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Testosterone is the male sex-hormone.  It is produced primarily by the testes, but also by the adrenal glands.  It is responsible for development of the secondary sexual characteristics that develop during puberty, eg. deepening of the voice, body hair, development of the genitalia, fertility, and increased muscle mass.

Reference ranges used within the NHS for diagnosing low testosterone are not age specific. Since we know there is a quantitative drop in testosterone with age, it makes no sense that a reference range used for a 30 year old should be the same range used for that of a 60 year old.

The amount of free usable testosterone also varies with a male’s sex-hormone binding globulin level, which can also vary from person to person.  Exogenous factors such as diet, lifestyle and medications also affect testosterone levels.

The Men’s Health Clinic philosophy is one of hormone optimisation tailored to the individual, within the refines of normal functioning established physiological reference ranges.

The Men’s Health Clinic utilises the ‘Ageing Male’s Symptoms’ questionnaire to ascertain whether you have the signs and symptoms of low testosterone.  This is followed up with a fasted morning blood test to measure your testosterone level.  Ideally this sample needs to be taken between the hours of 8.00-11.00am.

Ideally, we recommend having two testosterone blood levels done prior to commencing treatment.  There is the option to order a Total Testosterone test through an online service such as Medichecks, so that it can be done at exactly 9.00am in the comfort and convenience of your own home.  The second can be taken at your first clinic consultation.

We always aim to treat you, the patient, and not just the numbers.

How to Diagnose Low Testosterone

Yes, a healthy balanced diet and strength training has been associated with an increase in testosterone levels.  We advise all patients to address lifestyle, dietary and exercise factors first, before seeking medical attention.  Advice and support will be given to you.

There are many benefits of TRT, these benefits include:-

  • Increased muscle mass
  • Reduced visceral fat mass
  • Reduced total body fat mass
  • Beneficial effects on lipid profile.
  • Beneficial effects on cardiovascular function,
  • Beneficial effects on inflammatory markers
  • Beneficial effects on glucose metabolism, which reduces the risk of diabetes
  • Beneficial effects on longevity
  • improved sexual function and quality of life.

The Benefits of TRT

The following are approximate guidelines:-

  • Sexual interest – From 3 weeks onward and 6 weeks until maximum benefit reached
  • Erections / Ejaculations – From 12 onward and 26 weeks until maximum benefit reached
  • Quality of life – From 3-4 weeks onward and 78 weeks until maximum benefit reached
  • Depressive mood – From 3-6 weeks onward and 30 weeks until maximum benefit reached
  • Body composition – From 12-16 weeks and 52 weeks until maximum benefit reached
  • Bone mineral density – From 26 weeks onward and 156 weeks until maximum benefit reached
  • Glycaemic control – From 12 weeks onward and 52 weeks until maximum benefit reached
  • Inflammation – From 3 weeks onward and 12 weeks until maximum benefit reached

Side effects are rare, however, they may include:-

  • Prostate problems, such as growth of the prostate gland, increased PSA levels and worsening of prostate cancer
  • Headache
  • Nausea and vomiting
  • Alteration in mood
  • Change in sex drive
  • Breast pain, enlargement of the breasts
  • Persistent painful erection of the penis (Priapism). Tell your doctor straight away if you experience this
  • Decreased sperm count (Azoospermia)
  • Fluid retention (Oedema)
  • Increased blood pressure (Hypertension)
  • Increased levels of red blood cells and haemoglobin in the blood (Polycythaemia)
  • Weight gain
  • Pain in the muscle or joints
  • Male-pattern baldness
  • Acne
  • Itching
  • Raised cholesterol levels
  • Jaundice
  • Liver tumours

As with any medication, allergic reactions to any of the ingredients of the preparation may also occur.  It is therefore essential that you read the information leaflet that comes with the medication prior to administration.

TRT can increase the Haematocrit / HCT (red blood cell concentration), this essentially makes the blood more viscous increasing the risk of clots and subsequent organ damage.  A concentration of >54% is a contraindication to therapy.  It is therefore important to monitor your Full Blood Count whilst on treatment. Treatment options are available, such as venesection, if you wish to continue with treatment.

Testosterone, in part, breaks down to dihydrotestosterone which can stimulate the prostate.  It is interesting to note that the incidence of prostate cancer is highest in men with low testosterone, however, prostate cancer is known to be androgen receptive so testosterone may worsen the condition.  Screening for prostate cancer involves regular blood measurement of Prostate Specific Antigen (PSA) and digital rectal examination as appropriate.

These elevations tend to occur within the first 12 months, and can be monitored with regular blood tests (FBC & PSA).  Here at the Men’s Health Clinic we monitor your bloods every 6 months.

Here at the Men’s Heath Clinic we always suggest you address lifestyle factors first before considering Testosterone Replacement Therapy.  You have the option of either a depot injections or a topical gel.

Testosterone Enanthate Injection (250mg/ml)
  • Injections are normally administered every 3.5 or every other day, dependent on your testosterone level.
  • Dose range 50-250mg per week, dependent on your testosterone level.
  • Intramuscular injection, normally administered into the buttock.
  • This ester allows greater control over your testosterone level.
  • Testosterone levels are monitored every six months whilst on treatment and/or one month after a dose change.
 Testosterone Gel Dispenser (16.2 mg/g)
  • Requires daily application, usually to the shoulder, abdomen or upper arm. Dries within minutes.
  • Shorter duration of action, so suitable if you are only considering a trial of TRT or have concerns regarding possible side effects.
  • Aims to keep testosterone level more stable, compared to the injection.
  • Possible transfer to intimate contacts, try and avoid washing off or direct contact within 6 hours.
  • Occasional skin irritation

These bio-identical testosterone’s have the same chemical structure as the naturally occurring hormone which is produced in the body.

Always read the Patient Information Leaflet given with the medication.

Once you have completed the questionnaires, seen Dr Stevens in your ‘New Patient TRT Consultation‘ and have had your bloods taken, it normally takes less than a week before you can commence therapy.

You can take TRT for as long as you want, it all depends on whether you want to go back to feeling like you did before commencing treatment!

TRT interferes with the normal hypo-pituitary-gonadal axis.  Since you are having an optimal amount from your treatment, your brain does not send signals to the testicles to produce its own testosterone.

You can come off TRT at any time, your body will need to produce its own testosterone again and there may or may not be a permanent delay in this occurring.

TRT is contraindicated in males with:-

  • Prostate cancer
  • Prostate-specific antigen (PSA) >4 ng/mL
  • Male breast cancer
  • Severe sleep apnoea
  • Male infertility
  • Haematocrit >54% (FBC)
  • Severe lower urinary tract symptoms due to benign prostatic enlargement – (IPSS score) >19

No, TRT does not cause prostate cancer.  Interestingly the incidence of prostate cancer rises when testosterone levels fall with age; however prostate carcinoma is androgen receptive.

Regular blood monitoring of Prostate Specific Antigen is recommended, with digital rectal examination as indicated.

Dihydrotestosterone, a by-product of testosterone, it can increase the size of the prostate however it should be noted there is no correlation between prostate size and symptoms.

Caution should be advised with patients having an International Prostate Symptom Score (IPSS) of19>.  Check your IPSS here –

Testosterone stimulates erythropoiesis ie. production of red blood cells, this can cause a rise in the Haematocrit. If the concentration gets too high, the blood essentially becomes too viscous, increasing the risk of clots.  It is therefore important to regularly monitor the Full Blood Count to ensure it does not rise above normal limits.  Venesection is the treatment of choice if this happens.

Human Chorionic Gonadotropin (HCG) mimics Lutenising Hormone (LH).  HCG should be prescribed alongside TRT to help maintain some intratesticular production of testosterone and maintain testicular size.

HCG has a role in preserving fertility in patients who are on TRT.

There are LH receptors in the brain, so supplementation of testosterone with HCG can offer a qualitative improvement in the feeling of well-being.

There is also up-regulation of other steroid hormones in the cascade down from Pregnenolone with use of HCG.

It is well recognised that exogenous testosterone can suppress the hypothalamic–pituitary–gonadal axis, hence the testes not receiving natural hormonal stimulation from the pituitary gland.

Exogenous testosterone can interrupt the normal hypo-pituitary-gonadal axis, effectively signalling your brain to stop producing Follicle Stimulating Hormone & Luteinising Hormone which are essential in maintaining testicular function. If this happens, it causes azoospermia, an absence of motile sperm in semen.

Unfortunately it seems you can buy anything from anyone on the internet!  By engaging with The Men’s Health Clinic, you can be assured that Dr Stevens is fully registered with the General Medical Council –

All medicines prescribed should be ordered/collected from a registered EU pharmacy.  The source of medicines bought over the internet can not normally be traced, which means that you could be buying anything.  Underground Laboratories (UGLs) are very commonplace now, they are unregulated and therefore unsafe.

Of course, the more information we can gather, the more comprehensive service we can deliver.  However, please note that any blood test results must have been carried out within the last four weeks prior to the date of your appointment.  They must also be from an accredited laboratory and hard copies of the results will need to be brought along to your consultation.

An oral medication called Clomiphene can be used to stimulate Luteinising Hormone & Follicle Stimulating Hormone production, by blocking oestrogen receptors in the hypothalamus, this can lead to an increase in testosterone.

A subcutaneous injection of Human Chorionic Gonadotropin (HCG) can be used to stimulate intratesticular testosterone production and help preserve testicular size, it does this by mimicking your own body’s Luteinising Hormone.

I do not subscribe to these treatments as I do not feel they are long-term solutions to the issue of low testosterone.

Testosterone & Human Chorionic Gonadotrophin are classified as controlled drugs under the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001.They are both Class C, schedule 4 drugs.

If you are travelling abroad and need to administer treatment whilst away, you will require a flight letter in order to do this.

Please refer to

There is an addiotnal fee of £45 for this service.

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