What is TRT (testosterone replacement therapy)?
Testosterone Replacement Therapy is the medical treatment of a patient that provides restoration of testosterone levels back to a optimal physiological range. It is used to treat symptoms that arise from having insufficient levels of testosterone in the body. It involves providing the body with bioidentical (the same as the body normally produces) testosterone to provide an increase in levels and provide relief of these symptoms. The way in which this is done is personal and unique needs to be monitored to ensure hormones associated with testosterone are also balanced (such as Oestrogen).
How to get TRT?
If you think you need TRT and have had the necessary testosterone blood tests and spoken to your GP then the next step is to seek out treatment. Before you get TRT treatment it’s important to consider the risks and potential side effects of TRT as well as all the benefits of TRT which you can read about in this article.
There are two main ways to get TRT treatment in the UK, these are:
Is TRT always necessary/needed?
Testosterone replacement therapy (TRT) is NOT ALWAYS needed. Occasionally there are ways to boost border line testosterone levels without actually shutting down the pituitary axis. Younger patients can be assessed for testosterone boosting protocols prior to full TRT.
During investigation by your doctor, 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 improve testosterone levels, prior to considering full TRT as not everyone is a candidate.
If you are suitable for TRT then recipients often notice fast, dramatic positive improvements in symptoms and quality of life.
What symtoms of low testosterone may get resolved with TRT?
Low T Symptoms in Men and Women:
- increased body fat
- decreased muscle mass
- brain fog
- loss of height
- loss of confidence
- sleep disturbances
- inability to stay asleep
- sleep apnea
- Low sex drive (libido)
- Difficulty concentrating
Low T symptoms in Men:
- lack of morning erections
- lack of energy
- Weak Erections
- inability to maintain an erection
- frequent urnination at night
- Erectile dysfunction.
- Body and facial hair loss.
- Pelvic floor pain
- How does the body produce testosterone?
When a testosterone (temperature) drop is detected by the hypothalamus/pituitary (thermostat) a signal (LH/FSH from pituitary) goes out to tell the testicle/testes/balls (heater) to switch back on and produce testosterone (heat).Once the testosterone (temperature) climbs back up to the required/set temperature it is detected and the signal that caused the increase to begin with drops/switches off. This continuously happens in the body, much like heating in a house, to keep levels of testosterone relatively stable.
The LH/FSH (Gonadatrophin 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 feed back loop which 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 be taking control of your insufficient production of testosterone and optimising it. The naturally regulated process will still occur but to a lesser degree. You and your doctor determine how much, how often and how much testosterone your body receives. Age related Andropause or adult hypogonadism blunts your natural hormone production and this is treated with balanced TRT with or without HCG.
What are the benefits of TRT?
- Less fat build up and lean muscle production
- Increase muscle mass
- Clarity of mind
- Increased confidence
- Better sleep
- Less chance of getting diabetes
- Higher libido (sex drive)
- Less fatigue
- Higher degree of focus
- Less chance of mental health issues
- Stronger erections (for men)
- Strengthened hair and more facial hair
Does TRT increase risk of heart attack/stroke?
There are mixed studies on the risks and benefits of testosterone treatment and the effects on the heart. There is a passionate debate amongst practioners and researchers alike around the use of testosterone in ageing men and women. With the studies published there may be bias either for or against testosteroen treatment. There have been studies showing a link between heart attack and stroke and there have been studies showing that Testosterone treatment may reduce the incidence of heart attacks or stroke. 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 putting testosterone 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 evidence or inconclusive evidence to link testosterone to heart issues in order to scare the public or misinform them.
In the past there were some researchers making claims that Testosterone was linked to heart disease. Some argued that since women lived longer than men and women had less testosterone then somehow testosterone was to blame. It was false logic and not backed by any solid evidence. What we do know from recent studies is the link between low levels of Testosterone levels in men and a link to a greater risk of cardiovascular disease.
- Low Testosterone shown to be associated with an increased risk of all cause mortality independent of numerous risk factors.
- Serum tetosterone 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 aging 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: TheHealth 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 may cause frequent urination which can be disruptive.A hormonal imbalance is often the cause. In the past it was easy to blame testosterone but it’s more likely to be the metabolite of Testosterone, Oestradiol, 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 in has also been proven to reduce the symptoms of BPH and acts as a mild aromatase inhibitor.
Will TRT cause hair loss?
Testosterone therapy on it’s own may not be the main cause of hair loss but once your Testosterone levels are corrected to the correct levels for a man of your age, then you may be susceptible to male pattern baldness as is any other man.Hair loss is not caused by testosterone or DHT (produced from testosterone) alone. Your genetics determine whether you will lose your hair. If you have the genes for hair loss you will lose your hair regardless. Having optimal levels of testosterone and DHT will allow you to optimally express those genes you already have and you will lose hair at an optimal rate. In the same way that if you have the genes for hair loss and you were to remove your testosterone and DHT this may slow the process, emphasis being slow (as your genes sill cause you to lose your hair anyway). Doing this however would obviously cause awful symptoms of a low androgen state and cause negative health effects.
If hair loss is a worry for you then it is really a choice you have to make and balance the benefits versus the risks of TRT. In our experience clients that had initial worries pre TRT, once they feel the therapeutic benefit of testosterone, fell less worried about this issue once on therapy. There may be options to lessen the affects of hair loss if you are prone to it. The doctor can discuss this with you should you have concerns. These can include other medications. Others may opt for hair transplantation products such as (Regain®)monoxidil.
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 some unwanted side effects. These can be an increase 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 and possible infection at the injection site.
If extra fluid in the body occurs as this can cause problems for patients with pre-existing heart, kidney, or liver disease.
There may be sleep disturbances, slight insomnia or an undiagnosed sleep apnea may become apparent/exacerbated. Sleep apnea is more likely to occur with patients who have lung disease or are overweight.
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, which will be monitored with periodic blood tests. It is important whilst on TRT to have periodic blood tests to monitor various blood levels for hormones 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 ejaculate volume and reduce sperm count, possibly affecting fertility especially if HCG, HMG or exogenous gonadotropins is not used concomitantly. Whilst rare there may be an increased chance of hair loss or thinning especially if one is genetically predisposed to this.
Are there alternatives to TRT?
There are alternatives to TRT. Without trying to sound smart, the first option is to do nothing and wait to see if things improve. Some attempt to adjust lifestyle factors such as diet and exercise. We often find however that if your body is not producing effective levels of testosterone then doing these things is often 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 a therapy that may boost your own levels if effective. This can be the use of a SERM or HCG alone to try and improve responsiveness of the testicles. This option sometimes works in younger men but often therapeutically it lacks effectiveness. The third is the possibility of being treated to change your SHBH which is 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 contact us and book in a call.
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 with in the balls/testes) are 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 of 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 restore/maintain sperm count. This is why our Doctors at Balance my hormones provide HCG alongside a balanced TRT protocol to maintain fertility whilst optimising testosterone and other hormones.
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 essentially 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 and thereby having an anti ageing effect.
Can TRT help grow my facial hair?
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 lack of facial hair. Anecdotal as well as published evidence suggests some role for testosterone and facial hair growth. This is multifacetd 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. For some clients despite having more than doubled their Testosterone levels from baseline and after more than a year still had some patchiness or areas of no hair on their face. These cases are usually due to the lack of hair follicles in the area of the face and also due to a genetic predisposition of not having thick beard hair growth.
I have a 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 elswhere have much to do wiht the sensitivity and distribution of the hair follicle and androgen receptor and its sensitivity to androgens.
Can TRT help build muscles?
Testosterone is the hormone responsible for 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 are gifted with above average levels of natural testosteorne and combine that with an effective exercise programme and diet may find 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 because of the potential for abuse testosterone as a therapy is strictly controlled and is not reccomended by the manufacturer of various products. The use of testosterone therapy for muscle building is strictly prohibited and discouraged by the medical community and doping agencies.
Whilst testosterone and it’s anabolic cousins have been used medically for cacachia or muscle wasting in the past, or severe burns, the general trend has been to prescribe this in only the most rare cases for this use which would be an unlicenced use for testosterone.
Can TRT help with fatigue?
Fatigue is one of the symptoms mentioned by patients who also have suboptimal levels of testosteorne. Fatigue can be related to many other conditions besised low testosterone. A full hormone panel can help your doctor discover which hormones may be out of balance. There are anecdotal cases of Testosterone treatment improving or helping improve symptoms related to fatigue but the doctor will need to get to the source of what is causing fatigue. 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. We’ve heard from some patients who have self reported impovments in their fatigue symptoms after TRT. Some have reported 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 improvments 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 may overlap with one another and thyroid hormones may be prescribed in addition to testosterone treatment if there is an underlying or masked hypothyroidism.
Does TRT cause man boobs (gyno)(gynocomastia)?
In the male body, testosterone converts into oestrogen through a process known as aromatisation.
And when testosterone rises, so does oestrogen. But if there’s too much oestrogen in the body, this can cause nasty side effects, including:
- Gynaecomastia (Man boobs)
- Swelling / Puffiness
- Poor erection quality
- Moodiness and irritability
- Water retention
- Poor libido
- Oestrogenic body fat deposition
This is one of many factors that needs to be monitored closely on TRT. Levels will be checked before and during TRT regularly 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.
These side effects can usually be managed quite easily if they come up. Balance My Hormones can facilitate sensitive estradiol tests for men to give a true indication of your estradiol level.
Can TRT improve interest in sex (libido)?
The answer is yes. People with low testosterone often see a massive improvement in libido once levels are optimised. It must be noted however 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 have lack sex drive. In these cases it is key to work closely with the doctor to look at other causes.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.
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. When undertaking this next step you must be tested for the right things. Testing for testosterone alone will not tell the full story the reason being your body is complex and hormones don’t work in isolation.
Going to your NHS doctor 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.
Often they dismiss your symptoms out of hand – because you ‘don’t need to worry’ about testosterone and if you do manage to get a test through the NHS, they usually don’t test for the right things anyway.
So what’s the alternative?
Comprehensive blood tests are available, 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
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?
TRT can cost anywhere from your time and excess prescription fee from the NHS or thousands of pounds at private insurance based clinics.
Balance My Hormones offers sustainable support packages that focus on support through the process. Our introduced Doctors and experienced medical case manager team act as patient to patient advocates, and a support structure whilst you are going through your journey of TRT.
Contact the team today to discuss potential costs.
How do I get TRT in the UK with the NHS?
Because of its centralised structure, it is usually shacked and inflexible when trying to treat patients for low testosterone.
First you should to visit your GP to explain your symptoms you’re experiencing. Depending 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 9am, which in theory is when testosterone is at its highest.
Once the GP gets the lab results back confirming you have low testosterone, they will refer you to an endocrinologist.
The endocrinologist upon examination and review of your labs that must fall with in a narrow unforgiving reference range of under 6 nmol/L in some cases may then reluctantly prescribe you TRT treatment 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. topical 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 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 open-minded GP who is willing 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 endocrinologists, 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 (help!) or a massive injection every 12. 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.
For those that do receive effective testosterone treatment on the NHS are very fortunate. But there are many that fall foul of the standard care model and end up frustrated because they cannot get treatment or get a treatment that causes them to feel worse than before.
There are no doubt GPs and endocrinologists in the NHS who 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 painful time-consuming process where you will either feel like you have been fobbed off or if you are extremely lucky and find a doctor that knows how to provide TRT effectively then it can feel like hitting the lottery.
Using the Balance My Hormones as your support and introductory service you won’t have to wait months to see a specialist. You can get the process started with an open-minded and 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 an open minded GP that had then referred then to a consultant endocrinologist. This usually takes 6-8 months. After having seen the consultant and having further tests which may show levels above the NHS threshold for treatment they are often simply fobbed off and told there is nothing wrong and treatment is withheld. This not only is disappointing for the client but it exposes them to s 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. So even if you get one of these options 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 ?
How to get TRT?
There are private doctors who may be willing to prescribe TRT. Some can be found on Harley Street or in a few towns and cities throughout the UK. It can be a bit of trial and error trying to find the doctor with the right understanding of modern TRT.Balance My Hormones was founded to take the guesswork out of the equation and allow finding an effective TRT/HRT doctor easy. Many doctors may only deal with a part of TRT and be unable or unwilling to help you when you have unwanted side effects. Our associated doctors are experienced and together we have help hundreds of patients to date.
Balance My Hormones is a unique service which combines an online platform with full support level of service for clients looking for assistance with accessing TRT in the UK and Europe.
Balance My Hormones is under the supervision of independent medical doctors, and pharmacists and as such provide administrative and logistical support in a seamless way as a conduit between the patient our clients and the private independent doctors, pharmacies and laboratories. Balance My Hormones brokers and provides adult safeguarding and patient to patient advocacy support whilst creating an open environment to discuss personal experiences and the collective experience of others on TRT so as one who is new to TRT , you don’t have to feel that you are going through the process by your self.
Many times with traditional doctor practice set ups there just is not the support capacity. The balance my hormones team is there to provide this support and coordination and reassurance. We offer support to both clients who are our doctors patients and health care providers. Balance My Hormones does not act as the provider of care nor do they diagnose or treat medical conditions.
Our clients are at all times are diagnosed, treated, and monitored by their assigned doctor and the use of our medical case managers to assist our doctors in the logistical and administrative tasks. Our medical case managers are either have personal experience or formal training in hormone therapy and some have previous health care experience with the NHS, or in private healthcare and they may have been patients on hormone therapy as well. Having this background can offer a unique insight that you will not find anywhere else in the UK and Europe. TRT Medical Case Managers will help you complete your patient intake forms and help get you efficiently to blood testing services and then introduce your to your doctor and coordinate with the pharmacy.
All of the logistical parts are handled by our staff so you don’t have to collect at the pharmacy. You can get the process started by contacting us and filling out a confidential online form.
Do I have to be on TRT for life?
This is a common question/concern. In this situation the question that must be asked is what the alternative is. The options being to continue as you are with sub-optimal or dangerously low levels of testosterone for life with all the symptoms it causes or would you like medical treatment to optimise these levels and bring symptomatic relief.
There are Testosterone boosting protocols other than TRT but stopping these therapies does not often sustain the increase in levels achieved. You may be worried about the perceived dependence of having to take a hormone for life to allow symptomatic relief and bring about health benefits but if it allows all these things it must be considered against the alternative.
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 from experience 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 for 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 ceasing 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 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 sustainable and priced around your budget and medical advice from the introduced doctor. 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 TRT in the UK and Europe?
The best type of TRT depends on what is best for you the client as determined by symptoms and blood testing and discussions with the medical facilitators and doctors.
Some prefer injections, some prefer topical formulations. The doctor can determine administration dose and frequency depending on blood tests, age, medical history etc. It is highly individualistic the type of treatment that may be needed and a careful process must be undertaken to find what is best for you.
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 Enantate or Testosterone enanthate(Non-proprietary) , testosterone enantate 250 mg/mL dosed 250mg every 10-14 days- this is a more expensive option as there are limited manufactures 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-dentical topical testosterone for HRT and TRT
- Bespoke testosterone lozenges made in the right formulation for women and can be combined with bio-identical oestrogen’s 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?
There are several ways to administer Testosterone Replacement Therapy. However, the most commonly prescribed methods are testosterone injections testosterone gels and testosterone 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
Gels and creams are the one 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 because 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 various concentrations.
- They are easy to use and apply
- Absorption through the skin cause testosterone levels to fluctuate, thereby closely mimicking the body’s own production
- 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
Intramuscular testosterone Injections
Testosterone injections are another form of commonly prescribed TRT treatment. It has been considered the standard of care. Treatment efficacy is dependant on the type 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.
- 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
- 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
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 contact with skin 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 restoration and optimisation of testosterone levels using bio-identical testosterone. The treatment aims to reduce the symptoms of low testosterone and to actually feel the absolute best you can. Options include testosterone injections, testosterone creams or testosterone gels, testosterone lozenges or testosterone pellets. These all contain testosterone and need to be 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 with disease or episodes of illness or trauma that caused muscle wasting.
The testosterone molecule is the base model that Anabolic Steroids are built from.
As mentioned anabolic steroids are modified synthetic versions of testosterone that have similar structures but are not quite the same. They differ to 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 receptor and activate it like testosterone can. Once bound the 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 in 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 also will suppress the body’s natural testosterone levels causing impotence.
Anabolic steroids are used medically and in some cases as an adjunct to TRT. Nelson Vergel. mentions this in his book- Built to Survive where Anabolic Steroids were used with testosterone to maintain muscle mass in wasting diseases like HIV.
The base of TRT treatment is testosterone and 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 (estrogen) 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 going to your testes, from the pituitary, that stimulates Testosterone and Sperm. It is used alongside TRT to help maintain fertility and prevent testicular atrophy.
If responsive it 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 energy is the first to come back, but others have mentioned noticing increased morning erections, improvements in mood, and lifting of brain fog.
Female client have reported feeling more assertive and increased 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 increase in mood, energy, erections, sex drive, muscle growth, facial hair growth, body hair growth. Side effects may include mild acne, and some scalp hair loss. It’s all very individual. The majority of people see a massive improvements 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 therapuetic benefits. 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.
Will TRT help with depression?
We believe so, check out our blog post on the link between low testosterone and depression.
Will TRT help anxiety?
Low testosterone can cause anxiety. Anxiety is multifactorial. Contrary to popular belief anxiety also extremely common. If low testosterone has worsened anxiety then optimising can improve these symptoms. If there are other contributing factors these can also be investigated and treated accordingly examples being talking therapy and counselling in conjunction with TRT, other hormone imbalances or medical issues Some studies have shown men with general anxiety disorder have had improvements with the use of 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 be a cause of testosterone deficiency. If taking an anti-depressant, or other medications for that matter, then your TRT doctor will ensure it is suitable to begin TRT alongside these. Many of our clients have worked with their GP and our TRT doctor to wean off the anti-depressants as symptoms improve. Ideally you should not need to have an anti-depressant when on TRT but for some it is preferable, but be sure to consult with your GP or original anti-depressant prescribing doctor, and your Balance My Hormones facilitated doctor to find synergy for you.
One type of anti-depressant or note, should you need it, 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 and adjunct outside the UK 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. Previous studies were inconsistent. A prospective study was done looking 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 with 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 cavernosim (penile shaft). The shaft consist of spongy smooth muscle tissue which can be replaced by collagen if damaged or are 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. We are also working with The Rocket a prioneering new treatment for ED.