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.
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
- 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
- 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:
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.
(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
- Potentially dangerous to your health
- Probably brewed in a bath tub
More information on UK Steroid Law (I do not vouch to the authenticity or accuracy of this data): http://www.ipedinfo.co.uk/steroid_law.html
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!
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
16 CommentsLeave a comment
Love all your youtube vids, im getting close to seeing my endo on nhs, question though, do you know whether they use any other kind of t jabs apart from nebido as ive heard it can take a year to work , ive been speaking with your mate , mike kokcis, im half tempted.to.just go with him, what do you think?hope you are well
Thanks for the great question. I have answered it in a video on YouTube: https://www.youtube.com/watch?v=XkwsDw5T3Go&t=25s
My partner is on Nebido injections, he has 1000mg injected every 12 weeks. He has been on these injections for about 2 years (before I met him). We are currently ttc, however he was unaware that TRT can cause reversible infertility, his consultant never asked the question as to whether he wished to persevere his fertility, which at the time he didn’t question due to just wanting to get himself better. It was only once I researched this for myself that I stumbled across many articles explaining why fertility was affected. When I mentioned this to my partner he was in shock as he had no idea.
Now he has conceived one child before being treated for low T (with an ex partner). So my question is this, how likely is our GP or endo (who my partner hasn’t seen in a year and a half) going to prescribe HCG, which I’ve researched and it’s suggested can reverse the effect of infertility caused by TRT. I’m 31 and have 4 children from a previous relationship my partner is 43. We have been ttc for 6+months.
Any advice or questions that will help us when we visit the GP to get the ball rolling will be greatly appreciated.
On an end note, I’m infuriated by our healthcare system and lack of knowledge in male health from so called educated professionals, more needs to be done A) for men suffering the effects of low T and B) To make patients who wish to conceive in the future, the options available to them.
Thanks for reading,
Thanks for the question. I have created a video to help address your concerns. I hope it helps. Thanks.
Great website, just came across it by accident after searching remedies and help for weeks now. I have an appointment with my GP next week to try get eh ball rolling but as you said this can be a struggle, I have seen similar comments and heard similar stories on other websites/blogs. A few things surprised me and caused me concern when looking into this, one of them was how there are no Mens health clinics but there is an abundance of women’s clinics covering just about everything and all are free run by local authorities and the NHS. The other is how easy it seems for the transgender community to be referred for Testosterone treatment to change their hormones but MEN who are struggling to produce this naturally and are living in hell are blocked at every turn. Hopefully I will get a friendly ear from my GP who will assist. I had a road accident 6 years ago and things have spiralled since then so I am wondering if a head injury has affected my pituitary gland which I have read studies in the USA that this can be a cause. I will update as to what happens as I think websites like this are very important for other men going through this and helps us understand we are not alone. Cheers fella.
Funny you should mention the transgender thing. I actually did a video on that exact topic a while back: https://www.youtube.com/watch?v=enAYBxIm9go
Head traumas can be a definite cause of low testosterone when the pituitary gland is affected. Definitely go get that checked out. And let us know how it goes.
Thanks and good luck!
Went to see the doctor given blood test result this time was 13.4 last time 12.1 recommended see an eurologist not a endocrinologist also did not see the letters from the hospital with results should I see recommended eurologist or look for another doctor to try get another blood test bearing in mind all the doctors use the same hospital for blood tests
Unfortunately, you’re in that low range which most doctors/endos/the NHS will try to avoid treatment and consider you “normal”. However, we all know is low and not normal, especially if you are experiencing symptoms.
Try your luck at the doctor and endo first and stress the symptoms you are experiencing. It’s probably going to be a lottery as to whether they will treat you or not. If not, you will likely have to consider paid private treatment. Which is still worth it, compared to not being treated at all.
Thanks for the article. Another option is to explore the legally available products sold by nutrition companies. It would be interesting to know if you think there is any value in products sold…well at least the active ingredients. (I.e Tribulus)
Most of these supplements marketed as raising testosterone are usually misleading and either have no effect on testosterone, or, the effect is so negligible that it is not worth consuming, as the percentage increase in testosterone would not be felt or make any significant impact.
Cleaning up your lifestyle (diet, exercise, quit alcohol and drugs, reduce stress) is about the best natural approach you can take to raising T levels. The next step after that, if you’re still low, is TRT unfortunately.
I started TRT last year and i chose the black market option.
Honestly i don’t think its nearly as dangerous as people like to make out. What you did not mention in your article is that you can actually buy pharmaceutical testosterone from companies such as bayer, just sold by underground sources without prescriptions.
It costs me around £14 each month for my TRT and £100 for the blood tests twice a year. And i have the peace of mind knowing exactly what i am injecting. Pharmaceutical testosterone, exactly the same as a doctor would prescribe.
Agreed. I have no problem with people using the black market if they know exactly what they’re doing and they trust the sources. It would be irresponsible of me to promote it, but I definitely think it can be a viable alternative to those who don’t want to go through the system.
I believe in personal power and taking responsibility for one’s own actions – and from there everyone is free to make their own decisions. Best wishes with your treatment. Keep us posted from time to time on how things go.
Apologies if I came across as hostile in my original message. The article you have wrote here is informative and a great help to anyone who may be suffering from low testosterone.
And the black market sure can be a dangerous place… You just have to really know what you are doing, I guess.
It wasn’t my first choice though. I did try and get it prescribed through my doctor. They done blood tests and told me my test level was perfectly normal. I asked to see the actual blood results and my level was 370.
My instant response was, 370? What? Normal for a 70 year old man maybe? Definitely not optimal for a 24 year old man!
They refused to do anything to help raise it as I was still in the normal range. Despite my voice going high pitched, couldn’t make any gains in the gym despite paying for a personal trainer and eating right. My confidence was at an all time low and I developed social anxiety.
So unfortunately I had little option but to prescribe it to myself. Well I did have options but I refused to pay £150-£400 a month for 3ccs of testosterone!
To be fair I did destroy my own testosterone by running a steroid cycle when I was 18/19 years old.
Things changed as expected once o started TRT. My voice gone deep (people finally looked at me like a man) gained muscle mass, social anxiety practically gone ect.
I do run my TRT a little higher than most. 250mg a week… Puts me just out of the normal range but I get my bloods checked regularly!
Will keep you guys updated.
No worries. Honest feedback, especially real world solutions to real world problems, is always appreciated.
I would highly suggest that you do an article with all available testosterone brands (as I only know about nebido), with feedbacks for each of them. For newbies like me that really wants to change his life, asap.
Joshua should have also mentioned the source where he’s getting his testosterone. Some websites or other sources for people that can not get any help through NHS or, I say OR, are so depressed because of low T that they feel they no longer belong to this planet.
If you are lucky to get referred to an endo doc and live in UK (don’t know how long it takes anywhere else), chances are you will be seeing that doctor in 3 months, to tell you to make a blood test and see him again in another 3 months, so you will probably waste half year to get treatment starting.
Great idea. I’ll add that to the content schedule. I had the same experience with the endo and NHS in the UK. A year of suffering until I decided to go private.