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TRT UK. A guide to testosterone replacement therapy in the UK

The definitive guide to testosterone replacement therapy in the UK. What TRT is, how to get it, how much it costs and much more.

trt uk

So you want to know about TRT (Testosterone Replacement Therapy) in the UK?

It’s big in the US but TRT in the UK is still relatively unknown among the public because the media don’t cover it.

The awareness will grow as more UK men speak out about the greater quality of life they have from TRT.

Still, it’s likely that a lot of men in the UK don’t know they’re deficient in testosterone let alone know what TRT is.

Word is beginning to get out, however, and while the awareness of TRT in the UK is not at US levels, private medical companies, and the NHS to a lesser extent, are beginning to prescribe TRT to men in the UK who are testosterone deficient.

This article is an overview of TRT in the UK, how to get it, how much it costs and much more. Below is the table of contents you can click on and it will take you to each section.

Full disclosure: I’m not a medical professional and don’t play one on the internet. All the information here is for research and educational purposes only.

What is testosterone and why do men need it?

In short, testosterone is the hormone in a man’s body that differentiates him from a woman.

It plays an important role during puberty and if you were like me it gave you acne, embarrassing moments in gym class and made your voice go from high to deep and back again in one sentence.

Testosterone is created in the testes (otherwise known as your balls) and is associated with sex drive, aggression, competitiveness and risk taking.

It provides physical strength and a greater sense of well-being. It supports muscle growth, bone mass and red blood cell production.

Psychologically it provides confidence, determination and the drive to go out and achieve. CEOs of companies report having higher levels of testosterone than average.

A woman’s body creates testosterone just as a man’s creates the female hormone oestrogen (also spelt estrogen). In both cases, their bodies have much lower amounts of each. Too much or too little of either in both men and women can have detrimental effects to either sex.

Testosterone is a social hormone and a driver of why men seek power and status. Research has shown that both men and women’s testosterone levels rise when they gain positions of power.

A man needs testosterone simply to function as a man. Without it he would suffer all kinds of physical and mental health-related issues.

Often men do suffer due to their body being incapable of producing enough testosterone they need. On top of this, average levels of testosterone in men has decreased over the last couple of decades.

Decreasing levels of testosterone in men in the UK

Once a man turns 30 his body begins to produce less testosterone each year. The numbers vary and it differs from person to person based on their lifestyle and genetics but after 30 men lose around 1 to 2% of testosterone each year.

trt uk
Men’s testosterone production decrease as they age.

This doesn’t seem like much but factor in compounding and it quickly adds up. Once he hits 50 his testosterone levels will have diminished considerably.

If Mother Nature’s harsh reality wasn’t bad enough, research has found that average testosterone levels in men have decreased by 20 percent compared to men 20 years ago.

Why this is happening it is still unclear. A sedentary lifestyle, greater obesity rates, soy consumption and pollutants in plastics is the general prognosis. Conspiracy theorists believe it is done intentionally to ensure a more civil and law-abiding society.

Whatever you believe, we have problems and it explains why more men are using TRT in the UK and around the world.

What are the symptoms of low testosterone?

The symptoms vary from person to person but reported side effects include:

  • Increase in body fat
  • Loss of muscle mass
  • Loss of bone mass
  • Poor recovery
  • Low sex drive (inc erectile dysfunction)
  • Fatigue
  • Difficulty concentrating
  • Decrease in mood
  • Loss of ambition

Note. Even if you are suffering some of these symptoms it does not mean you have low testosterone. The only way to find out is to have a blood test which I cover below.

Low testosterone is caused by male hypergonadism of which there are two types.

The first type usually affects males from birth which can cause height defects and so on. The second type develops later in life from infection, obesity or through the ageing process.

How to increase testosterone levels naturally

Before you even consider TRT you should work on increasing your testosterone levels naturally. If you’re fat, out-of-shape, stressed-out and pay no attention to diet and exercise then I’ve got new for you, TRT won’t solve your problems.

If this is the case your lifestyle may be the cause of your low testosterone. Are you stressed? The stress hormone cortisol can flatten testosterone in a second. The mighty T is no match for the mighty C.

If your days consist of you stressed and feeling out of control then the first step is to remove any toxicity from your life.

You can increase testosterone naturally by living a healthy lifestyle. It could bump your testosterone levels up to a place where you don’t need TRT.

At least for the time being since age waits for no man.

Mike Mahler has written a great article on tips to boost testosterone naturally. His advice includes:

  • Increase healthy fat intake
  • Get deep sleep every night
  • Intake vitamin and mineral intake
  • Avoid high sugar consumption
  • Lift heavy weights and focus on compound exercises
  • Don’t be a chump (live aggressively)
  • Avoid alcohol especially beer
  • Take supplements to support testosterone production

Read the article in full and apply it to your life.

Many men don’t need TRT therapy because they lead healthy lifestyles.

Check out P. D. Mangan. He’s in his 60s, strong as a bull and has natural testosterone levels any man in his 20s would be proud of.

How? Because he lives a healthy life and applies scientifically sound principles to his diet, training and overall lifestyle. He also writes one of the best blogs on health and longevity in the world.

Tip: Always listen to older guys like Mangan or Steve Maxwell who are in their 60s and are fit as fiddles. They know first-hand how to optimise the human body over a lifetime. Unlike the juiced-up 20-year-old gym bros.

Let’s assume your diet is on point, you’re training hard, resting well and living a fairly stress-free life and your testosterone levels are still low, how do you get on TRT in the UK?

Read on.

First, some background on what TRT is.

What is TRT?

trt uk

Testosterone Replacement Therapy is a form of hormone replacement therapy (HRT) whereby a man’s testosterone production is increased by replacing his natural testosterone with a synthetic version.

As men age, their natural production of testosterone decreases each year. A combination of genetics, bad lifestyle habits and ageing can speed up the process.

Some men are born with low testosterone and in their 20s can have the same levels you would expect to see in a man in his 70s.

While some men do not suffer from low testosterone (or put it down to the natural age process) other men suffer a lot of the symptoms which prompts them to look into TRT.

The results from TRT vary from person to person.

Some men report positive and life-changing effects after going on TRT. For others it doesn’t have the same desired effect and the symptoms persist.

There is no guarantee of success although there are many men who (online at least) swear by it.

Remember though, going down the TRT route can be a long and frustrating path. If the symptoms are so bad and you feel you have no other option then it’s a no-brainer.

If, on the other hand, you feel that life is fine without it then don’t give yourself the hassle of blood tests, prescriptions, injections and potentially dealing with the bureaucratic system of the NHS.

Famous men on TRT

trt uk

If you ever see famous older men that have grown considerably musclier in recent years chances are they’re supplementing with testosterone.

Men who are open of have been discovered to be using TRT are listed below. Chances are many other men are on TRT but not open about their usage.

Isn’t TRT just anabolic steroids?

In a word, no. The role of TRT is to increase a man’s testosterone level to a natural and healthy range.

Bodybuilders take testosterone (among other performance enhancing drugs) in superphysiological doses which boost their levels to an unnaturally high state.

In other words, they put way more into their bodies than their body itself could ever create. This is why bodybuilders get super freakishly big.

Men on TRT do report muscle growth and strength gains in the gym. This is expected given their bodies have more testosterone pumping around it. But you wouldn’t be able to tell if a man is on TRT unless you saw a before and after photo. Even then you might just assume he’s been working out.

This is one of the reasons why TRT is misunderstood. The absurdity is people assume taking a mild dose of a male hormone to increase it to a normal level is the same as going on a cycle of anabolic steroids which is not the case at all.

What is a healthy testosterone range?

Good question because what is deemed a healthy testosterone range differs from one organisation to another.

Just last week LabCorp changed its ‘normal values’ of testosterone from 12-42 nmol/L (348-1197 ng/dL) to 9-32 nmol/L (264-916 ng/dL).

This is a considerable decrease and partly due to the obesity crisis we find ourselves in. LabCorp even states that the lower range reflects a difference in the average subject’s BMI. In other words, the average subject is fatter than before.

In other words, the average subject is fatter than before.

Organisations like the NHS don’t look at increasing a patient’s testosterone level to an optimised number. But rather focus on whether a patient is “within range”.

The problem with this approach is, what might be within range to a 50-year-old man is not the desired range to a man 25 years his junior.

TRT UK
Average testosterone ranges per age.

In the chart above you can see that total testosterone, free testosterone and SHBG (Sex Hormone Binding Globulin) all vary depending on age.

(As a sidenote and to make thing confusing, in the US testosterone is measured in ng/dL whereas in the UK it’s measured in nmol/L. To make a convert either measure use a conversion site like this.)

By now you might be wondering what these three variables are?

Total testosterone is the total amount of testosterone in the blood. Much of it sticks to proteins making it unusable.

Free testosterone is the amount of testosterone that does not bind to proteins making it free for the body to use.

SHBG is what testosterone binds to making it unavailable to use. Knowing how much SHGB is in the blood gives an indication of how much free testosterone there is available.

This is where we start getting into the science of it and where it can get confusing to some. Thankfully, you don’t have to have an in-depth understanding of it all (though the more you know the better) but it’s worth remembering the following:

Thankfully, you don’t have to have an in-depth understanding of it all (though the more you know the better) but it’s worth remembering the following:

The more total and free testosterone and the least SHBG in the blood the better.

Free testosterone is the real indicator of if you need TRT. Chances are, if your total testosterone is low then so will your free testosterone and vice versa.

How much oestrogen is in the blood plays a part too. The more oestrogen, the less effective the testosterone will be. At the same time, you need a level of oestrogen in your body to keep you healthy because too little can cause problems.

Confused yet?

How is TRT administrated?

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Testosterone gel is one way to take TRT in the UK.

TRT in the UK comes in four methods, which are:

  • Testosterone gel. You rub the gel into either the arms, shoulders or abdomen for 2 to 5 hours where the testosterone seeps through the skin. Touching a loved on while the gel is on is not advised as you can transfer it to them.
  • Testosterone pellets. A doctor implants a pellet under the skin and provides a slow release of testosterone in the body over a 3 to 6 months period. Once implanted you can’t change the dose so if it’s too much or too little you have problems.
  • Testosterone tablets. You add the tablet to the side of the gum every twelve hours where it dissolves and slowly releases testosterone into the body.
  • Testosterone injections. You inject (or the doctor does it for you) the shoulder, leg or glute muscle on average once every one to two weeks. Injection is the most common form of TRT.

Testosterone injections come in three different forms:

  1. Cypionate
  2. Enanthate
  3. Propionate

Injectible TRT usually comes in the form of either cypionate or enanthate. A common dose of either is usually around 100mg every 7 to ten days. It varies from person to person but this dose is not uncommon.

Doctors don’t usually prescribe testosterone propionate as much as cypionate or enanthate because it has a shorter life and requires more frequent injections.

That said, it’s more appealing to some users as it causes less bloating than the other two as it more closely mimics the body’s natural testosterone production.

Injections are usually done intramuscularly (through the muscle) but there is growing evidence to suggest that injecting subcutaneously (through the skin but not through the muscle) can have just as good, if not greater, effects.

Working with a doctor he will usually inject you each week and monitor your progress. If everything is going well you may start injecting yourself.

The doctor will keep an eye on you for the first year to ensure there are no problems and you’re receiving the correct dose. He’ll also want to periodically blood test you to ensure your levels are in the correct range.

An increase in testosterone can often increase your oestrogen too and if it rises too high you may suffer the same symptoms as if your testosterone was low.

In which case you may want to take something called an aromatase inhibitor (AI). Aromatase is the enzyme that converts testosterone into oestrogen and an AI ‘inhibits’ this from happening. Again, something you would have to work on with a doctor if the situation arises.

There are cases of doctors prescribing Nebido which is a longer lasting testosterone which requires injection every 8 to 10 weeks. Some swear by it, although it seems to have fallen out of favour with the NHS or at least NHS Scotland.

Does testosterone shrink your balls?

This is the most common question when it comes to testosterone and TRT. In a word, yes it does because supplementing with testosterone causes the testes to stop producing their own and therefore they reduce in size.

The general consensus is they shrink to about 75% of their natural size. This doesn’t bother some people but for others it can deter them from going on TRT altogether.

There is a way to stop it from happening. Some people choose to inject hCG (Human Chorionic Gonadrotropin) which stimulates the testes into producing testosterone even when you are on TRT so you’ll have a full set regardless.

How do I get a TRT test in the UK?

First off, if you aren’t suffering from any of the symptoms listed above then it’s unlikely you will need TRT.

If on the other hand, you’ve reached a point in your life where, despite living healthy, your mood, sex drive and ambition have tanked and you can’t make gains in the gym (if you train) then you should start with a blood test.

There are two ways to get a blood test in the UK to find out if your testosterone levels are low.

TRT UK NHS blood test

You can try getting a blood test on the NHS if your GP will allow it. If you have no symptoms you may not get a test.

If you have symptoms your GP may test you but getting a test doesn’t mean you’ll get on TRT.

The NHS is not averse to TRT. The Sun has been critical of it spending money on it but reports of people successfully getting on TRT with the NHS are sparse.

TRT UK blood test on the NHS price = £0.

TRT UK private blood test

There are private services in the UK that provide both at-clinic and at-home style testing. They will measure your testosterone levels and other blood variables related to TRT for a price.

Blood testing in the UK is becoming cheaper thanks to at-home finger-prick testing services like Medichecks. They offer all kinds of tests including a UK TRT blood test which I’ve bought and reviewed on this blog previously.

The Medichecks blood test is comprehensive and goes way beyond what the NHS will test you for. It includes forty individual tests relating to red and white blood cells, clotting status, kidney function, liver function, proteins, iron, cholesterol, thyroid function and of course hormones.

TRT UK blood test with Medichecks = £119 (buy here)

A TRT blood test on the NHS is financially the best option provided your GP intends to test you as comprehensively as Medichecks does. It’s unlikely he will.

If he only tests you from total testosterone and fails to include free testosterone, SHBG and oestrogen it’s safe to assume that he knows very little about TRT.

There is enough anecdotal evidence online to suggest that many UK GPs are still in the dark when it comes to TRT.

If you feel this is the case with your own GP you can either try another GP which is a game of chance. Or if money is not a deciding factor you can go private and get a comprehensive test.

Medichecks TRT Check Plus
Medichecks TRT Check Plus data results.

How to get TRT in the UK?

There are two ways to get TRT in the UK. One is on the NHS and the other is to go private.

How to get TRT in the UK on the NHS

Once you’ve had a blood test your GP will decide to refer you to an endocrinologist for further evaluation.

There is a lot of anecdotal evidence online to suggest that getting on TRT on the NHS is difficult no matter how low your testosterone levels are.

Not all GPs are the same and some have successfully turn patients’ lives around by helping them get on TRT tough these examples are rare.

UK GPs usually start patients off on testosterone gel and move them onto injections if it has been successful.

In 2010 the British Society of Sexual Medicine published a set of guidelines on the role testosterone plays in sexual health.

Titled Guidelines on the management of sexual problems in men: the role of androgens (pdf) it recommends TRT should be prescribed if a man’s testosterone level is below 8 nmol/L (230 ng/dl). It also states that a testosterone level above 12 nmol/L (350 ng/dl) should not be prescribed TRT.

TRT UK
From the British Society of Sexual Medicine’s Guidelines on the management of sexual problems in men: the role of androgens

If your aim is to get on TRT with the NHS take these guidelines with you when you visit your GP. It’s unlikely he will be aware it even exists but it will help you make the case provided your levels are low enough. allows you to make the case of why you should be prescribed TRT

If they aren’t below the recommended 8 nmol/L (which is very low) then you may not be prescribed TRT even if you have all the symptoms.

Hat tip on this information to Paolo Broccado who has a great blog and YouTube on all things TRT in the UK.

How to get TRT in the UK privately

If you can’t get TRT on the NHS or you don’t want to you can go private. This comes with a price of course but it also provides more peace of mind.

Private clinics generally have more experience in prescribing TRT and often come with a better service.

More private clinics are beginning to provide TRT to paying customers due to the increasing demand. A quick Google search will show you a number of UK companies advertising their services.

Private clinics specialise in testosterone optimisation and are more likely to prescribe TRT to patients to boost their levels to an optimal range.

One company that looks interesting (again thanks to Paolo Croccado) is Balance My Hormones which is a UK-based private hormone replacement clinic.

Balance My Hormones is based online which means it doesn’t have the overhead costs as a physical clinic which brings the cost down to customers.

Below is an interesting interview by Paolo Croccado with the founder of Balance My Hormones, Mike Kocsis, on its business model and services.

 

I have not affiliation with Balance My Hormones but it looks like a useful and cost-effect private TRT service, especially when compared to clinics with prime London addresses.

TRT on the UK black market

Actually, there’s a third way to get TRT in the UK but it involves the black market. This option can be dangerous in terms of the quality of the testosterone you’re receiving and the lack of medical supervision. Besides, there are grey and murky areas as to what is and isn’t legal when it comes to this method and how frequent a supply you can get.

I would stay away from this option.

How much does TRT in the UK cost?

This is a simple one. If you manage to get onto TRT on the NHS then you’ll likely pay nothing. The NHS will cover the blood tests, doctor appointments and the treatment itself.

There may be some costs to pay. A contribution to your prescription for example but this depends on your personal circumstances. The bulk of it the taxpayer covers.

Going private is a different matter. Costs vary but there are reports of private TRT clinics charging up to £200 per month which is a lot. That said, if you’re suffering badly from the symptoms it may be worth it.

Again, I’m going to use Balance My Hormones as an example because it seems to be cheapest private UK TRT clinic. It may serve as a sign of where TRT in the UK is heading.

In the video above, founder Mike Kocsis says an average UK TRT prescription costs from £60 to £100 per month. The price variation depends on the requirements of the individual. Not included in this price is the initial consultation, blood test and review which cost £159.

Using Balance My Hormone again, if we take an average of Mike’s £60 to £100 and include three blood tests per year an annual cost works out as the following:

TRT at £80 per month x 12 = £960

Blood test at £159 x 3 = £477

A yearly TRT cost in the UK = £1,437 (£119.75 per month)  

The price will vary from person to person so you may pay more or less but this serves as a ballpark figure. Prepare to pay something similar if you plan on going on TRT in the UK using a service like Balance My Hormones.

It’s likely you’ll pay more if you go to a bricks and mortar clinic but if you like that face-to-face consultation and money is no problem do as you like.

Further reading and information on TRT

Don’t just read this article. TRT is a complex topic which requires research and consideration. Below are some additional resources for further research.

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