What is TRT?

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TRT stands for Testosterone Replacement Therapy, and is a treatment offered to men whose testosterone levels are lower than they should be. TRT is offered in several different forms including injections, patches, gels, and capsules.

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Therapy with testosterone is nothing new (although it has been much improved since it first came on the scene way back in the 1930s!), but it has become increasingly popular in recent years for a few reasons: 

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• There’s evidence to suggest that suffering from low testosterone is becoming more common.
• Men are paying more attention to their own health and wellbeing (although there’s a way to go in this area: 64% of men wait more than seven days with symptoms before visiting the doctor). 
• More people have opened up about their journey with TRT, including several famous faces: celebrities, from Robbie Williams to Steve Redgrave, have spoken openly about how TRT has helped them feel more like their old selves.
• TRT is now more widely available through private practices, both in-person and online. 

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Here in the UK, all forms of TRT are UK-licensed (for men) and have undergone rigorous testing. 

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In this post, we’ll give you an overview of what TRT is, the symptoms it helps alleviate, the forms it can take, the risks and benefits of treatment, and how to find out whether it’s right for you. 

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But first: what causes low testosterone? 

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It’s normal for testosterone to naturally decline from the age of 30 (by around 1-2% per year), but sometimes it can start declining earlier, or drop faster than it should. 

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Genetics, diet, and lifestyle can all play a role in this, and there are also a few specific medical reasons that can cause low testosterone. But sometimes, it just happens. No two men are the same; lifestyle factors aside, one might start noticing a rapid decline in their early thirties, while for another this might happen in their late forties. 

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There’s also some evidence to suggest that there’s actually a generational decline in testosterone, meaning the average man has less testosterone now than their dad had at their age. Again, this has been put down to our collective lifestyle shift; more sedentary work, more processed food, and more stress, to name a few factors. But it’s early days, and more research is needed to understand the causes and long-term effects of this trend. 

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Either way, it’s relatively common for men to have low testosterone levels at some point in their life:

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• Around 40% of men over 45 will suffer from low testosterone
• This figure rises to 50% for men with diabetes

What are the symptoms of low testosterone?

Testosterone plays an important role in the body, affecting different parts of how you look and feel. 

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When your testosterone levels are lower than they should be or drop suddenly, you might notice one or a combination of the following symptoms. 

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• Difficulty getting or keeping an erection
• Loss of morning erections
• Less interest in having sex
• Brain fog 
• Poor sleep
• Increased or stubborn body fat
• Feeling more tired than usual
• Feeling low, depressed, or not enjoying things as much as you used to
• Losing muscle 
• Hair loss 
• Weaker bones
• Lack of drive/ low energy levels

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Ted’s Tip: Wondering which symptoms are most common? For around two-thirds of our patients, ‘fatigue or poor sleep’ is what led them to check their testosterone levels. Over half were experiencing ‘loss of libido’ as a symptom of concern. These were the two most common symptoms among our patients before starting treatment.

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Several of the symptoms linked with low testosterone are subtle and are easy to write off as being caused by other things. As such, testosterone deficiency can sometimes go undiagnosed or misdiagnosed as something else, such as depression or simply 'getting older' – even by healthcare professionals. Unless testing is performed, it is sometimes hard to know that low testosterone levels are contributing to many of these symptoms.

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Although subtle, we find that these symptoms can chip away at our quality of life and self-esteem – whether caused by low testosterone or something else. 

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So it’s important to take any symptoms seriously and avoid self-diagnosing; consult a qualified medical professional if you’re not feeling like yourself.  

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Ted's Tip: Most of the time, these symptoms won’t come on suddenly – it will be a more gradual process. This can make it hard to notice yourself; sometimes, it’s those closest to us that can help us understand how we’ve changed.

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What form does TRT take?

TRT works by topping up the body’s natural testosterone production so you reach a normal level for your age. 

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It comes in a few different forms:

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• Injections into a muscle (we normally recommend the thigh)
• Transdermal patches (which can be worn on the thigh, stomach, back, or upper arm)
• A gel which can be applied to the thighs
• A capsule which can be swallowed

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Injection is considered to be the most effective treatment and is what we generally recommend to our patients. It delivers a predictable amount of testosterone very efficiently. 

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But needles aren’t everyone’s cup of tea, so we have other options on hand. Needle-free options are still highly effective when used properly.

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How can I start TRT?

Here in the UK, TRT is available on the NHS, through private in-person clinics, and via online men’s health practices (like Ted’s Health). 

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If you’re experiencing any symptoms of low testosterone, your GP should be your first port of call, and we always recommend seeing them first if you can. 

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Remember, low testosterone can itself be a symptom of underlying medical conditions, and it’s important that these are ruled out first. 

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That said, many patients choose to explore private options, either before or after visiting a doctor. 

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There are many reasons for this, but ‘long waiting times for treatment or appointments’ and ‘not feeling heard by my doctor’ are both reasons we hear. After all, GPs are unlikely to be specialists in endocrine (hormone) disorders; it’s still a relatively poorly-resourced area of medicine. 

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The testosterone levels you need in order to be offered TRT on the NHS are also lower than the optimum testosterone levels, which are what we benchmark against here at Ted’s Health. 

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In short, you’ll only be offered TRT on the NHS if you’re found to have severely low testosterone – and you may unfortunately face an uphill battle getting a test in the first place. 

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Ted’s tip: TRT is not a ‘set it and forget it’ solution; you should have regular appointments to examine how well TRT is working for you. 

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How do I know if I need TRT? 

Whether you go to your GP or a private clinic, a blood test performed in the morning (between 7am and 11am, when your testosterone levels are naturally higher) is the first step to working out whether your testosterone levels are low. 

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Not much blood is required for this, so an at-home blood test kit usually works just fine; you just prick your finger and fill a small vial with blood. The whole process takes around 30 minutes. 

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If you can’t extract enough blood on your own, or your sample fails for some other reason, it might be necessary for a nurse or doctor to draw blood from a vein using a needle and syringe instead. 

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Your doctor or private practice may also ask you to complete a symptom questionnaire. 

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Once a medical professional has reviewed your bloodwork and spoken to you about your symptoms, they can advise you on the next steps. If your testosterone levels are within the expected range for your age, they generally won’t recommend TRT. If they’re lower than they should be, they’ll discuss your options with you to find a TRT method and treatment plan that works for you. 

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Ted’s tip: Testosterone plays a significant role in men’s bodies, so treatment should be carefully personalised to match your existing levels of testosterone. We would always advise against taking testosterone that has not been prescribed to you by a medical professional. In the UK, it is illegal to buy or sell testosterone that has not been prescribed to you. 

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How much does it cost?

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If you are prescribed TRT by the NHS, you’ll only pay for your prescription. If you go down the private route, expect to pay upwards of £30 per month depending on your dosage and treatment method, and how often you have consultations. 

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Benefits of TRT

When prescribed correctly, TRT can dramatically improve the lives of men suffering from low testosterone levels. 

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You can expect to notice an improvement around 6 weeks after starting treatment, although it can take up to 6 months to feel the full benefit.

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After starting TRT, you may notice: 

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• Improved mood 
• Better memory 
• A better sex life and more interest in sex 
• More muscle mass
• Less body fat
• More energy 
• Feeling more ‘switched on’

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Sometimes, it’s hard to pinpoint the change; some patients simply say they feel ‘better’, ‘more like their old self’, or that they have ‘a new lease of life’. That said, TRT is not a 'one-size-fits-all' solution, and some may experience only modest improvements or not notice much of a change at all. 

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Longer-term benefits of TRT

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Several studies also suggest that (safely) increasing testosterone levels comes with longer-term health benefits, too. 

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TRT may reduce the chance of cardiac events by an average of 33% (although it’s worth noting that TRT is not recommended for those who already have heart problems), and reduce your chance of getting diabetes by 40%. More research is needed to confirm this longer-term positive impact, but the early signs are encouraging. 

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Potential side effects of TRT

Like all medications, TRT comes with some risk of side effects, including:  

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• Worsening sleep apnoea 
• Skin reactions (around the injection are or where you are applying gel) 
• Prostate changes 
• Increased production of red blood cells (causing your blood to thicken) 
• Negative changes in mood (irritability, mood swings and – very occasionally – aggression and excessive libido)
• Gynaecomastia (‘man boobs’) 
• Smaller testicles 
• Conflicts with other medications
• Ankle swelling 
• A reduced sperm count, leading to fertility issues. While fertility may return in many cases after stopping treatment, it may take several months, and in some cases, fertility issues can persist and it may never return. Men planning to have children should discuss fertility preservation options with their doctor before starting TRT.

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All forms of testosterone replacement therapy are UK-licensed and have therefore undergone rigorous testing to ensure their safety. Discuss these potential risks thoroughly with your doctor before beginning treatment.

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Here at Ted's Health, we’re well aware of the potential side effects of TRT. We perform routine monitoring tests (including blood tests) to ensure your safety and that any side effects are picked up early. You will be supported by our medical team with this. The above list is of all the potential side effects, but it is very unlikely you would have several of these at the same time (and with our routine monitoring to ensure safe dosing, many men do not experience any side effects at all). 

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Is TRT necessary or can you raise testosterone naturally? 

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For some men, lifestyle changes like improved diet and exercise can help raise testosterone levels naturally, and this is worth trying before starting treatment and even whilst on treatment. However, these changes may not fully replace the need for TRT.

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Doing any or a combination of the following may naturally raise your testosterone levels: 

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• Reducing your stress levels (by prioritising sleep, exercise, and relaxation) 
• Stopping smoking, or smoking less 
• Reducing alcohol intake
• Starting strength and resistance training, or increasing the amount you do 
• Improving your diet and reducing your intake of sugar and cholesterol 
• Improving your sleep quality, and trying to sleep for longer
• Raising your vitamin D intake (either through vitamin D-rich foods, or using an over-the-counter supplement) 

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FAQs

How long do you spend on TRT? 

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Many men will spend several years or even the rest of their lives on TRT. But you can stop treatment at any time; your testosterone levels will just drop to their natural levels. 

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Is TRT recommended for women too?

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Testosterone is not currently licensed for use by women in the UK, but it can still be prescribed off-license to alleviate some symptoms associated with the menopause, such as a drop in sex drive. However, its use in women is still uncommon, and carefully considered due to potential risks and side effects.