Testosterone Replacement Therapy (TRT) is a medically supervised treatment designed to manage Testosterone Deficiency. The premise behind TRT is to restore your testosterone levels to that of a healthy person. TRT should be personalised to meet the needs of the individual, which means offering the best available options.
Our gold standard TRT is daily subcutaneous Testosterone Cypionate and Human Chorionic Gonadotropin (HCG) injections, we believe this is the most effective method of not only achieving healthy stable male androgen levels, but also mimicking the diurnal variation in testosterone levels that occurs naturally. Our prescribing rationale is clearly explained in ‘Microdosing TRT – The Future of Testosterone Replacement Therapy’.
We believe that TRT should be viewed as Hormone Replacement Therapy (HRT), which is why we recommend the use of Human Chorionic Gonadotropin (HCG) alongside testosterone; however, this is personal choice. Traditional testosterone monotherapy suppresses the release of Lutenising Hormone (LH) and Follicle Stimulating Hormone (FSH) from the pituitary gland. This can result in infertility, testicular atrophy, and dysregulation of the neuroendocrine system resulting in a lower libido, something discussed in more detail in ‘The Benefits of Using HCG with TRT’ .
Whilst microdosing daily subcutaneous Testosterone Cypionate and HCG may be the option that most men choose, it is important to offer an element of choice. Your personalised TRT protocol should not only be effective from a pharmacological perspective, but it should also allow for compliance, both practical and financial. This is why it is always important to offer different treatment options, as it serves in the best interests of you, the patient.
Our gold standard TRT, Testosterone Cypionate is suspended in olive oil which is 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 and so we hold authorisation from the MHRA to import it from Europe for our patients.
The half-life of Testosterone Cypionate and Enanthate are practically identical, which means that they are interchangeable when administered via the intramuscular route. We work alongside a growing number of NHS GPs who are willing to support their patients in prescribing Testosterone Enanthate through the NHS, which obviously makes their TRT treatment more affordable.
Unfortunately, Testosterone Enanthate is less suited to subcutaneous injections due to the viscosity of the carrier oil and its preservative. You would therefore likely need to switch to intramuscular injections if you choose this treatment option.
If frequent injections are entirely impractical for you due to logistics or any other reason, we have a few patients who have had great success from administering weekly shallow intramuscular injections of Testosterone Undecanoate (Nebido). It must be noted however that due to its long half-life, Testosterone Undecanoate has a long titration period to achieve stable male androgen levels.
Testosterone Cypionate and Enanthate are very well tolerated by most patients. However, in the rare event that qualitative stability is not achieved with these esters due to extremely low Sex Hormone Binding Globulin (SHBG) levels, Testosterone Undecanoate can be an effective alternative option.
We have not found Testogel monotherapy to be an effective TRT option, due to it’s unbound testosterone being metabolised too quickly in order to achieve stable male androgen levels throughout the day. However, we have found that the use of HCG alongside the gel can allow for relative stability.
Testogel is often more suited to older patients or patients who are extremely adverse to the idea of injections. We have had many patients who originally started on Testogel, transfer over to injectable testosterone after realising the positive effects of TRT and appreciating the potential for tighter control, resulting in improved qualitative symptoms.
Testosterone Deficiency is a well-recognised medical condition. Not only do you need two confirmatory blood tests to establish the diagnosis, you also need to explore possible reversible conditions for low testosterone, such as thyroid dysregulation. This is one of the reasons that you need a thorough diagnostic work up – Testosterone – Which Blood Test Do I Need & Why?. You should only commit to TRT after you have explored all natural ways of improving your own testosterone levels, something we have discussed in ‘How to Increase Natural Testosterone Levels‘.
We do not advocate the use of Clomiphene (Clomid) or HCG monotherapy, nor experimental combinations of Clomiphene, Mesterolone (Proviron) and DHEA to ‘boost’ your system. If you cannot improve your natural male androgen levels through sustained changes to lifestyle, nutrition and exercise, we believe that testosterone replacement is the most suitable option available.
Sustanon is commonly prescribed by the NHS as it is an extremely cost effective testosterone treatment. It is also commonly prescribed in private sector, likely due to the profits that can be made on what is otherwise a very cheap testosterone blend. The original premise behind Sustanon was to produce a timed-release of testosterone using four individual esters, thus allowing for a much less intensive injection frequency. In practice, the injection frequency is determined by the shortest acting ester, in this case Testosterone Propionate, which results in the need for more frequent injections. Conversely, the long acting Decanoate ester results in an extended washout period, which is counterintuitive and makes it difficult to achieve true stability. Therefore, the use of Sustanon is not routinely recommended to our patients.
We also do not support the use of compounded testosterone creams, it is only licensed medications that have undergone the necessary rigorous scrutinization that can ensure both safety and effectiveness. TRT is a lifelong therapy, not a quick fix. We do not support the use of TRT to attain supraphysiological testosterone levels, nor the use of TRT as a Performance Enhancing Drug (PED).
If you are on a alternative form of Testosterone Replacement and would like to change, or you are simply wishing to transfer your treatment over to The Men’s Health Clinic for a higher level of care and supervision, we would be happy to discuss your needs to see if we can work together. Please email firstname.lastname@example.org.
TRT should be both effective and practical, this is why we offer our patients choice. TRT is a lifelong therapy, if one methodology is either ineffective or impractical, we will work with you to find a suitable alternative that meets your personal requirements. When we counsel our patients, they are always advised that TRT does not just ‘work’, it allows YOU to work! Your choice of TRT should always be made with your prescribing doctor, who has your best interests at heart.