subscription is £89.99 on average which includes all testosterone medication, support, doctors letters and follow up consultations. Some plans that we offer are better value whereas other subscriptions are slightly more expensive if you require extra medications such as hCG.

For less than a pint of beer or a cup of coffee a day you can get back to normal and feeling great again. Please contact us here for more information about our UK TRT service, or complete the form at the bottom of this page.

We are very proud to have over 80 reviews from our patients on Trustpilot, and we would encourage you to read them before making such an important decision on your future.

The Black Market

This is not a valid option. It is dangerous to rely on unscrupulous dealers to provide medications. These products are rarely of pharmaceutical grade and are illegal to purchase or sell in the UK. You don’t know what strength or quality of product you are getting. You run the risk of infection from injecting non-sterile medication or unpleasant side-effects from unknown chemicals.

TRT UK 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 emergency medical 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, job and freedom should be too important to risk this.

Where can I get advice?

We are happy to provide advice not only on how to get NHS treatment but also which blood test is best to order, which medications to choose, pros and cons of each and which service to use.

We provide support for men who are looking to get treatment through the NHS as well as advice on whether it is the right treatment for them and whether the NHS can meet their needs.

Can I transfer from another TRT UK clinic?

Yes you can! It is simple to transfer – we still require a consultation with our doctor but this is at a discounted rate.

We have patients transferring to us weekly from other providers as we provide better value, better service and a better selection of the medications you need such as Testosterone Cypionate, Testosterone Enanthate and HCG for an experience and treatment plan that is tailored to each patient.

Contact us here for more information!

UK BSSM guidelines on testosterone deficiency and TRT UK

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 in your conversations, 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. The 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) and men 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).
  • 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.

What side effects, if any, should I worry about?

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.

However, there is an increased risk of cardiovascular events for people who abuse testosterone by taking too much or taking steroids which increase the thickness of the blood and worsen the lipid profile.

Prostate Cancer

There is no known link between TRT and prostate cancer.

However, low testosterone is known to protect against prostate cancer. Once testosterone levels are over 8nmol/l (a low level) further increases in testosterone do not increase the risk of prostate cancer further.

This is known as the receptor saturation theory (Once the androgen receptors in the prostate are saturated there is no further increase in cancer risk), so unless you want to keep a low testosterone level throughout your life to reduce the risk of prostate cancer (and increase your risk of more dangerous conditions) then TRT does not increase your risk to more than someone with normal testosterone levels.

Raised Oestrogen/Oestradiol levels

As TRT replaces your low levels of testosterone with high normal levels it doesn’t always cause increased oestrogen.

In men testosterone is converted by aromatase into oestrogen.  Most men do not require medication to control oestrogen as their 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 sometimes 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. This also has more of a tendency to be an issue for men who are overweight.

These symptoms can indicate high oestrogen:

  • gynaecomastia (breast tissue growth)
  • itchy nipples
  • bloating
  • moodiness
  • reduced libido
  • hot flushes
  • headaches


Testosterone increases sebum (skin oil) production. This can lead to increased spots particularly on the back and shoulders. This is a common side effect of TRT but can indicate that your testosterone levels are too high and you may need to reduce your dosage. Anecdotally we have found this to be more of an issue with Sustanon than with other Testosterone medications like Enanthate or Cypionate.

Hair growth

Testosterone also increases hair growth (also called hirsutism). Most men will notice a slight increase in body hair growth once starting TRT, for some men with low testosterone this is a positive side effect as they may have struggled to grow a beard in the past.

Wrap up

If you think you have low testosterone then contact us today and see what we can do to help you get back to normal again!

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.

Dr Chris Airey

Dr Chris Airey

Medical Director

This article has been medically reviewed for accuracy by Dr Airey on 12th September 2020.

Dr Chris Airey is a fully registered UK doctor with the GMC (General Medical Council) Reference No: 7490533.
He trained at the University Hospital Southampton and graduated as a Doctor with a joint Bachelor of Medicine and a Bachelor of Surgery, plus a Masters in Medical Science, completing his research project in the Medical Neurosciences Department.
He is undertaking a Master of Science course in Endocrinology and is a member of the European Society for Sexual Medicine, and the Androgen Society.
He has personal experience with taking Testosterone Replacement Therapy and is a pioneer in UK treatment protocols for Testosterone Deficiency Syndrome.

Please feel welcome to contact us with any TRT UK questions with the form below: