Testosterone Replacement Therapy (TRT) for Men

 Testosterone is an important hormone in men and plays a role in:

• Libido and sexual function
• Energy levels
• Mood and motivation
• Muscle mass and strength
• Bone health
• Red blood cell production
• Fertility and sperm production
• General wellbeing

Testosterone levels naturally vary between men and can be affected by age, body weight, sleep, stress, alcohol, medication, illness and training load.

A diagnosis of testosterone deficiency usually requires both:

• Symptoms consistent with low testosterone
• Confirmed low testosterone levels on appropriate blood testing

 Symptoms may include:

• Reduced libido
• Fewer morning erections
• Erectile dysfunction
• Fatigue or reduced energy
• Poor concentration or “brain fog”
• Reduced motivation
• Low mood or irritability
• Reduced muscle strength
• Increased body fat
• Poor recovery after exercise
• Reduced exercise tolerance

These symptoms are not specific to low testosterone, which is why a proper clinical assessment is important.

 At Better Bloods, we aim to understand the whole picture before considering treatment.

Your assessment may include reviewing:

• Symptoms and duration
• Previous blood results
• Medical history
• Current medication
• Sleep quality
• Weight and metabolic health
• Alcohol intake
• Exercise and recovery
• Fertility plans
• Erectile function
• Mood and stress
• Cardiovascular risk factors
• Prostate-related symptoms where relevant

We will also consider other possible causes of your symptoms, such as thyroid disease, diabetes, anaemia, vitamin deficiencies, sleep apnoea, stress, overtraining, medication side effects or lifestyle factors.

Before testosterone replacement therapy is considered, we usually recommend a comprehensive blood panel.

This may include:

• Total testosterone
• SHBG
• Calculated free testosterone
• LH and FSH
• Oestradiol
• Prolactin
• Full blood count
• Liver function
• Kidney function
• Lipid profile
• HbA1c or glucose
• Thyroid function
• PSA where clinically appropriate
• Vitamin and nutritional markers where indicated

In many cases, testosterone should be checked on two separate morning samples before treatment is started.

 Treatment is individualised. Not every man with borderline or low testosterone requires testosterone replacement therapy. Where treatment is appropriate, options may include:

Testosterone Gel

Testosterone gel is applied to the skin daily. It may be suitable for men who prefer to avoid injections or who want a treatment that can be adjusted gradually.

Potential advantages:

• No injections
• Daily steady absorption
• Easy dose adjustment
• Simple to stop if required

Important considerations:

• Must be applied every day
• Risk of transfer to partners or children if skin contact occurs before the gel has dried
• Skin irritation can occur
• Some patients absorb gel less effectively than others

Injectable testosterone may be suitable for men who prefer less frequent dosing or who do not respond well to gel.

Options may include:

• Testosterone cypionate
• Sustanon
• Testosterone enanthate
• Testosterone undecanoate

The choice of preparation depends on clinical suitability, availability, patient preference, cost and monitoring requirements.

At Better Bloods, injectable treatment is prescribed with clear instructions on dose, frequency, safe administration, storage, sharps disposal and follow-up monitoring.

Some testosterone injections are supplied as single-use ampoules or single-use vials. Where a product is intended for single use, any remaining medication should be discarded after use.

Some preparations are supplied as multidose vials. These should only be used according to the relevant product information, clinical guidance and the clinic’s medicines management protocol.

Patient safety and medicines governance are central to how we prescribe and monitor treatment.

Testosterone treatment requires ongoing monitoring to ensure it remains safe, effective and appropriate.

A typical Better Bloods pathway is:

• Full clinical consultation
• Baseline blood testing
• Review of symptoms, risks and suitability
• Discussion of treatment options
• Fertility discussion where relevant
• Shared decision-making before treatment is prescribed

After starting treatment, blood testing and review are usually arranged at approximately:

• 6 weeks
• 3 months

This allows us to assess response, side effects and whether dose adjustment is required.

Once stable, patients are usually reviewed every 6 months.

Blood testing is usually repeated at least annually, or more often if clinically indicated, such as after dose changes or if there are any safety concerns.

  Monitoring may include:

• Testosterone level
• Free testosterone
• Oestradiol
• Full blood count and haematocrit
• Liver function
• Kidney function
• Lipid profile
• PSA where appropriate
• Blood pressure and cardiovascular risk
• Symptom response
• Side effects
• Fertility considerations

Monitoring is an essential part of safe testosterone prescribing.

Testosterone replacement therapy can reduce sperm production and may significantly affect fertility.

Men who are actively trying to conceive, or who may want children in the future, should discuss this before starting treatment.

In some cases, alternative or additional approaches may be more appropriate.

 Potential side effects of testosterone treatment may include:

• Acne or oily skin
• Increased red blood cell count
• Raised haematocrit
• Fluid retention
• Breast tenderness
• Mood changes
• Reduced sperm production
• Testicular shrinkage
• Worsening of untreated sleep apnoea
• Changes in prostate monitoring parameters

Any treatment decision should involve a balanced discussion of potential benefits, limitations and risks.