How does one get testosterone replacement therapy (TRT) in the UK, and can you get it on the NHS? It depends! The answer isn’t quite as black or white as you might expect. The good news is that you have options!
Testosterone Replacement therapy is the process where men with low testosterone are treated with external (exogenous) testosterone to get their levels back into the normal range.
The most common forms of TRT administered in the UK are injections, gels and sometimes testosterone pellets.
Usually men will experience symptoms of low testosterone, which leads them down the path of seeking treatment, called testosterone replacement therapy.
In this guide, I will try to make that process as simple as possible for you, and detail the most common paths (and obstacles) that a man with low testosterone could follow in the UK.
Before We Begin
If you suspect you may have low testosterone or may qualify for TRT, then you’ll need to speak to your local GP about having a blood test done.
This is the start and first step in the process of getting treatment.
You don’t have to follow the sequence of events I’m about to present to you, but they are the most common route followed by most men. So let’s get to it!
NOTE: If at any point during your journey you find you are “blocked” by a GP who refuses to test or treat you, find another one. Due to the poor quality of the public health system in the UK, finding a GP that’s experienced with TRT may be hit or miss. They may refuse a blood test or try to stall you. Don’t give up!
Option 1 – Talk To Your GP
Your first step will be to inform your GP of your symptoms and request to have your testosterone measured by having a blood test done. He may suggest this too.
Based on these results, if your testosterone levels are low enough (and you’re lucky), your GP may prescribe testosterone replacement therapy. However, this is not usually the case.
What is more likely to occur, is that your GP will decline treatment, or refer you to an endocrinologist for further evaluation and testing. This may be due to levels being low, but not low “enough” for him to definitively diagnose you as having low testosterone.
GP visits are free on the NHS. If you are fortunate enough to get a prescription at this point, treatment is free, but subject to the normal dispensary costs you would pay for any prescription.
NOTE: Due to the very restrictive UK guidelines for treating low testosterone and low reference ranges, and the bureaucracy surrounding government-controlled healthcare, getting treated for low testosterone is quite rare, unless your levels are extremely low without question.
Red range = usually treated, Orange / Yellow range = usually not treated
Men with low testosterone in the orange and yellow zones should usually be considered for TRT based on their symptoms. With the NHS however, this is seldom the case, and typically they would only consider people in the red zone.
I hate being so pessimistic, but this is the reality of things. Me and many other guys in the UK have experienced this first hand. In fact, one of the main reasons I started my YouTube Channel was to bring attention to this and help others in the same predicament.
Option 2 – The Endocrinologist
Working with an endocrinologist may in some cases prove more successful, as they will do more intensive blood work and try to find the root cause of your symptoms and low testosterone.
There are a number of potential causes of low testosterone – also called hypogonadism. They are either Primary (testicular) or Secondary (in
the brain).
These include, but are not limited to:
Primary hypogonadism (the body doesn’t produce enough testosterone)
Testicular damage/trauma
Radiation / Chemotherapy used when treating cancer
Castration
Klinefelter syndrome
Secondary hypogonadism (also called hypogonadotropic hypogonadism)
Pituitary tumors or diseases
Traumatic brain injury
Injury to the testicles
Radiation / Chemotherapy used when treating cancer
Other chronic diseases like liver or kidney disease
Obesity
Nutritional deficiencies
It’s becoming increasingly common to see cases of low testosterone which have no obvious cause. This is a growing and concerning factor.
Based on their findings, the endocrinologist will recommend a course of action. This may or may not include testosterone replacement therapy. The decision is at their discretion.
My personal experience (along with other men’s too) has been that if they cannot find a definitive reason for your low testosterone, or your levels aren’t extremely low, then they will decline treatment. Even if your levels are considerably low (around the 9-15 nmol/l levels).
However, don’t let our personal experiences stop you from trying – each person’s case is individual and should be looked at and treated as such.
If you fall within the “questionable” range and your doctor or endocrinologist isn’t receptive to the idea of TRT, try giving them a copy of the UK guidelines for treating low testosterone and see how they respond.
The guide explicitly states levels under 12 nmol/L should be re-tested and testosterone therapy considered. Sending these guidelines before a follow up appointment is preferable.
Another alternative should the endocrinologist not go according to plan, is to get a referral to UCLH Andrology in London. This is a tertiary service offered by the NHS who particularly deal with male fertility issues, including low testosterone. Patients can self-refer through their GP: https://www.uclh.nhs.uk/OurServices/ServiceA-Z/UROL/AND/Pages/Home.aspx
This would also open the door to alternative treatment options like Clomid or HCG, which is a far superior option for those who are secondary hypogonadal.
Endocrinologist visits are free on the NHS.
So, what do you do if you’ve come this far, but haven’t been able to get treatment? You can keep trying again, with different doctors and endocrinologists and hope for the best. Or, you can go private.
Option 3 – Going Private
Private treatment is the most common route for TRT in the UK, especially for men in the orange and yellow “questionable” ranges. (see diagram further up)
Going private does not guarantee treatment. However, your chances of treatment are greater. This is due to less government bureaucracy and more experienced and open-minded medical practitioners.
There are a number of options available to private patients. These are the main ones I am aware of:
Private GPs
These are your regular doctors and general practitioners, like the ones you would see on the NHS. The only difference is that you pay for your consultations.
Like most things in life, you typically get what you pay for. Therefore, that level of service from private doctors usually creams that of NHS GPs, which in my personal experience, are sub-standard.
Consultation costs start at £50-100 upwards.
The big plus about paying for a private doctor is that IF they are also an NHS doctor, then they may write to your local GP and explain your situation. This may open the door to obtaining TRT through the NHS, having the private doctor act as a “consultant”.
Finding a Private GP in your area is already quite tough in the UK, however finding one that has experience with TRT is even tougher. Those that have been fortunate enough to find one however, usually report positive experiences in getting treated.
Men’s Health And Sex Clinics
These are your typical “Harley Street” men’s health and anti-aging clinics.
They typically cater to the older or more wealthier clientele seeking hormone treatment and anti-aging treatments. This includes testosterone replacement therapy, as well as a multitude of other services, like treating erectile dysfunction.
TRT is typically the most expensive at these clinics, with initial consultations alone costing anywhere from £350-£600 or more. The treatments (such as the testosterone injections) are usually heavily marked up in price as well.
Third Party Medical Facilitators
For those of us that have not been able to get treatment via the NHS, have not been able to find a private doctor or refuse to splash out an arm and a leg for testosterone therapy, at the clinics, medical facilitators may be the best option.
Medical facilitators are like middle men – they work with doctors and pharmacies and help you find treatment.
They handle your blood tests, prescription and medication, provided you qualify. Blood work is done, just like at any other doctor. However, they are much more reasonable with the ranges in which they prescribe, and pay more attention to your symptoms too. Your testosterone prescription is usually mailed to you and you administrator it yourself, usually via an injection.
Medical facilitators are slightly more expensive than going private and a lot cheaper than the men’s health clinics. However, they offer the convenience of handling everything for you and having everything done from the privacy of your home. Treatments start from £60 for basic TRT and increase from there based on how more advanced your treatment gets.
I currently make use of a medical facilitator personally, which I have spoken about many times on my YouTube Channel.
The Black Market – Is It Worth The Risk?
(Not An) Option 4 – The Black Market
In the spirit of being completely transparent, it would be intellectually dishonest if I didn’t list the black market as an option.
This is the route that most bodybuilders follow, usually purchasing their drugs from friends, or ordering from websites online.
I would like to make it explicitly clear that I DO NOT recommend that you follow this route. In fact, I highly advise that you DON’T, for multiple reasons, which I will detail in a separate article, but include:
You don’t get a legal prescription and purchasing these drugs is most likely illegal in your country
TRT should be used to improve and optimize your health. The black market in most cases works against that goal, unless managed extremely intelligently and carefully.
I do not recommend and discourage this path for TRT!
Conclusion
Whatever path you take, please be patient and be prepared to invest some time and research into your options.
Your health is crucial and should be addressed with care. Better be safe than sorry, so if you still have any questions, send me a message or leave a comment on social media.
Getting this wrong could be devastating. However, getting it right could change your life and potentially make you a new, or at the very least, an improved man.
All The Best!
Co-edited By Oliver Wilson-Hall – Special Thanks!
Personal Note: If this article helped you get on the right path to treatment, please feel free to send me some feedback on your situation and journey. With your permission (names can be kept private) I would love to share your story to help and inspire others in a similar situation. Thank You – Paolo
