Your TRT
options

Testosterone Cypionate + hCG

Testosterone Cypionate Monotherapy

Testosterone Cypionate is usually well-tolerated via the subcutaneous injection route. This is our preferred method of administration as it is much less painful than intramuscular injections, and there is less conversion of testosterone to oestradiol.

Testosterone Cypionate is the most widely used ester in the USA and other countries worldwide. It also has the most scientific literature behind it, supporting both its safety profile and effectiveness.

Despite being licenced in both the USA and Europe, Testosterone Cypionate is not currently available in the UK on a standard prescription. We therefore have it imported into the UK for our patients, via our global pharmaceutical distributors, with authorisation from the MHRA.

Testosterone Undecanoate + hCG

For some men, frequent injections may be impractical due to lifestyle or logistical reasons. In these cases, we have seen excellent results with weekly shallow intramuscular injections of Testosterone Undecanoate (Nebido), combined with hCG.

While Testosterone Cypionate and Enanthate are well tolerated and effective for the vast majority of patients, there are rare circumstances – such as in men with extremely low Sex Hormone Binding Globulin (SHBG) – where qualitative stability is harder to achieve. In these instances, Testosterone Undecanoate can provide a useful alternative.

It is important to note that, due to its long half-life, Testosterone Undecanoate requires a longer titration period before stable androgen levels are reached. The concurrent use of hCG is essential, as without it the drug’s stability can paradoxically blunt the natural subjective benefits that patients typically experience.

Testosterone Enanthate + hCG

Testosterone Enanthate Monotherapy

The half-life of Testosterone Cypionate and Enanthate is practically identical, which means they are interchangeable when administered via the intramuscular route.

We work alongside a growing number of NHS GPs who are willing to continue prescribing Testosterone Enanthate once stability on Testosterone Cypionate has been demonstrated, allowing treatment to be provided under the NHS and therefore making TRT more affordable for some patients. This option is only available where your GP has agreed to take over prescribing as part of a shared-care arrangement.

It is important to note that Testosterone Enanthate is less suited to subcutaneous injections due to the viscosity of its carrier oil and preservative. For this reason, you would likely need to switch to intramuscular injections if this treatment pathway is pursued.

Traditionally, our gold-standard TRT protocol has involved either daily subcutaneous injections of Testosterone Cypionate, or weekly Testosterone Undecanoate, combined with Human Chorionic Gonadotropin (hCG). We have found this approach to be the most effective way of achieving stable, healthy male androgen levels while closely mimicking the natural diurnal variation in testosterone. You can read more about this prescribing rationale in Microdosing TRT – The Future of Testosterone Replacement Therapy.

We view TRT as a form of Hormone Replacement Therapy (HRT), which is why we recommend the addition of hCG alongside testosterone. This helps preserve fertility and testicular function by preventing suppression of Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) from the pituitary gland—issues that can otherwise lead to infertility, testicular atrophy, and lowered libido. For more detail, see The Benefits of Using HCG with TRT.

That said, testosterone monotherapy remains an established and effective option for many men. This can be particularly suitable for those who do not wish to retain testicular function, including fertility, whilst on treatment. It may also be preferred in men with low Sex Hormone Binding Globulin (SHBG) levels, or in those with a history of anxiety who may not respond well to the neurostimulatory effects of hCG.

The aim of treatment, whether using monotherapy or combined therapy, is always to mimic the natural diurnal release of testosterone by the body, minimising potential side effects. With monotherapy, this is best achieved through daily microdosing. However, in men with higher SHBG levels, relative stability can sometimes be achieved with a less intensive injection schedule. Your prescribing doctor will advise you if this could be a suitable option for your personalised needs.

While daily microdosing with Testosterone Cypionate and hCG remains a popular choice, we understand the importance of offering treatment options that suit your lifestyle and budget. Your personalised TRT protocol should be both pharmacologically effective and practical for you to maintain consistently. That’s why we provide a range of treatment options, ensuring we always act in your best interests.

We do not advocate the use of Clomiphene (Clomid) or hCG monotherapy, nor experimental combinations such as Clomiphene, Mesterolone (Proviron), and DHEA marketed as ways to “boost” your system. If natural testosterone levels cannot be improved through sustained changes in lifestyle, nutrition, and exercise, then testosterone replacement remains the most appropriate and effective option.

Sustanon is commonly prescribed within the NHS because it is a cost-effective treatment option. It is also frequently used in the private sector, likely due to its low cost and wide availability. Sustanon was originally designed to provide a timed release of testosterone via four different esters, theoretically allowing for less frequent injections. In practice, dosing is dictated by the shortest-acting ester, Testosterone Propionate, which requires more regular injections. At the other end of the spectrum, the longer-acting Decanoate ester creates an extended washout period, making it difficult to achieve consistent stability. For these reasons, we do not routinely recommend Sustanon to our patients.

We also do not support the use of testosterone gels. While they are widely prescribed, absorption through the skin can be highly variable, leading to inconsistent results and difficulties in achieving true stability. There is also the risk of transference to others through close skin contact, which raises additional safety concerns.

Similarly, we do not support the use of compounded testosterone creams. Only licensed medications that have undergone rigorous regulatory scrutiny can guarantee both safety and effectiveness. TRT is a lifelong medical therapy, not a quick fix. We therefore do not support prescribing TRT to achieve supraphysiological testosterone levels, nor its use as a Performance Enhancing Drug (PED).

If you are currently on an alternative form of testosterone treatment and would like to transition to a more stable and carefully supervised approach – or if you wish to transfer your care to The Men’s Health Clinic for a higher standard of ongoing support – we would be pleased to discuss your needs and explore how we can work together.

Testosterone Deficiency is a well-recognised medical condition that requires careful and comprehensive assessment for accurate diagnosis. To confirm the diagnosis, it is essential to have at least two blood tests measuring testosterone levels, taken at the appropriate time of day (typically between 7 and 11 AM) and spaced several weeks apart. This helps ensure the results reflect a consistent hormonal state rather than a temporary fluctuation.

Beyond confirming low testosterone, it is equally important to investigate potential reversible causes that may contribute to reduced hormone levels. Conditions such as thyroid dysfunction, nutritional deficiencies, chronic illness, or medication effects can all impact testosterone production. This is why a thorough diagnostic workup is vital, including a broad panel of blood tests, as detailed in our guide, Testosterone – Which Blood Test Do I Need & Why?. Understanding the full picture allows for targeted treatment and can sometimes reveal underlying issues that can be addressed without hormone therapy.

Before committing to Testosterone Replacement Therapy (TRT), it is strongly recommended to explore and optimise natural methods to support your body’s own testosterone production. Lifestyle factors such as improving sleep quality, managing stress, enhancing nutrition, and increasing physical activity can have a significant impact. We provide practical advice and evidence-based strategies in our article, How to Increase Natural Testosterone Levels, to help you maximise these opportunities for improvement.

Ultimately, TRT should be considered only after a careful diagnosis and when natural approaches have been thoroughly explored, ensuring that treatment is both necessary and effective for your long-term health and wellbeing.

The primary goal of Testosterone Replacement Therapy (TRT) is to reverse the negative symptoms associated with testosterone deficiency. These commonly include low mood, anxiety, depersonalisation, brain fog, fatigue, and low libido. By addressing these symptoms, TRT helps restore not just physical health but also psychological well-being.

TRT works by replacing the deficient hormones, carefully titrating hormone levels to achieve optimal balance. This balance is crucial for supporting long-term physical health – such as muscle mass, bone density, and cardiovascular function – as well as mental and emotional stability.

We believe TRT should be both effective and practical, which is why we provide our patients with options tailored to their individual needs and lifestyles. Since TRT is a lifelong therapy, it’s essential that your treatment method fits your personal preferences and daily routine. If one approach proves ineffective or inconvenient, we will collaborate closely with you to find an alternative that works better for you.

When counseling our patients, we emphasize that TRT does not simply “work” on its own – it empowers YOU to work. The success of therapy depends on a partnership between you and your prescribing doctor, who acts with your best interests at heart. Together, you can make informed decisions that support your health, well-being, and quality of life.