One of our primary goals at The Men’s Health Clinic is to increase awareness and understanding around Testosterone Deficiency and Testosterone Replacement Therapy (TRT). We want to set the standard when it comes to delivering high quality patient care, and improve access to safe and effective care. Information is power, if we work together we have a real opportunity to affect a positive change, not only for the individual, but also for the collective. Male Hormone Replacement Therapy needs a voice, your voice. Sharing information is pivotal to this.
With that in mind, in November 2017 I wrote TRT Wars – How to get TRT in the UK with the hope of doing just that. We also produced a YouTube video – TRT Wars – How to Get TRT in the UK – The Men’s Health Clinic.
If you are ready to approach your NHS doctor, we would recommend familiarising yourself and printing out the following documents to help you fight your corner and educate your doctor. At times it might seem hard to believe, but they really do have your best interests at heart.
- British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice (2018 edition)
- A Practical Guide – On The Assessment and Management of Testosterone Deficiency in Adult Men (2018 edition)
- Guidelines on the Management of Sexual Problems in Men: The role of Androgens
When it comes to your choice of TRT, it’s worth checking which testosterone preparations are available in your region prior to your appointment. Simply type your region (eg. Dorset) followed by “prescribing formulary” into Google, click on the relevant link and then type testosterone into the search bar on the page.
Our prescribing rationale is clearly documented in the article Microdosing TRT – The Future of Testosterone Replacement Therapy. We have had great success achieving stable male androgen levels using a single ester testosterone preparation, such as Testosterone Cypionate or Testosterone Enanthate, alongside Human Chorionic Gonadotropin (HCG) as indicated. We currently have patients travel to our clinic from 30 different countries outside of the UK. Feel free to print a copy of that blog to share with your prescribing doctor.
Unfortunately, HCG isn’t currently licensed for use in TRT even though the benefits of using HCG alongside TRT are well-documented. HCG mimics Lutenising Hormone, which is the primary hormone that drives intratesticular production of testosterone. This in turn leads to aromatisation of testosterone to oestradiol, which helps facilitate spermatogenesis. To date, we have been informed of 40+ successful conceptions using HCG alongside testosterone, two of my patients have three HCG babies! However, it is unlikely that you would have HCG prescribed by the NHS. Interestingly, HCG is currently used off-license by NHS Infertility Clinics for this very purpose. However, as we’ve said, information is power. If we continue to chip away at the NHS, we can eventually affect a positive change. Again, please feel to print off a copy of this blog for their information, there’s no harm in trying!
Dr Robert Stevens MBChB MRCGP Dip.FIPT