Dr. Diana Rangave
Dr. Diana RangaveCurious about TRT in the UK?
Well, you’ve come to the right place.
In this comprehensive overview, we’ll get into everything you need to know about Testosterone Replacement Therapy (TRT) in the United Kingdom.
We also answer your most important questions, including:
- Is TRT available online?
- Can I get TRT through the NHS?
- Do I need to see a specialist doctor for TRT?
…And so much more!
We also explain what TRT actually is, the most common TRT side effects, TRT treatment costs, and legal issues that you MUST be aware of!
Whether you’re interested in getting hormone testing to see if you should start TRT, or have been on treatment for a while, there is something in this guide for you.
First, let’s take a look at what testosterone is…
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What is Testosterone?
Testosterone is a vital hormone that plays an important role in the health of both men and women [1, 2].
It is often referred to as the male sex hormone, because it causes teenage boys to develop typically male characteristics, like facial hair, a lower voice, and increased muscle mass.
Adequate testosterone levels are essential for optimum health, sexual and reproductive ability, and physical performance throughout the lifespan [3].
Men’s testosterone levels are generally 10—20 times higher than women’s, although it plays an important role in both genders [4].
In women, estrogen is the primary sex hormone.
As expected, estrogen levels are much higher in women than in men. However, just like testosterone in women, men do require some amount of estrogen for good health.
Men’s hormonal health is substantially impacted by the ratio of testosterone to estrogen.
In fact, this ratio may be even more important than men’s total testosterone levels for their overall health and well-being [5].
Levels of circulating testosterone should always outweigh estrogen by several orders of magnitude, but a corresponding amount of estrogen is required for optimal hormonal balance [6].
Concerningly, rates of hypogonadism (low testosterone levels) seem to have been increasing in men of all ages. It has long been known that older men commonly experience low testosterone, but researchers are now noticing it in middle-aged men, and even teenagers [7, 8, 9].
Low testosterone levels can cause several problems in men of any age, including [1, 10, 11, 12]
- Fatigue, depression, and lack of energy
- Sexual problems, such as erectile dysfunction and lack of sex drive
- Obesity and difficulty building muscle
- Increased risk of medical issues, like heart disease, diabetes, and osteoporosis
Fortunately, if a man finds out he has low testosterone, effective treatments are available.
What is TRT (Testosterone Replacement Therapy)?
Testosterone replacement therapy (or TRT) is a well-established, effective, and safe way to treat low testosterone levels [13].
It is sometimes also referred to as Hormone Replacement Therapy (HRT) — both terms describe the same treatment.
If a hormone test identifies low testosterone levels, several treatments can be prescribed by a doctor to bring levels back into a normal range. Testosterone medications are available in the following forms:
- Injections
- Gels
- Creams
- Patches
All of these forms of testosterone are effective, and a TRT doctor can help decide which might be best suited to a patient’s individual needs [14].
Some people (and doctors) are wary of using TRT, believing that it is the same as taking anabolic steroids.
Testosterone is technically a steroid, but using it to treat low testosterone levels is very different to anabolic steroid abuse.
Bodybuilders and athletes take anabolic steroids for several reasons — most commonly to enhance physical performance and increase muscle mass [15].
The purpose of using anabolic steroids is to increase testosterone levels well above normal ranges. To achieve this, steroid users often take a variety of other substances in addition to testosterone.
When used for TRT, the only goal of testosterone treatment is to bring low levels into a normal range.
Most TRT involves administering a form of testosterone that is very similar to what is already present in the body. “Bio-identical HRT” is now becoming more popular and utilizes testosterone that is identical to the form naturally produced in humans.
TRT has a good safety profile, but there are some side effects to note [13].
Testosterone Replacement Therapy | Side Effects and Safety Concerns
Every medication has safety concerns and potential side effects.
Some uncommon, but potential side effects of TRT are [16]:
- Raised liver enzymes
- Enlarged breast tissue, aka “gynecomastia”
- Retention of fluid
- Increased prostate size
- Development (or worsening of) acne
- Local skin or tissue irritation
It is important to note that safety concerns about TRT are very rare.
In fact, recent research suggests that several of these issues (including the safety concerns below) may not be as much of a concern as initially thought [17].
The main safety concerns noted with TRT are [16]:
- May potentially make prostate cancer progress faster
- Can increase the general risk of cardiovascular problems
- Fertility can be impacted
- May exacerbate sleep apnea
Doctors and patients should keep the above list of potential concerns in mind.
But research shows that when properly administered and monitored, the vast majority of men do not experience any problems from TRT [13].
Before making a decision on whether to start TRT, men should weigh the massive potential benefits in overall health, wellbeing, and quality of life, with any possible risks [16].
TRT in the UK | Legalities, Regulations, and More
Now, we’re going to cover some technical legal information here.
But don’t worry, we’ll explain everything in an easy to understand way, so that you have all the facts about the legalities of HRT in the UK.
Testosterone has a bit of a bad reputation amongst some people.
This is largely cause by the illegal use of anabolic steroids in sports. This has made many men wary about discussing TRT with their doctor, sometimes because of a mistaken belief that it might be illegal in some way.
Well, we are pleased to advise that TRT (and the possession of testosterone for personal use) is completely legal in the UK.
Just to cover all bases, let’s have a brief look at the relevant legislation.
How Is Testosterone Scheduled in the UK?
All drugs (and medications) in the UK are scheduled into certain classifications under the Misuse of Drugs Act 1971 [18].
There are 3 classes of controlled drugs in the legislation: ‘class A’ drugs are the most harmful, while ‘class C’ drugs are the least harmful.
Testosterone is a controlled drug that falls into ‘Class C’ of the restricted drugs under the Act [19].
The next piece of legislation we need to cover is the Misuse of Drugs Regulations 2001 [20].
This is the Act that provides the basis for legal enforcement around possession and supply of restricted drugs.
Testosterone comes under schedule 4, part 2 of this legislation. The Act states these are:
“Controlled drugs excepted from the prohibition on possession when in the form of a medicinal product; excluded from the application of offences arising from the prohibition on importation and exportation when imported or exported in the form of a medicinal product by any person for administration to himself.”
Phew! Take a breath and we’ll give you the short version in plain language right now…
Is Testosterone Illegal in the UK?
There is a very clear answer to this question: no – testosterone is NOT illegal in the UK.
While testosterone is technically considered a controlled substance, it is not illegal to possess testosterone for personal use in the UK.
However, please be aware — it is ILLEGAL to sell or supply testosterone to another person in the UK (other than by valid prescription).
There are penalties applicable to this in the Misuse of Drugs Regulations 2001.
So, that all sounds like good news for men in the UK who need TRT, right? Getting treated for low testosterone should be as simple as seeing your doctor, having a hormone test, then getting a prescription.
Unfortunately, it’s still a bit of a struggle for many men in the UK to get prescribed TRT…
Don’t stress, though. Next, we’ll cover all the important information you need to know about getting prescribed TRT from a doctor. Soon, we’ll even review some of the best HRT providers in the UK.
How to Get Testosterone Replacement Therapy in the UK
Many men wonder — if TRT is legal, easily available, and safe — why is it so hard to get a prescription in the UK?
There is no single answer. The main contributing factors are:
- Confusion amongst doctors about NHS guidelines for TRT
- The bad reputation testosterone has in the community (mainly because of illegal use in sports)
- Lack of awareness in the medical community about the benefits of TRT and the negative effects of low testosterone
We can’t do much about testosterone’s reputation, but we can help you work through the other issues.
Let’s start by looking at how TRT fits in with the NHS.
TRT and the NHS
While the NHS does a wonderful job of facilitating medical treatment for many health problems, its guidelines (or lack of them) don’t work all that well for TRT.
Really, the only ‘rule’ that the NHS has around TRT, is the classification of testosterone as an “Amber” drug [21]. This indicates that testosterone falls in the middle of the “traffic light system” the NHS uses to guide the prescription of certain drugs.
Being an amber drug means that testosterone must be initiated by a specialist, then can potentially be transferred to a primary care doctor (GP) for ongoing management.
The specialist required to initiate TRT is an endocrinologist.
The good news with this, is that if you see your GP and they agree to refer you to an endocrinologist, you may be able to get TRT provided through the NHS.
The bad news is, if the endocrinologist doesn’t think you need TRT, or if your GP won’t refer you in the first place, you won’t be getting TRT through the NHS.
Because there essentially are no NHS guidelines about what actually constitutes a diagnosis of low testosterone, you really are at the mercy of your doctor’s views about TRT.
Some doctors are very understanding and won’t insist on a super low testosterone level to start treatment. However, other doctors are more stringent.
Most doctors use either the guidelines from the Society for Endocrinology or the British Society for Sexual Medicine (BSSM) [22, 23]. Both recommend a cut-off of around 8nmol/L to start TRT, with possibility of a trial of treatment if levels are below 12nmol/L and symptoms of low testosterone are present.
Curiously, recommendations in both guidelines are to aim for testosterone levels of 15 —30nmol/L in men receiving TRT, identifying these as target levels for “optimal response”.
This seems to suggest that many men could have far lower than ideal testosterone levels according to the guidelines, yet not qualify for TRT.
Add to these problems the fact that there can often be a wait of 6 – 8 months to see an NHS endocrinologist, and it is no wonder that many men in the UK seek private treatment for TRT.
Understanding Private Scripts
For people who have trouble getting TRT through the NHS, there is another option — a private script.
It is perfectly legal for doctors to provide private treatment and prescriptions.
The term is used to describe medical care that is provided outside of the NHS, with the cost being fully funded by the patient.
This gets around the barriers to TRT that can often be present with the NHS, or with a doctor who isn’t knowledgeable and compassionate about low testosterone.
The key with private scripts is to see a doctor who is experienced with TRT and provides high-quality, comprehensive care.
While this will inevitably be more expensive than the NHS, you may be surprised to find that it is quite affordable — particularly through online TRT services.
How To Talk To a Doctor About TRT
Thankfully, there are now many doctors in the UK who are understanding about TRT.
They recognize that following Government guidelines won’t always provide the best care, and are willing to give their customers a fair go.
If you think you might have low testosterone, the most important thing is to see a doctor experienced in TRT.
Finding a doctor who understands TRT and doesn’t have any personal bias or prejudice against this important treatment, is MUCH easier than trying to change the mind of a doctor that’s not supportive.
When you have found a doctor, start by explaining the symptoms you believe are related to low testosterone. This document by the BSSM has a good list of official descriptions of symptoms that will be familiar to your doctor [24].
In any case, here are some of the most common signs of low T:
- Low energy
- Reduced muscle mass
- Increased fat mass
- Impaired sexual health
A blood test will likely be required, but remember, symptoms are an important factor that goes into considering whether to start TRT.
Your doctor will likely cover the potential for abuse of testosterone, and also possible side effects and risks. This is because even when treatment isn’t provided through the NHS, doctors are still legally bound to provide safe and high-quality medical care.
An exciting change in recent years in the UK, is that there are now TRT doctors available via telehealth and online.
Let’s take a look at our top recommendation for online TRT.
Online TRT Doctors in the UK | #1 Option?
When it comes to online TRT doctors in the UK, our number one pick is Balance My Hormones.
There are other options out there, but none can compete with the professional, accessible, individualized service offered by Balance My Hormones.
To get started, head over to their website and take the ADAM (Androgen Deficiency in Aging Males) questionnaire to see if you might be suffering from low testosterone. If so, leave your details, or chat with an online consultant.
Before you know it, you will be speaking to a medical case manager, who will guide you through the process of ordering a blood test online, then arranging an online consultation with a doctor.
You can choose to go into a clinic if you prefer, but many people in the UK (and the EU) undertake all their treatment through Balance My Hormones online.
The doctor will go through the results from your blood tests, plus discuss your symptoms and personal medical history.
One of the best things about Balance My Hormones, is that they offer a truly comprehensive service regarding hormonal issues and men’s health.
Not only will they look after low testosterone levels, but they can also provide:
- Treatments for erectile dysfunction
- Anti-aging with HGH and IGF-1
- Comprehensive hormone balancing, including anti-estrogen treatment
- Gynecomastia management
Balance My Hormones don’t just give you testosterone and call it a day.
They work with you to make sure every aspect of hormonal and sexual health is looked after. All treatment is provided on an individual basis and caters to the specific needs of the patient.
Doctor’s appointments can be done online via telehealth and medications can be picked up at a local pharmacy, or delivered directly to your home — it really is that easy!
If you notice a bit of a different vibe with Balance My Hormones, that is because it isn’t your average TRT clinic.
Many of the staff at Balance My Hormones — from the founder, to the case managers, to the doctors — have personal experience with TRT. They know what it’s like to suffer from low testosterone levels, and to have difficulty accessing treatment through the NHS.
Balance My Hormones is a completely private, fee-for-service clinic. Despite this, their personalized treatment is surprisingly affordable.
Costs vary on the treatment provided, but most men receive all their medical input for TRT, medications, and monitoring for between ￡70 and ￡113 per month.
TRT Cost in the UK | What You Must Know
Unfortunately, we can’t give an exact breakdown of the exact amount HRT costs in the UK.
Costs vary depending on the doctor who manages your treatment, what form of TRT you choose (gels, patches, injection), and several other individual factors.
What we can tell you, is that it’s worth putting some serious consideration into whether the cost savings of pursuing treatment through the NHS is worth it.
Some men get lucky and have a smooth ride arranging TRT through their GP and endocrinologist. But many others encounter so many barriers that they give up on this life-changing treatment altogether.
Problems like:
- Long wait times for specialist appointments (commonly 6 – 8 months)
- Huge variance between providers in how low testosterone is diagnosed
- Lack of flexibility and choice in what form of TRT will be prescribed (HRT patches in the UK are uncommon)
- Being treated like you are trying to obtain an illegal or dangerous drug
Are all incredibly common when trying to get TRT through the NHS.
The fact is, while it’s not the cheapest option, a private script is the most reliable way for men in the UK to obtain TRT.
TRT in London, UK
Our top TRT clinic in London offers online as well as in-person clinic appointments. So, if you don’t live nearby, they can still help you out.
Optimale has clinics in London and Southampton.
They are a straight-shooting, no-fluff service, that is dedicated to providing fast, convenient, and effective TRT to men who need it.
The founder and lead doctors at Optimale have all experienced low testosterone themselves, then gone on to successfully regain their health and vitality with TRT. They understand the personal experience of low testosterone and offer a reliable, discrete, and efficient service.
By partnering with local pharmacies they make getting medications a breeze. They can even arrange home delivery, meaning that all treatment can be provided from the comfort of your own home.
To see if you might benefit from TRT, start by doing Optimale’s online assessment.
TRT in Manchester, UK
People living in Manchester should count themselves lucky. They have access to one of the leading male health clinics in the UK — Center for Men’s Health.
With locations in London and Manchester, Center for Men’s Health has been at the forefront of men’s health for over 25 years.
Their doctors are experts in TRT and provide, diagnosis, treatment, and ongoing management of low testosterone, erectile dysfunction, and several other sexual and general health issues.
What sets Center for Men’s health apart from other TRT clinics in Manchester, is their wealth of experience treating men with low testosterone. Their male hormone specialists have spent over 30 years refining their unique approach to TRT.
When you choose the Center for Men’s Health for treatment, you can be confident that you are in the hands of one of the most skilled teams of doctors for TRT in the UK.
TRT in Birmingham, UK
Choosing a TRT clinic in Birmingham is simple—TransformNow is by far the best offering in the area.
TransformNow opened its doors in 2013 and has since grown into a network of 6 clinics throughout the UK. They provide TRT and several other men’s health services, both in-person and online.
While TransformNow has historically focused on treating athletes, they have developed comprehensive TRT and men’s health programs for executives, and over 40’s. Like all good HRT services, they provide individualized assessment and treatment, focused on the overall health goals of each patient.
In addition to prescribing TRT, TransformNow will work with men to optimize all aspects of health. They address lifestyle factors like diet, exercise, sleep, and stress management, all of which help to ensure men get the most benefit from TRT.
The best place to start, is to head over to their website and complete a survey to see if you might have low testosterone.
TRT in Glasgow, UK
Our number one recommendation for a TRT clinic in Glasgow is Men’s Health Scotland.
A professional operation through and through, Men’s Health Scotland provides high-quality, compassionate, and discrete treatment for men with low testosterone and sexual health problems.
The mission of Men’s Health Scotland is to make more proactive treatment available for men’s health issues, rather than waiting until problems reach crisis point. They understand the particular health needs of men, especially when it comes to hormonal and sexual difficulties.
Your general practitioner can refer to the clinic, or men are welcome to make contact directly to book an appointment.
Please know, Men’s Health Scotland is not some fly-by-night TRT operation.
It is operated by two well-respected senior urologists, who are at the forefront of practice when it comes to TRT.
If you want the confidence of knowing that your hormonal and sexual health problems will be handled by experts at the top of their game, reach out to Men’s Health Scotland and book an appointment.
TRT in the UK | The Ultimate Guide
We covered some complex topics in great detail in this guide.
Due to NHS bureaucracy and misplaced negative views about testosterone, getting TRT in the UK can be more difficult than it needs to be.
Many doctors in the UK lack detailed knowledge about low testosterone. While going to your general practitioner about this issue is an understandable first step, it is quite likely that this won’t result in getting the treatment you need.
Thankfully, there are doctors in the UK who are dedicated to helping men with low testosterone.
Such doctors recognize the devastating impact of low testosterone. They realize that TRT is a safe, effective, legal way of treating low testosterone, that results in huge benefits in health and quality of life for men.
Here are our recommended TRT clinics in the UK:
- Online TRT – Balance My Hormones
- London TRT – Optimale
- Manchester TRT – Center for Men’s Health
- Birmingham TRT – TransformNow
- Glasgow TRT – Men’s Health Scotland
Our main recommendation is to start with online TRT.
Getting treatment online or by telehealth is usually the most affordable, fastest, and least complicated way for men to get TRT.
We also covered some local options for men who prefer to attend a clinic in person.
For most men, starting TRT rapidly resolves all the problems that come with low testosterone. Once treatment is started, periodical blood tests and a checkup a few times a year are all that is required for ongoing management.
