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TRT UK – How To Get TRT in the UK?

By Mike Kocsis | 15 minutes read | Last updated: April 29, 2022

Medically Reviewed by Dr. George Touliatos

Evidence Based Research

What is Testosterone Replacement Therapy (TRT)?

TRT UK - How To Get TRT
Testosterone Replacement Therapy (TRT) is a form of hormone therapy that aims to restore your testosterone levels back to optimal physiological range. Low testosterone levels can be caused by abnormal testicular function, abnormal pituitary gland function, or simply natural ageing processes. Some of the most common symptoms of low testosterone include fatigue, weight gain, and low libido (sex drive) – TRT is a great option that helps to relieve such symptoms. Testosterone Replacement Therapy involves providing the body with bioidentical testosterone (chemically identical to your body’s testosterone) to raise the body’s testosterone levels to optimal range. The main ways testosterone is administered is by patch, injection, topical gel, or pill but it can also be administered through an implant.

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How to get TRT in the UK?

Whichever route you take to getting TRT, you must first take a blood test and then get approval from a doctor to make sure you are in fact testosterone deficient. Your doctor will talk you through all the potential side effects and benefits of TRT before you receive any treatment.

How To Get TRT?

Balance My Hormones takes the guesswork out of the equation when it comes to knowing which private clinic to get TRT from. Some doctors, such as NHS doctors, often have insufficient TRT knowledge and are restricted in the treatments they can offer. Our specialised doctors are experienced in hormone therapy and have the autonomy to prescribe a wide range of treatments ensuring a bespoke experience.

Balance My Hormones offer a unique service that combines an online platform with full in-house support for clients looking for assistance with accessing and managing their TRT journey. We are not just an online service, so feel free to book an appointment and stop by our offices to ask us any questions.

Balance My Hormones works with GMC licensed doctors, clinics, accredited blood testing services, and GPHC pharmacies to facilitate clients’ access to these services. The balance My Hormones team is there to provide clients with support, coordination, and reassurance at every step of their TRT journey. With us, you can be sure to receive a seamless TRT experience where your treatment preferences are listened to and specific circumstances are catered to.

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Can I get Testosterone Replacement Therapy in the UK (TRT UK)?

To get TRT in the UK NHS or private your total testosterone must be less than 15nmol/L. You must first obtain a TRT blood test and then get approval from a doctor that your testosterone levels are indeed lower than they should be. Our research shows that over 20% of men in the UK who are over 50 suffer from low testosterone however, only 1% of these men get their testosterone analysed and treated. The statistics are shocking and although men are becoming increasingly aware of their health and the availability of TRT, there is still much more work needed to be done to help raise awareness of the “male menopause”.  If you get blood test results that indicate your total testosterone is not within optimal range, our doctors will walk you through TRT treatment options, how it works, how you can get it in the UK, and tell you everything you need to know prior to commencing treatment. We have a truly bespoke service that is well researched and thousands of happy customers who benefit from our corrective Testosterone Replacement Therapy.

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2 How To Get TRT?

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Quick Low Testosterone Test

If you know your total testosterone reading from a previous blood test input the results to the left above to see if your testosterone levels are normal.

Low Testosterone Levels

You may have low testosterone depending on the symptoms you have, please contact us to find out how we can help.

Take our ADAMS low testosterone questionnaire.

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The Total Testosterone Level You Entered Is Incorrect. Figure Must be in nmol/L you can use our converter here.

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Normal Testosterone Levels

Your testosterone levels appear to be in the normal range.

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Further testosterone tests not necessary

You must be over 38, have had your ovaries removed or have suffered with premature menopause to warrant further hormone tests.

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Further investigation needed

Please contact us to discuss your hormones, we need your total testosterone levels to validate your hormone deficiency. You can order a blood test here.

Take our ADAMS low testosterone questionnaire.

Low Testosterone Levels

You may have low testosterone depending on the symptoms you have, please contact us to find out how we can help.

Take our ADAMS low testosterone questionnaire.

High Testosterone Levels

You appear to have higher than normal testosterone levels, please contact us for further investigation.

Take our ADAMS low testosterone questionnaire.

Normal Testosterone Levels

You appear to have normal testosterone levels. Contact us if you have any concerns.

Take our ADAMS low testosterone questionnaire.

Self-prescribed TRT online / Buy TRT online

A lot of people look to get TRT in the UK online or in an inexpensive way. Sadly this is often through the black market or illegally, which we highly discourage. Lots of people often look into how to self administer or self prescribe TRT, particularly in countries where medical provisioning is lacking. There are many risks and issues with this and Balance My Hormones strongly suggests not going down this road. We would advise booking a free consultation with us to talk about your symptoms, it’s highly likely we can come up with a solution for you that will be safer and more beneficial to you in the long run.

Even in a country where TRT is widely administered by specialists using pharmaceutical standard preparations, treating a patient correctly is complicated, very personal, and can take time. Doctors can spend up to a year assessing symptoms and bloodwork to ensure that the dosing structure of treatment, i.e administration type, frequency and dose is adapted to ensure a patient’s symptoms are resolved. Multiple factors can affect the body’s response to bioidentical testosterone. Such as, how quickly one excretes testosterone from the body, levels of SHBG, alongside other hormones that must be balanced for TRT treatment to work effectively. This is why it’s so important to seek professional advice before trying to self prescribe TRT or buy TRT online.

With the black market selling testosterone on websites it is easy to get hold of what is often advertised as good quality, pure, and accurately dosed substances. The problem is what you are purchasing has likely been dosed inaccurately, mixed with other substances, and will have varying degrees of purity. It’s also highly likely that the substance was not made in sterile conditions and did not undergo the necessary quality control processes required that make bioidentical hormones safe to administer.

So taking this into consideration, even if black market testosterone was sterile, checked for quality, purity and sterility, the task of making TRT work for patients in an effective way (for symptom resolution, health and longevity) requires a skilled Doctor. If you are considering buying TRT online please speak to one of our experts first before purchasing and trying to self administer TRT.

Is TRT always necessary/needed?

Testosterone replacement therapy is not always needed. Occasionally there are ways to boost borderline testosterone levels without actually shutting down the pituitary axis. Younger patients can be assessed for testosterone boosting protocols prior to full TRT.

When your doctor assesses your testosterone levels, your hormones levels must be screened for other possible causes of symptoms. This involves comprehensive blood testing. As previously mentioned there are other medical treatment options, that can boost your testosterone levels back to optimal range.

TRT UK – BSSM Testosterone deficiency guidelines for clinic diagnosis

The British Society for Sexual Medicine (BSSM) provide a set of guidelines that are worth reading if you think you may have a testosterone deficiency. They outline symptoms as we have listed below, what screening measures should be taken, thresholds for undertaking TRT and the benefits and risks associated with testosterone therapy.

Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but its diagnosis and management can be challenging.
British Society for Sexual Medicine

For full BSSM guidelines on testosterone deficiency in adults guidelines please view this article here.

Low Testosterone Symptoms

Low T Symptoms in Men and Women:

Low T Symptoms in Men:

signs of low testosterone in men
signs of low testosterone in women
types of low testosterone

When a testosterone drop is detected by the hypothalamus/pituitary gland, a signal (LH/FSH from the pituitary) goes out to tell the testicle/testes/balls to switch back on and produce more testosterone. Once the testosterone climbs back up to the required range it is detected and the signal that caused the increase to begin switches off. This continuously happens in the body, much like thermostat-controlled heating in a house, to keep levels of testosterone relatively stable.

The LH/FSH (Gonadotrophin releasing hormones) not only tells the testicles to produce testosterone but also sperm. When the cells in the testicles are stimulated it allows testicular size to be maintained. Without this signal, which can be blunted by taking testosterone alone, then the activity of the Leydig cells can lower and sometimes cease. When this happens, testicular atrophy can become apparent. This can be prevented using HCG or recombinant LH and FSH as an adjunct whilst on male Testosterone Replacement Therapy.

In summary, your sex hormones (testosterone and oestrogen) along with your gonadotropins (LH and FSH) operate naturally in a tightly regulated and automated process. The brain creates a feedback loop that regulates how much testosterone is released. There is an interplay between the signal from the hypothalamus, the pituitary gland, and your testes. This process keeps the testes functioning and healthy. When you start Testosterone Replacement Therapy your doctor will essentially take control of your testosterone production in order to optimise it. The naturally regulated process will still occur but to a lesser degree. Both you and your doctor will determine how much and how often your body receives testosterone. Age-related Andropause or adult hypogonadism blunts your natural hormone production and this is treated with balanced TRT with or without HCG.

Benefits of TRT

 

Does TRT increase the risk of heart attack/stroke?

There are mixed studies on the risks and benefits of testosterone treatment and its effects on the heart. There is debate amongst practitioners and researchers around the use of testosterone in ageing men and women. With the studies published, there may be bias either for or against testosterone treatment. There have been studies showing a link to heart attacks and strokes but equally, there have been studies showing that TRT may reduce the incidence of heart attacks and strokes. Some of the studies which showed a link between testosterone treatment and heart issues had underdosed men to the point of having no benefit at all. The types of studies and the way they are set up have been critically analysed by some forward-thinking doctors in the USA to uncover deceptions in the data. Some recent studies casting TRT in a bad light used composite prescription data which failed to discern if the prescription was actually taken after being dispensed by the pharmacy. Without proper controls, you can’t be sure the patients in the study even took the treatment prescribed. Some in the medical community seek to diminish the benefits of TRT and use outdated or inconclusive evidence to link testosterone to heart issues in order to scare the public or misinform them.

In the past, researchers made claims that testosterone was linked to heart disease. Some argued that since women lived longer than men and women had less testosterone that somehow testosterone was to blame. It was false logic and not backed by any solid evidence. What we do know from recent studies is that there is a link between low levels of testosterone and a greater risk of cardiovascular disease.

does TRT increase risk of heart attack
  • Low Testosterone was shown to be associated with an increased risk of all-cause mortality independent of numerous risk factors.
  • Serum testosterone levels were inversely related to mortality due to cardiovascular disease and cancer. This means the lower the Testosterone level the greater the risk.
  • Haring, R., et al., “Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20-79,” European Heart Jour 2010; 31(12):1494-1501.
  • Vermeulen, A., “Androgen replacement therapy in the ageing male—a critical evaluation,” Jour Clin Endocrinol Metabol 2001; 86:2380-90.
  • Hyde, Z., et al., “Low free testosterone predicts mortality from CVD but not other causes: The Health in Men Study,” Jour of Clin Endocriol and Met2012; 97(1):179.
  • Guder, G., et al., “Low circulating androgens and mortality risk in heart failure,” Heart 2010; 96:504- 09.
  • Jankowska, E., et al., “Anabolic deficiency in men with chronic heart failure: prevalence and detrimental impact on survival,” Circulation 2006;114:1829-37.

Will TRT cause my prostate to grow?

Prostate growth is normally referred to as Benign Prostatic hyperplasia. It is a benign condition and is not to be confused with prostate cancer. The growth of the prostate can put pressure on the bladder and can cause frequent urination – a hormonal imbalance is often the cause. In the past, it was easy to blame testosterone but it’s more likely to be Oestradiol (a metabolite of testosterone), and the ratio of androgens to Oestradiol that may be the real culprit of the enlargement. It may also be due to the local activity of the aromatase enzyme in the prostate causing an overgrowth of the stromal cells which are mostly responsible for the growth of the prostate(BPH). It’s been found that using an aromatase inhibitor could help prevent this growth. Low dose Cialis has also been proven to reduce the symptoms of BPH acting as a mild aromatase inhibitor. There have also been studies conducted and evidence that supports no major increase in the risk of getting cancer whilst on TRT.

will TRT cause my prostate to grow

More recent data has shown no apparent increase in pCA rates in clinical trials of T supplementation in normal men or men at increased risk for pCA, no relationship of pCA risk with serum T levels in multiple longitudinal studies, and no reduced risk of pCA in men with low T.
European Association of Urology

Will TRT cause hair loss?

will TRT cause hair loss

Testosterone therapy alone doesn’t directly cause hair loss. However, the average man will experience pattern baldness as part of normal ageing processes so it is possible you may experience hair loss as your testosterone levels are brought up to a range normal for your age. It is genetics that largely determines the rate of hair loss an individual might experience.

Additionally, there are studies that show high levels of DHT directly correlating to hair loss. DHT is a synthetic form of testosterone in your body that is usually created when testosterone combines with other elements in your body. The assumption is that testosterone injections can increase DHT levels and therefore cause hair loss but there is no conclusive evidence of a link between testosterone treatment and hair loss.

If hair loss is of concern for you, there may be options to lessen the effects of hair loss if you are prone to it. Our specialised doctors will discuss a variety of medications and treatment options that take into account possible side effect concerns.

TRT side effects

If TRT is managed and administered properly the side effects can easily be avoided and quickly dealt with if they arise. Testosterone use, if not monitored properly or if used in excess, may cause unwanted side effects. Side effects can include; oily skin, fluid retention or oedema, hair loss, hair growth, enlarged breasts, enlarged clitoris (in women), gastrointestinal symptoms, drowsiness, acne, irritability and mood changes. If treatment is provided as an injection, it is possible one may experience soreness or pain at the injection site.

If a person receiving TRT does not monitor oestrogen and it climbs too high in relation to the levels of androgens then some may experience benign prostate enlargement which may cause problems with urinating or cause an urgent feeling to urinate even if the bladder is empty. There may be changes in cholesterol levels, red blood cell levels, PSA levels, liver function enzymes, and other hormone levels. It is important to have regular blood tests throughout your treatment to monitor hormone levels and other health indicators. If treatment is stopped, symptoms associated with low testosterone may return or get worse. Long term Testosterone Replacement Therapy may reduce sperm count, possibly affecting fertility especially if HCG, HMG or exogenous gonadotropins are not used concomitantly. Whilst rare there may be an increased chance of hair loss or thinning especially if one is genetically predisposed to this.

What are the side effects of TRT

Are there alternatives to TRT?

There are alternatives to TRT. Without sounding trivial, the first option is to do nothing and wait to see if things improve but you can also adjust lifestyle factors such as diet and exercise. We often find however that if your body is not producing enough testosterone then doing these things is ineffective and can make symptoms worse. The second is to speak to the doctor about whether you personally (following blood test etc.) may be suitable for TRT that may boost your levels. This can be the use of a SERM or HCG alone to try and improve the responsiveness of the testicles. This option sometimes works in younger men but often lacks effectiveness. The third is the possibility of being treated to change your SHBH which in some men can improve symptoms. To discuss a blood test, getting a blood test or whether you may be a candidate for TRT or an alternative treatment contact us and your free consultation today.

Does TRT cause infertility?

Testosterone is critical for the production of sperm but what is more important is where in the body this testosterone is located. Intra-testicular testosterone (the testosterone within the balls/testes) is present at levels 100x greater than the systemic circulating testosterone (as measured by a standard blood test). When receiving TRT with exogenous testosterone, you provide the body with the testosterone it needs but this doesn’t increase intra-testicular testosterone… actually the contrary happens. The brain detects that there is enough testosterone (as you have provided this via injection or cream etc.) so it switches off the signal (LH and FSH) from the brain that tells the testicles to produce testosterone and sperm. This causes a drop in intra-testicular testosterone and sperm production which can reduce fertility in some men, despite having good levels of systemic circulating testosterone.

HCG can be used alongside TRT to restore the signal from the brain, increase intra-testicular testosterone, and increase sperm count. This is why our doctors at Balance My Hormones provide HCG alongside a balanced TRT protocol to maintain fertility whilst optimising testosterone levels.

does TRT cause infertility
We know that sperm production in previously fertile men can be recovered from a study published in the Lancet in 2006 looking at the recovery of fertility after the use of exogenous testosterone as a male contraceptive. In the 2006 study, they looked at over 1500 men from different backgrounds given exogenous testosterone and artificial progestins (something not used commonly with TRT). What they found was that all the men regained fertility as defined by 20 million sperm or more within 2 years. In other words, it was completely reversible and this was with the use of progestins which are thought to have an even greater impact on causing infertility. The median time to full recovery for sperm count was 3.4 months without any intervention like adding HCG or Clomid after treatment.
So testosterone treatment on its own or with anastrozole may be even easier to recover from should fertility be desired and HCG is not available or wanted when starting TRT.

Can I maintain fertility on TRT?

One way to maintain fertility whilst on TRT is to keep a very high level of testosterone within the testes. This is achieved by ensuring the testes produce testosterone locally. The most common and cost-effective method is to add HCG to a TRT protocol and ensure estradiol is managed. HCG mimics the actions of gonadotropins LH and to a lesser degree FSH to maintain fertility. Many of our clients choose Balanced TRT with HCG and oestrogen control so they can have both the benefits of exogenous testosterone whilst keeping the signal to the testes present.

Does TRT or HRT have an anti-ageing effect?

We know from studies that the telomeres through the actions of hormones may have an anti-ageing effect. One study recently published, shows women on long term HRT had the longest telomeres. It is thought that longer telomeres are associated with longer lifespans and greater potential longevity. Shorter telomeres are related to ageing and disease.
Testosterone has been shown to increase the production of an enzyme called telomerase. This enzyme keeps the telomeres from shortening, therefore having an anti-ageing effect.

TRT and antiageing

Can TRT help grow my facial hair?

Can TRT help my hair grow

Testosterone is the precursor hormone for Dihydrotestosterone or DHT. DHT is the androgen responsible for masculinising features including the growth of facial hair during puberty in males and menopause in women.  Men with low testosterone may complain of a lack of facial hair. Anecdotal as well as published evidence suggests some role for testosterone and facial hair growth. This is multifaceted and genetics may play a big part in hair growth as well as auto-immunity.  Some of our clients have noticed increased facial and body hair growth after starting TRT treatment. Some clients, despite having more than doubled their testosterone levels, still had some beard bald patches. These cases are usually due to the lack of hair follicles on the face and also due to a genetic predisposition regarding beard hair growth.

I have patchy facial hair and I can’t grow a beard. Does this mean I have low testosterone?
No, not necessarily. Men who can’t grow a beard or have patchy beards usually have normal testosterone levels. There is a perception that men with little facial hair do not have sufficient or may have low testosterone but this is usually not the case. Hair growth on the face and elsewhere have much to do with the distribution of the hair follicles and androgen receptors and your sensitivity to androgens.

Can TRT help build muscles?

Testosterone is the hormone responsible for the growth and maintenance of lean muscle mass. Having optimal levels of your own natural testosterone levels may help improve your ability to build muscle and lose fat more easily in comparison to being deficient in testosterone. These effects are amplified when the body produces optimal testosterone levels. Of course, those who have above-average levels of natural testosterone and combine that with lots of exercise and a good diet may find an increase in lean muscle mass. This characteristic of testosterone is also why it was investigated and used medically for some people experiencing muscle loss through illness or trauma. In recent times, testosterone as therapy is strictly controlled and is not recommended by the manufacturer of various products. The use of testosterone therapy specifically for muscle building is strictly prohibited and discouraged by the medical community and doping agencies.

 

Can TRT help with fatigue?

Fatigue is one of the main symptoms mentioned by patients who also have low levels of testosterone but fatigue can be related to other conditions as well. There are cases of non-testosterone related fatigue due to other factors, such as lack of sleep, stress, or hormone deficiencies like cortisol, and thyroid which may need to be addressed separately. A full hormone assessment can help your doctor discover which hormones may be out of balance and therefore which medication/treatment they should prescribe. We’ve heard from some patients who have self-reported an improvement in fatigue after TRT such as reporting being “able to get through their day without coming home from work and crashing on the sofa”. We cannot make the claim due to strict UK censorship laws that testosterone treatment will correct fatigue as improvements in symptoms of fatigue after starting testosterone treatment may be due to many factors some not related to testosterone deficiency. In addition, the symptoms of low testosterone and low thyroid can overlap with one another. Although should that be the case, thyroid hormones can be prescribed in addition to testosterone treatment if there is underlying or masked hypothyroidism.

Does TRT cause man boobs (gynecomastia)?

Does TRT cause man boobs
You’ve probably read about the incredible benefits of Testosterone Replacement Therapy, and are wondering about the side effects. A common concern is the risk of developing breast tissue (Gynecomastia) while on TRT.
In the male body, testosterone converts into oestrogen through a process known as aromatisation so
when testosterone levels rise, as does oestrogen. But if there’s too much oestrogen in the body, this can cause side effects, including:
  • Gynaecomastia (Man boobs)
  • Swelling / Puffiness
  • Poor erection quality
  • Moodiness and irritability
  • Water retention
  • Poor libido
  • Anxiety
  • Oestrogenic body fat deposition

This is one of many factors that needs to be monitored closely on TRT. Hormone levels will be regularly checked before and during your treatment to ensure symptoms don’t arise from too high (or too low!) Oestrogen. This way, they can often be prevented and if they do occur then quickly and effectively treated.

Should you experience breast tissue growth during TRT, don’t panic – Gynecomastia is easily managed. Balance My Hormones can facilitate sensitive estradiol tests for men to give a true indication of their estradiol level.

Can TRT improve your sex drive (libido)?

The answer is yes. People with low testosterone often see a massive improvement in libido once levels are optimised. However, It must be noted that libido is multifactorial. Testosterone is one of the hormones responsible for sex drive in both men and women. Many chemical pathways can affect desire. Having optimal testosterone is only one of many factors. There are occasions where levels of testosterone are optimised yet people still lack sex drive. In these cases, it is key to work closely with your doctor to look into other potential causes of low libido. This can be balancing of other hormones, other medical issues including effects of medication past or present, environmental issues or psychological issues/past trauma. This can be investigated and treated accordingly.

Can TRT improve libido

What blood tests are needed for TRT in the UK

The world of Testosterone Replacement Therapy is often difficult to navigate. It is filled with misinformation and bro-science on forums. You may have many of the symptoms of low testosterone, but confirmation is needed via blood tests. The type of blood test you’ll need is dependent on your unique circumstances but a testosterone blood test will usually screen for a Complete Blood Count, PSA Serum Total, and Testosterone Total & Free.

Going to your GP for a blood test is the first port of call for most men. The problem is, they often lack specialist knowledge in hormones – especially testosterone. As a result of this, they are likely to attribute low testosterone symptoms to other conditions such as depression and anxiety.

Private Testosterone Replacement Therapy in the UK

Instead of using the NHS, you can go to a private TRT clinic such as Balance My Hormones to get an assessment and blood tests for low testosterone, check out our range of TRT blood tests and what we can check for.

Our TRT blood tests can check for:

  • Serum testosterone
  • Free testosterone(calculated) as assays tend to be unreliable from lab to lab
  • Sex Hormone Binding Globulin
  • LH-Luteinising Hormone
  • FSH-Follicle Stimulation Hormone
  • Estradiol
  • Prolactin
  • Albumin
  • Cortisol

Hormones are the foundation of your health as a man, and testosterone is central to that. Creating a picture of the hormonal system with your body and how effectively it is working is the first step on the road to getting symptomatic relief.

How much does TRT cost in the UK?

We find that patients often think private TRT costs are less expensive than they initially thought. Harley street TRT clinics are usually very expensive but private clinics like Balance My Hormones are reasonably priced.

The journey of TRT starts with comprehensive blood testing prior to thorough medical consultations and examinations. If approved for TRT, blood testing must be done throughout, alongside doctor follow-ups at certain intervals to ensure you are properly monitored. This is generally at 6 months, a year, and then yearly following that. Face to face consultations and examinations are highly recommended and in most cases, they are required by the doctor to start treatment. Follow up consultation may be done via skype or remote consultation. If you live near one of our clinics we highly recommend you stop in for your annual consultation and examination when possible.

Balance My Hormones (BMH) is a clinical and healthcare service company, not just an online website selling blood tests like many others out there, we are different. Being part of BMH allows members to receive ongoing support, organisation of treatment as well as your monitoring and blood testing in an efficient and hassle-free manner.

Balance My Hormones have a very experienced team that offers you regular support to discuss any questions/anxieties you may have which often reduces the need for patients to scour forums for unhelpful and inaccurate information. We also offer unique pricing subscription packages to match your treatment plan. Our plans include all the medication required, delivery costs and personal support from our staff, doctors, and partners. This is before, during and after treatment. Personal Case Manager (PCM) support is also included throughout.

Treatment Options Price bandings
TRT treatment packages Between £99-£149
Doctor Consultation £199
Comprehensive Blood Test £155
Basic TRT test £49.95
Fertility Treatment packages From £35
Erectile Dysfunction treatment packages From £24

 

Contact the team today to discuss your potential costs for TRT treatment.

How do I get TRT in the UK with the NHS?

testosterone replacement therapy on NHS

Getting testosterone replacement therapy in the UK on the NHS is not a straightforward procedure. Despite its excellent standard of care, its centralised structure often prevents those who need treatment from getting it.

TRT UK Process with the NHS.

First, you visit your GP to explain the symptoms you’re experiencing. Depending on how sympathetic they are, they will send you off for a testosterone blood test. They will normally send you for two lab tests to confirm a diagnosis of low testosterone. Tests are typically done before 9 am when testosterone levels are at their highest. Once the GP gets the lab results back confirming you have low testosterone, they will refer you to an endocrinologist.

The endocrinologist will examine your bloodwork and depending on your results, will decide whether you are eligible for TRT. The NHS have much narrower testosterone margin criteria which unfortunately only includes men with dangerously low testosterone levels. NHS TRT treatment is usually in the form of a 4ml slow-release testosterone injection once every 4 months (which leaves you in a hypogonadal state for a third of the time), or a topical treatment that does not provide enough testosterone.

Generally speaking, the NHS standardised model of care works well for many medical conditions. Patients visit their doctor with symptoms and have tests to validate the symptoms, they are then treated accordingly. However, the NHS has serious flaws when it comes to treating a condition as nuanced as low testosterone. The need for an underfunded service to always be comparing the cost to efficacy limits this provision.

Firstly, most doctors, let alone GPs are not well informed on Testosterone Replacement Therapy. So you might end up being treated for depression with medication instead of a testosterone deficiency. Although you may have an open-minded GP who is willing to send you for further tests, if your blood tests show your total testosterone within the so-called ‘normal’ range, then in most cases you’re out of luck. This is because doctors are trained to treat for testosterone deficiency only when patients’ testosterone levels are outside the normal reference range regardless of their symptoms – even if they want to help, their hands are tied. If you do manage to get a referral to an endocrinologist, you may have to wait several months for an appointment. Furthermore, once you do get to see an endocrinologist, there is no guarantee you will get the right type of treatment.

The method of treatment tends to vary significantly between specialists. Some may prescribe testosterone gels to their patients, whereas others may ask you to inject every 2 weeks. Every one of these options either leaves you with periods of high then low testosterone or not enough from the therapy at all. The NHS will not monitor oestradiol levels, and rarely will they monitor prolactin or free testosterone levels. We have even seen men end up with lower testosterone levels ON therapy than before they started!

This entire process could take many months. Those that do receive effective testosterone treatment on the NHS are very fortunate. But there are many that fall short and end up frustrated because they cannot get treatment or effective treatment to relieve their symptoms.

Watch our TRT on the NHS YouTube Video

The Solution

There are no doubt GPs and endocrinologists in the NHS that do an excellent job. But in order to qualify for Testosterone Replacement Therapy on the NHS, patients have to jump through countless hoops as described above. It can be a painfully time-consuming process where you will either feel like just another patient or even totally disregarded altogether.

With Balance My Hormones, you won’t have to wait months to see a specialist. You can get the process started with an open mind and an experienced Hormone Replacement Therapy doctor.

You can get approval for treatment in as little as 48 hours if you have all the appropriate blood tests and forms complete. If you don’t get a diagnosis for TRT then you don’t pay the doctor’s fee and we aim to treat our clients as individuals – not just as a lab number.

What’s more, you don’t always have to go out and physically visit your doctor. You can have a remote consultation in the comfort of your own home that is flexible and fluid once a relationship with your doctor is established.

The service is concierge so you have the doctor’s email address if you have questions. Also, staff at Balance My Hormones are always on hand to assist in other aspects related to supporting you through your TRT journey. So if you think you’re suffering from the symptoms of low testosterone, get in contact with us today.

Will my GP prescribe TRT on the NHS in the UK?

In our experience, many of our clients come to us following a search for a GP and endocrinologist consultation. This can take 6-8 months and even if you have low testosterone levels, there is no guarantee you will receive treatment. This not only is disappointing for the client but it imposes a further 6-8 months of low testosterone symptoms. We have heard from clients who had gone to the NHS and were refused treatment despite them having total levels of testosterone as low as 6 nmol/L.

If attempting the NHS route you would have to find an open-minded GP that is willing to treat you. For this, you would need two blood tests that show levels under the NHS threshold for treatment. Even if this happens your treatment options will likely be a 4ml large injection every 12 weeks (NEBIDO) or a low strength Gel (ANDROGEL or similar alternative). Neither of these options show great efficacy in practice, they cause fluctuations in levels or don’t provide enough testosterone at all. In rare cases, we have heard that Sustanon has been used but only dosing every 2-4 weeks. Despite the treatment you get, the NHS will not monitor Oestradiol (oestrogen) levels and rarely will they monitor prolactin or free testosterone levels.

Should TRT be offered on the NHS?

A YouGov survey asked respondents if libido enhancing treatments like testosterone should be offered on the NHS. 53% said it should be offered for both men and women. Only 35% said it shouldn’t. There is still a long way to go before testosterone is seen as more than a lifestyle/cosmetic treatment in the UK. It’s encouraging to see that the majority who had agreed to having the NHS offer hormone treatments had the view that both men and women should have the option. You don’t have to wait for the NHS to offer Testosterone for both men and women, Private clinics such as Balance My Hormones are experienced in Hormone Therapy for both sexes.
TRT UK Statistics

Do I have to be on TRT for life?

Ultimately, Testosterone Replacement Therapy is a lifelong commitment. We are restoring your testosterone levels back to optimal range so stopping treatment is likely to cause a drop in testosterone and therefore experience low-t symptoms once again.

There are Testosterone boosting protocols other than TRT but stopping these therapies does not often sustain the increase in levels achieved. We understand you may be worried about having to take a hormone for life to allow symptomatic relief and bring about health benefits but we find low-t patients have a much better quality of life on TRT than not.

Another common question is if your body can start making testosterone again on its own after discontinuing treatment. In nearly all cases and from the literature the answer is yes. It takes time with the median being 3.5 months but we have seen that within a few weeks those that stop can recover to at least the baseline from where they started. It must be noted that the baseline was insufficient and was causing symptoms, however.

A common and antiquated opinion is that cycling testosterone is beneficial but there is no benefit to going on and off testosterone. It just causes periods of hormonal deprivation, disrupts homeostasis and caused Hypogonadal symptoms to come back.

What happens if I stop TRT? What happens if I need to come off TRT?

If Testosterone Replacement Therapy relieves your symptoms of low testosterone, then often stopping treatment will cause symptoms to recur. It is for this reason that TRT is usually a lifelong commitment. This may sound daunting, but once you feel the symptomatic relief and benefits of Testosterone Therapy, stopping treatment often becomes less of a concern.

Should you need to stop TRT there are ways to assist the body in producing its own levels of testosterone faster than just stopping TRT alone. In some studies, the median time for recovery of sperm is around 3.5 months. Testosterone production can return in some individuals in as little as 3-6 weeks. Factors affecting how quickly your testosterone will return depends on the original strength or signal from the pituitary gland (Leutinising  Hormone and Follicle Stimulating Hormone), and how sensitive or efficient your Leydig cells (testosterone producing factories) located in your balls(testes) are.

In our experience, this can occur quite quickly. It must be noted that if you are starting from a low baseline before beginning TRT restoration back to this lower level is likely all you will achieve.

What if I can no longer afford TRT treatment?

You are under no obligation to continue treatment. It is a private service and therefore a personal choice. However, in the grand scheme of things our treatment packages are affordable and priced around your budget and medical advice from our GMC registered doctors. Please contact us and we can work with you and the doctor to find a package that is right for you.

What is the best type of testosterone replacement therapy in the UK?

The best type of testosterone replacement therapy is very much dependent on the individual. Based on your bloodwork, symptoms, and your preferences, our specialised doctors will figure out which treatment is best for you.

Some prefer injections, some prefer topical formulations. The doctor can determine administration dose and frequency depending on blood tests, age, medical history etc. The type of treatment needed is specific to you and a careful process is undertaken to find out which treatment that may be.

Injectable Testosterone Preparations

  • Sustanon®(Aspen), testosterone propionate 30 mg, testosterone phenylpropionate 60 mg, testosterone isocaproate 60 mg, and testosterone decanoate 100 mg/mL. If you are allergic to peanuts or benzyl alcohol then this preparation would not be for you.
  • Testosterone Enanthate or Testosterone enanthate(Non-proprietary), testosterone enanthate 250 mg/mL dosed 250mg every 10-14 days- this is a more expensive option as there are limited manufacturers in the UK. If you are allergic to castor oil, or benzyl benzoate then this would not be for you.
  • Testosterone Propionate 100mg/2ml 2-mL amp Short-Acting Testosterone ester dosed 2-3 times weekly
    Topical Testosterone Options

Bespoke bio-identical topical testosterone for HRT and TRT

  • Bespoke testosterone lozenges are made in the right formulation for women and can be combined with bio-identical oestrogens and progesterone.
  • Bespoke high concentration cream prepared by a compounding pharmacy
  • Branded Testosterone Creams and Gels (often least effective)

How do I administer TRT and do I have to inject on TRT?

UK TRT treatment methods vary, and there are several ways to administer Testosterone Replacement Therapy. However, the most commonly prescribed methods are testosterone injections, gels, and creams.
Before undergoing TRT, it’s important to understand the main distinction between these methods. You should also understand the pros and cons of each, so you can make an informed decision on your treatment.

Transdermal Testosterone Gels and Creams

UK Gels and creams are the of the most favoured methods of Testosterone Replacement Therapy for those unable or unwilling to inject themselves. Many doctors swear by its efficacy to raise low testosterone. The reason they’re so popular is that they’re simple to use. They are usually applied to the skin in the morning and the evening before bed for best results. Typical areas of application include; the shoulders, upper arms and scrotum. Gels and creams tend to come in varying concentrations.

PROS

  • They are easy to use and apply
  • Pain-free
  • Absorption through the skin causes testosterone levels to fluctuate, thereby closely mimicking the body’s own production

CONS

  • Absorption through the skin may be inefficient, due to sweat, food consumption, etc
  • May produce oily skin due to elevation of DHT and cause estrogenic side effects
  • Unable to wash, swim or engage in vigorous exercise for hours after application
  • Possible transfer risk to others

testosterone replacement therapy in the UK gels

Intramuscular Testosterone Injections

Testosterone injections are another form of commonly prescribed TRT treatment. It has been considered the standard of care. Treatment efficacy is dependent on the type of testosterone preparation used, e.g. Sustanon, Enanthate, Propionate and administration frequency.

Testosterone can be injected one of two ways; subcutaneously (subQ) – i.e. through fat, or intramuscularly (IM). Doctors prescribe testosterone injections because of their predictability and titratable nature. This allows stability of blood testosterone levels.

testosterone replacement therapy injections

PROS

  • Injections allow testosterone to effectively reach the bloodstream, minimising loss of T through absorption that may happen with topical testosterone preparations.
  • Helps to maintain stable levels of testosterone, avoiding so-called ‘peaks and valleys’ and is easily adjusted
  • Doesn’t prohibit you from engaging in other activities

CONS

  • Requires training to practice correct injection technique
  • Takes practice before being confident filling testosterone into a syringe and self-injecting
  • Using needles is daunting for some, and they must be disposed of properly

Final Thoughts

There is no right or wrong choice. Both injections and some topical formulations can be effective methods of treatment for low testosterone. The question is, which one is right for you? Ultimately it depends on your individual circumstances. Using a topical formulation would be the easiest route for administering Testosterone Replacement Therapy if you are not able to comfortably inject. They’re easy to apply with minimal hassle. But if you are someone who leads an active lifestyle then they may not be for you. Sweating interferes with the absorption of the testosterone if you’ve recently applied it, requiring reapplication. Similarly, the topical formulation such as a cream or gel can be transferred to another person if there is skin-to-skin contact with where it was applied. This is often why scrotal application can be beneficial.

Remember, any decision on treatment should always be taken under the supervision of a qualified doctor. If you want to book an appointment with a doctor to discuss testosterone treatment options, then get in contact with us.

Are there famous people or celebrities on TRT and hormone therapy?

Yes, we have made a blog post listing famous people on TRT.

Is TRT the same as anabolic steroids?

Testosterone Replacement Therapy is medically restoring and optimising testosterone levels using bio-identical testosterone. The treatment aims to reduce the symptoms of low testosterone so you can feel your best. Options include testosterone injections, testosterone creams or testosterone gels, testosterone lozenges or testosterone pellets. These all contain testosterone and are utilised in a way that releases optimal amounts of the hormone in a steady and stable manner. Anabolic Steroids were developed for medical use. They were made by altering the structure of hormones, like testosterone to make them more anabolic and often less androgenic. Alongside testosterone, these were used to maintain muscle mass and function in cases of people suffering from disease, illness, or trauma that causes muscle wasting.

The testosterone molecule is the base model that Anabolic Steroids are built from.

Testosterone is anabolic and androgenic and is a naturally occurring compound found in the body. in addition, testosterone metabolises into DHT (dihydrotestosterone) and Oestrogen (oestrogen) which the body also utilises. As mentioned anabolic steroids are modified synthetic versions of testosterone that have similar structures but are not quite the same. They differ from testosterone in anabolic and androgenic effects. Androgen hormones bind to the androgen receptor. This begins a cascade of effects on the body. Like testosterone, anabolic steroids can fit into androgen receptors and activate them as testosterone can. Once bound they exert differing effects. Anabolic steroids vary in level of activity at the androgen receptor. Their effects are androgenic and anabolic at different ratios. Alongside this, Anabolic Steroids have different metabolites that also can cause other effects on the body. Some anabolic steroids improve nitrogen retention rapidly, leading to enhanced lean body mass. This can be at a greater degree than natural testosterone. They do not exert the same effects on the body that testosterone does so cannot be a substitute. They can also suppress the body’s natural testosterone levels causing impotence.
Testosterone Replacement Therapy UK

Anabolic steroids are sometimes used in TRT but can also be used to treat other medical conditions such as anaemia. Having said that, long term use of only anabolic steroids may not always be ideal and is normally not recognised as the standard of care for TRT as a monotherapy.

 

How can I stop high oestrogen on TRT?

Please check out our useful blog post on high estrogen in men

How is HCG used with TRT?

HCG can be used in many ways to enhance TRT. HCG is important as it mimics the signal to your testes (from the pituitary gland) that stimulates Testosterone and Sperm. It is used alongside TRT to help maintain fertility and prevent testicular atrophy.

HCG allows steroidogenesis to occur where hormones are made from cholesterol in the testes. It allows intra-testicular testosterone (testosterone that is produced in your testes locally) to be produced. This can be reduced with TRT alone. High intra-testicular testosterone is needed to maintain fertility. Studies show when 500IU of HCG is used 2-3 times per week along with exogenous testosterone in males, fertility can be maintained.

In some cases, HCG can be used at higher doses as a mono-therapy starting at 500IU every other day and, in rarer cases, as high as 3000IU every other day.

How quickly does TRT work?

Some notice a slight difference after the first injection or application and for others, it may take a little longer. Usually, increased energy is the first to be noticed, but others have mentioned noticing increased morning erections, improvements in mood, and lifting of brain fog.

Female clients have reported feeling more energised and an increase in sex drive. It’s very individual and making sure your hormones are balanced plays a big part in how quickly TRT will work for you.

What changes will I expect on TRT?

Some people experience an increase in mood, energy, erections, sex drive, muscle growth, facial hair growth, and body hair growth. Side effects may include mild acne and some scalp hair loss. Generally speaking. the majority of people see a massive improvement in symptoms associated with low testosterone.

What happens if TRT doesn’t help/work?

It is important to get blood tests regularly whilst on TRT. Frequent blood testing helps the doctor identify why your treatment may not be providing symptomatic relief. In some cases, the doctor may alter your dose, dose frequency, or add in ancillary medications to manage other hormone imbalances.

Can I cycle TRT?

TRT works best when it is used continuously. Cycling has connotations with illicit anabolic steroids in bodybuilding and really doesn’t have a place in TRT. Steady stable levels in the optimal range provide the best therapeutic benefits. The ups and downs of cycling may cause harm or frustrate the balance that has been created.

Can I take TRT with other medications?

There are very few contraindications and reactions with TRT and other medications. Our doctors will review your case and determine if any medications you are on will conflict with your existing medications.

Benefits of TRT
low testosterone and depression

Will TRT help with depression?

We believe so, check out our blog post on the link between low testosterone and depression.

TRT reduces depressive symptoms, according to data coming from small-sized, placebo-controlled RCTs of patients with pretreatment clinical mild depression.
National Library of Medicine

Will TRT help anxiety?

Anxiety is often multifactorial but low testosterone has been found to bring on anxiety in those who’re predisposed to the condition. If low testosterone has worsened anxiety then optimising your testosterone levels can improve these symptoms. If there are other contributing factors these can also be investigated and treated accordingly, for example, through therapy and counselling in conjunction with TRT.

BMH clients who experienced anxiety before starting TRT have noticed improvements in their symptoms.

Can I have TRT with antidepressants?

Some anti-depressants can raise levels of prolactin. Hyperprolactinaemia (high prolactin) can cause testosterone deficiency. If you are taking anti-depressants or other medications alike, then your TRT doctor will make sure it is suitable to begin TRT alongside these. Many of our clients have worked with their GP and our TRT doctors to wean themselves off anti-depressants as low testosterone symptoms improve. Ideally, you should not need anti-depressants when on TRT but for some it is preferable. Be sure to consult with your GP or original anti-depressant prescribing doctor, and your Balance My Hormones doctor to find the best TRT route for you.

One type of anti-depressant that has reported very few sexual side effects or raises in prolactin is Bupropion. It is not offered widely in the UK and is also known as the smoking cessation drug ZYBAN. This medication may be beneficial in increasing dopamine and improving mood and may even help you quit smoking. This particular anti-depressant is routinely prescribed as an adjunct to offset the negative sexual side effects whilst on an SSRI anti-depressant.

A 2018 study looked at low circulating testosterone and the association with dementia. The study looked at over 4000 older men who did not have dementia between 71 to 88 years of age. They found that men in the lowest quartiles of calculated free testosterone had an increased risk of developing dementia compared to those in the higher quartile. This study shows an association and further studies may help determine if testosterone treatment can help ameliorate or prevent the risk of dementia in older men with low testosterone.

Can TRT help with ED (erectile dysfunction)?

TRT can help with ED especially when low testosterone is the cause of erectile dysfunction. Some patients are refractory to PDE-5 inhibitors when they have low testosterone. When the testosterone level is optimised PDE-5 inhibitors work even better. The longer you have suffered from low testosterone the longer it may take to reverse the changes caused by chronically low levels. Low testosterone over prolonged periods of time can cause tissue remodelling of the corpus cavernosum (penile shaft). The shaft consists of spongy smooth muscle tissue which can be replaced by collagen if damaged or exposed to a low testosterone environment. The corpus cavernous structure allows for rigidity in the erect penis by relaxing and engorging with blood. If collagen is present then the engorgement doesn’t happen.

**Please note the information on this page is not intended to promote prescription-only medications. We are not providing medical advice and are not a provider of medical care nor do we make any claims. The information on this page is not meant to be a substitute for medical advice provided by your healthcare practitioner. Please consult with your doctor should you have any questions or contact us to arrange a proper consultation with an independent doctor provider. The information on this page may not necessarily reflect the views of all doctors in our network. **

Evidence-Based Research

This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.

References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.

Our team of healthcare experts and GMC registered doctors are licensed to UK GMC standards. We strive to provide you with the latest evidence based, researched articles that are unbiased, honest and provide you with accurate insights, statistics and helpful information on the discussed topic to ensure you gain a better understanding of the subject.

We value your feedback on our articles, if you have a well-researched paper you would like to share with us please contact us.

About the Author: Mike Kocsis

Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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Last update: April 29th, 2022

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Sources, Scientific References / Resources / Further Reading / Studies on TRT

The below links are scientific references, resources to perform further analysis and reading along with studies that have been conducted:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897047/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701485/
https://www.clinicaltrials.gov/ct2/show/NCT03518034
https://www.fda.gov/media/123591/download
https://wjmh.org/DOIx.php?id=10.5534/wjmh.190166
https://uroweb.org/wp-content/uploads/EAU-Guidelines-Male-Hypogonadism-2016-1.pdf