Is TRT right for me?

TRT is likely to help you if...

• You have multiple symptoms consistent with androgen deficiency: low libido, erectile dysfunction, morning erections absent, fatigue, loss of muscle mass, loss of body hair, depressed mood, poor concentration

• Your morning total testosterone is clearly below 10 nmol/L on at least two separate tests

• Reversible causes have been excluded or corrected (BMI, sleep apnoea, opioid use)

• You understand that TRT is generally a long-term commitment

• You are prepared for monthly dosing, quarterly bloods, and annual review

• You have no absolute contraindications (active prostate or breast cancer, severe heart failure, untreated sleep apnoea, planning pregnancy imminently)

TRT is probably not the right answer if...

• Your testosterone is borderline (10 to 14 nmol/L) and symptoms are vague

• You have significant obesity that you have not attempted to address - weight loss alone can raise testosterone substantially

• You have untreated sleep apnoea - treat this first

• You are actively trying to conceive with your partner - TRT suppresses sperm production

• You have a history of prostate cancer and have not had urology clearance

• Your main complaint is low mood with no other hypogonadal symptoms - treat the depression

• You want TRT for performance enhancement rather than treatment of deficiency - we do not prescribe for this

Specific groups who should proceed with particular care

Men under 40 with hypogonadism need investigation for pituitary causes before TRT is started. We do this as part of initial assessment.

Men with a personal or strong family history of prostate cancer need urology input and baseline PSA/MRI before starting.

Men with erythrocytosis (haematocrit over 0.52) or active venous thromboembolism history need specialist discussion.

Men who want to maintain fertility can usually do so with clomiphene, HCG, or careful combined regimens but this needs active management not set-and-forget TRT.

What a first assessment with us actually looks like

• 30-minute GP consultation reviewing your symptoms, medical history, and goals

• Review of bloods already done or organising bloods before consultation

• Shared decision on whether TRT is the right next step, a trial of lifestyle changes first, or referral elsewhere

• If TRT is appropriate, we choose delivery form together and arrange medication dispensing from our pharmacy

• Clear monitoring schedule agreed before you start

When we will refer you on or decline to prescribe

We do not prescribe TRT for men with normal testosterone and nonspecific symptoms, men actively trying to conceive, men with uncontrolled cardiovascular disease, men with prostate cancer without urology clearance, or men seeking supraphysiological dosing for performance reasons.

We refer out when pituitary disease is suspected, when prostate risk is significant, or when complex endocrinology requires specialist input. Our endocrinology consultant is available for case review where this is borderline.

The honest bottom line

TRT genuinely transforms life for men with real hypogonadism. For men without real hypogonadism, TRT is expensive, lifelong, and brings risks without benefits. Our job is to tell you honestly which group you are in.