Is TRT Right for You? A Patient's Guide to Testosterone Replacement Therapy
What Is Testosterone and Why Does It Matter?
Testosterone is the primary male sex hormone, though it's also present in smaller amounts in women. In men, it plays a vital role in:
- Maintaining sex drive (libido)
- Producing sperm
- Building and maintaining muscle mass and bone density
- Regulating mood and energy levels
- Distributing body fat
- Producing red blood cells
Signs and Symptoms of Low Testosterone
Low testosterone can manifest in a range of physical and psychological symptoms. You might experience:
Physical symptoms:- Reduced sex drive (low libido)
- Erectile dysfunction
- Fatigue and low energy, even with adequate sleep
- Loss of muscle mass and strength
- Increased body fat, particularly around the abdomen
- Reduced bone density (potentially leading to osteoporosis)
- Hair loss (body and facial hair)
- Hot flushes or sweats (similar to menopause in women)
- Low mood or depression
- Irritability or mood swings
- Difficulty concentrating or "brain fog"
- Loss of motivation
- Reduced sense of wellbeing
How Is Low Testosterone Diagnosed?
Diagnosis requires a blood test measuring your testosterone level. Because testosterone levels fluctuate throughout the day (they're highest in the morning), tests should ideally be taken between 7am and 10am.
Two separate morning blood tests on different days are typically required to confirm low testosterone, as a single reading may not be accurate.What Do the Numbers Mean?
The normal testosterone range for adult men is generally considered to be 8–30 nmol/L (nanomoles per litre), though labs may use slightly different reference ranges.
- Below 8 nmol/L: Clearly low (hypogonadism)
- 8–12 nmol/L: Borderline — symptoms and clinical picture are crucial
- Above 12 nmol/L: Usually normal (though symptomatic men in this range may still benefit from further investigation)
- LH (luteinising hormone) and FSH (follicle-stimulating hormone) — to identify whether the problem originates in the testes or the brain (primary vs secondary hypogonadism)
- SHBG (sex hormone-binding globulin) — to calculate free testosterone (the biologically active fraction)
- Haematocrit / full blood count — important before starting TRT
- PSA (prostate-specific antigen) — important screening, especially in older men
- Prolactin — elevated levels can suppress testosterone
Treatment Options
There are several effective forms of TRT available in the UK:
1. Testosterone Gel (e.g., Testogel, Tostran)
- Applied daily to the skin (shoulders, abdomen)
- Provides stable testosterone levels
- Easy to use, absorbed through skin
- Advantage: No needles; easy to adjust dose
- Consideration: Risk of transference to partners/children — wash hands and allow to dry before skin contact
2. Testosterone Injections
- Short-acting (e.g., Sustanon 250): Injected every 2–3 weeks
- Long-acting (e.g., Nebido / Testosterone Undecanoate): Injected every 10–14 weeks
- Advantage: No daily applications; very effective
- Consideration: Level "peaks and troughs" with short-acting injections can cause mood fluctuations
3. Testosterone Patches (e.g., Testopatch)
- Applied to skin daily
- Less commonly used in the UK now
4. Testosterone Pellets (SubQ implants)
- Small pellets implanted under the skin — lasts 3–6 months
- Not widely available in the UK currently
What to Expect From TRT
Effects on different symptoms vary in how quickly they appear:
| Effect | Typical Timeframe |
|---|---|
| Improved energy and mood | 3–6 weeks |
| Increased libido | 3–6 weeks |
| Improved erectile function | 3–6 months |
| Increased muscle mass | 3–6 months |
| Reduced fat mass | 3–6 months |
| Improved bone density | 12–24 months |
Risks and Side Effects
TRT is generally safe when properly monitored, but there are important risks to understand:
Common side effects:- Acne or oily skin
- Swelling or tenderness at injection sites
- Hair thinning (if genetically predisposed)
- Increased red blood cell count (polycythaemia) — can increase blood viscosity
- Testicular shrinkage (atrophy) — because the testes reduce their own testosterone production
- Reduced sperm count / fertility
- Fertility: TRT suppresses sperm production. If you are trying for children (now or in the future), discuss this with your prescriber — alternatives like clomiphene or HCG may preserve fertility
- Prostate: TRT does not cause prostate cancer, but it can stimulate growth of existing prostate cancer cells. PSA monitoring is essential
- Cardiovascular: Studies are mixed, but most recent evidence suggests no significant increased cardiovascular risk in properly monitored patients
- Haematocrit monitoring: High red blood cell count can increase stroke/clot risk — regular monitoring is essential
Who Should NOT Take TRT?
TRT is not suitable for men who:
- Have or are suspected to have prostate or breast cancer
- Are actively trying to conceive naturally
- Have severe untreated sleep apnoea
- Have untreated severe heart failure
- Have high red blood cell count (haematocrit >54%)
Getting Started: What to Expect
If you decide to explore TRT:
1. Consultation with a prescriber — thorough medical history, review of symptoms
2. Blood tests — morning testosterone (x2 on different days), LH, FSH, SHBG, FBC, PSA, prolactin, LFTs, renal function
3. Treatment discussion — if eligible, discuss most suitable form of TRT
4. Start treatment — with clear dosing instructions
5. Follow-up at 6–12 weeks — repeat bloods, symptom review, dose adjustment if needed
6. Ongoing monitoring — every 3–6 months initially, then annually
At GetClinic, our prescribers are experienced in men's health and testosterone management. Your first consultation includes a full clinical assessment and blood test review.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Testosterone replacement therapy must be prescribed and monitored by a qualified healthcare professional.