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 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 and the best medications available to remove symptoms and improve your quality of life.
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.
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.
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, including injections, HCG (very important for all men on TRT), creams, gels or pellets, 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.
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) 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.
For more information
Contact us for more information on low testosterone or TRT.
How easy is it to get TRT in the UK?
1. Check that you have low testosterone symptoms through our ADAM questionnaire.
2. Get a blood test showing low total or free testosterone levels (free testosterone levels are often low despite a more normal total testosterone level).
3. If levels are low on two tests (a regulatory requirement in the UK) then you can move to consultation, which can be done remotely in most men.
4. After consultation, sign up for treatment and get medication delivered within days.
Start with the ADAM questionnaire test below to check your symptoms:
Low Testosterone Test
The ADAM questionnaire has been shown to have 88% sensitivity in testing for low testosterone.
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
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.
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 hermetic 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.
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!
• 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.
• 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.
• Cortisol – this can indicate whether there are other issues with your pituitary gland.
• 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.
Testosterone test kits
Order an at-home test kit to get started.
How much does TRT Cost with Optimale?
Our initial consultation is only £149.99 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 £99.99.
TRT plans in the UK can cost as little as £89.99 per month for medication and support with Optimale. HCG as an add-on to a TRT plan is £35 per vial which lasts from 4 to 10 weeks depending on your dosage.
HCG monotherapy (on its own without TRT) is £69.99 per month including support.
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.
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, but it is sub-optimal and favoured by clinics that want a cheap, easily accessible option if they can’t get Enanth or Cyp.
• Pellets which are inserted every 6 months – these may have issues with side effects and it is difficult to adjust the dose.
You can read more on the different options and preferred approaches in our article ‘What is the Best TRT protocol?’
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.
For more information
Contact us for more information on low testosterone or TRT.
- Wu, Y., Eisenegger, C., Sivanathan, N. et al. The role of social status and testosterone in human conspicuous consumption. Sci Rep 7, 11803 (2017)
- Wenker EP, Dupree JM, Langille GM, Kovac J, Ramasamy R, Lamb D, Mills JN, Lipshultz LI. The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use. J Sex Med. 2015 Jun;12(6):1334-7. doi: 10.1111/jsm.12890. Epub 2015 Apr 22. PMID: 25904023.
- Croes K, Den Hond E, Bruckers L, Govarts E, Schoeters G, Covaci A, Loots I, Morrens B, Nelen V, Sioen I, Van Larebeke N, Baeyens W. (2015) Endocrine actions of pesticides measured in the Flemish environment and health studies (FLEHS I and II). Environ Sci Pollut Res Int. 22(19)
- Søeborg T, Frederiksen H, Mouritsen A, Johannsen TH, Main KM, Jørgensen N, Petersen JH, Andersson AM, Juul A. (2014) Sex, age, pubertal development and use of oral contraceptives in relation to serum concentrations of A, AS, 17α-hyerone, Δ4-anone, testosterone and their ratios in children, adolescents and young adults. Clin Chim Acta. 1;437:6-13.
- Rasmussen JJ, Selmer C, Østergren PB, Pedersen KB, Schou M, et al. (2016) Former Abusers of Anabc Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study. PLOS ONE 11(8): e0161208.
- Nagata C, Inaba S, Kawakami N, Kakizoe T, Shimizu H. (2000) Inverse association of soy product intake with serum andrn and estrogen concentrations in Japanese men. Nutr Cancer. 36(1):14-8. doi: 10.1207/S15327914NC3601_3. PMID: 10798211.
- Smith,G., Ben-Shlomo, Y., et al. (2005) Cortisol, Testosterone, and Coronary Heart Disease Prospective Evidence From the Caerphilly Study Circulation. 112:332-340
- Wang Y, Gong C, Qin M, Liu Y, Tian Y.(2017) Clinical and genetic features of 64 young male paediatric patients with congenital hypogonadotropic hypogonadism. Clin Endocrinol (Oxf). 87(6):757-766. doi: 10.1111/cen.13451. Epub 2017 Sep 13. PMID: 28833369.
- Liu CC, Wu WJ, Lee YC, Wang CJ, Ke HL, Li WM, Hsiao HL, Yeh HC, Li CC, Chou YH, Huang CH, Huang SP. (2009) The prevalence of and risk factors for androgen deficiency in aging Taiwanese men. J Sex Med. 6(4):936-946. doi: 10.1111/j.1743-6109.2008.01171.
- Croes K, Den Hond E, Bruckers L, Govarts E, Schoeters G, Covaci A, Loots I, Morrens B, Nelen V, Sioen I, Van Larebeke N, Baeyens W. (2015) Endocrine actions of pesticides measured in the Flemish environment and health studies (FLEHS I and II). Environ Sci Pollut Res Int. 22(19):14589-99. doi: 10.1007/s11356-014-3437.
- Eriksson J, Haring R, Grarup N, Vandenput L, Wallaschofski H, Lorentzen E, Hansen T, Mellström D, Pedersen O, Nauck M, Lorentzon M, Nystrup Husemoen LL, Völzke H, Karlsson M, Baumeister SE, Linneberg A, Ohlsson C. (2017) Causal relationship between obesity and serum testosterone status in men: A bi-directional mendelian randomization analysis. PLoS One. 27;12(4):e0176277. doi: 10.1371/journal.pone.0176277.
- Yeap, B.B., Hui, J., Knuiman, M.W., Flicker, L., Divitini, M.L., Arscott, G.M. et al. (2020) U-Shaped Relationship of Leukocyte Telomere Length With All-Cause and Cancer-Related Mortality in Older Men, The Journals of Gerontology: Series A, 10.1093/gerona/glaa190
- García-Cruz E, Piqueras M, Huguet J, Peri L, Izquierdo L, Musquera M, Franco A, Alvarez-Vijande R, Ribal MJ, Alcaraz A. (2012) Low testosterone levels are related to poor prognosis factors in men with prostate cancer prior to treatment. BJU Int. 2012 Dec;110(11 Pt B):E541-6. doi: 10.1111/j.1464-410X.2012.11232.x. PMID: 22584031.
- Celec P, Ostatníková D, Hodosy J. On the effects of testosterone on brain behavioral functions. Front Neurosci. 2015;9:12. Published 2015 Feb 17. doi:10.3389/fnins.2015.00012
- Farthing MJ, Mattei AM, Edwards CR, Dawson AM. Relationship between plasma testosterone and dihone concentrations and male facial hair growth. Br J Dermatol. 1982 Nov;107(5):559-64. doi: 10.1111/j.1365-2133.1982.tb00406.x. PMID: 7126460.
- Jacob BC. Testosterone replacement therapy in males with erectile dysfunction. J Pharm Pract. 2011 Jun;24(3):298-306. doi: 10.1177/0897190010397715. Epub 2011 Mar 31. PMID: 21676853.
Published: April 14th, 2022
Last updated: April 27th, 2022