About TRT
What is testosterone?
Testosterone is one of the Androgens, the group of sex hormones that give men their ‘male’ characteristics (collectively called virilisation). The major sex hormone in men is testosterone, which is produced mainly in the testes. It is essential for the development of male growth and masculine characteristics. The brain signals sent to the pituitary gland at the base of the brain control testosterone production in men. The pituitary gland then relays signals to the testes to produce testosterone. A “feedback loop” closely regulates the amount of hormones in the blood. When testosterone levels rise too high, the brain sends signals to the pituitary to reduce production.
What does testosterone do?
Testosterone plays multiple vital roles, such as:
Penis and testes development.
Deepening of the voice during puberty.
The appearance of facial and pubic hair starting at puberty; later in life, it may play a role in balding.
Muscle size and strength.
Bone growth and strength.
Sex drive (libido).
Sperm production.
Testosterone may also help maintain a normal mood.
Can you have too little testosterone?
In recent years, research has focused on the effects of testosterone deficiency, especially among men. As men age, testosterone levels drop gradually, about 1% to 2% each year.
The testes produce less testosterone, with fewer signals from the pituitary signalling the testes to make testosterone. Their livers produce more sex hormone-binding globulin (SHBG), which binds to testosterone circulating in the bloodstream. This reduces the active (free) form of testosterone in the body.
1 in 4 men over the age of 40 may have lower testosterone levels than what might be considered normal.
Symptoms of testosterone deficiency in adult men include
Low testosterone can impact the lives of fit, healthy men in various ways –
- Reduced body and facial hair.
- Loss of muscle mass.
- Flabby pectoral muscles.
- Low libido, impotence, small testicles, reduced sperm count, and infertility.
- Hot flushes.
- Irritability, poor concentration, and low mood.
- Disturbed sleep patterns.
- Weight gain.
- Brittle bones and an increased risk of fracture.
If you have any of these symptoms, you are not alone. Many men over the age of 30 experience similar symptoms.
How Testosterone Replacement Therapy (TRT) can help you?
Some men who have testosterone deficiency have symptoms or conditions related to their low testosterone that will improve when they take testosterone replacement. For example, a man with osteoporosis and low testosterone can increase bone strength and reduce his fracture risk with TRT.
Testosterone levels are checked through a simple morning blood test, and symptoms related to testosterone levels are evaluated using a validated assessment such as the ADAM questionnaire (Androgen Deficiency in the Ageing Male).
The challenging part is interpreting the results and deciding the best way forward. Testosterone levels vary over the course of the day. Even with a reduced level that is replicated on a repeat blood test, the decision to begin testosterone replacement therapy and decide the appropriate testosterone dose requires a careful conversation with your doctor. Your doctor needs to take into account your full medical history and any other medications you may also be taking.
Blood Tests for Measuring Testosterone: Why Choosing the Right One Matters
All blood tests begin the same way, either with a simple finger prick or a venous sample taken by a healthcare professional. But that is where the similarity ends.
The key difference lies in what is being tested. Some providers only assess basic Testosterone levels and a few additional markers before initiating treatment. At Smiths Medical Group we believe this approach is inadequate and not in line with best clinical practice, so we do not operate that way.
Testosterone exists in several forms within the body and binds to different proteins. That is why we test Total Testosterone, Free Testosterone, Albumin (which binds to Testosterone), and SHBG (Sex Hormone Binding Globulin), helping us understand why your Testosterone may be low. Comprehensive testing is simply good medicine, it is essential to fully understand your individual hormonal picture before starting any treatment.
In total, Smiths Medical Group tests for over 49 blood markers. Do not worry, it is still just one sample. We use this detailed information during your personalised consultation to assess your overall health, identify contributing factors, and ensure treatment is safe, effective, and tailored to you.
Your safety is always our priority.
Prostate Cancer
A high PSA level may indicate that you have or are at risk of Prostate Cancer. In many cases TRT may not be suitable and the best way forward with other options would need to be discussed with you with reference to your medical history and other blood parameters.
Cardiac Health
TRT may impact your Blood Pressure and Cardiac Health, we think it’s vital that we assess these before we initiate so together we can make the right plan for you
Male hypogonadism
This is essential to check for Primary or Secondary Hypogonadism which would lead to low Testosterone. It’s important that we rule out any underlying issues
Haematocrit and polycythaemia
The increased risk of blood clots (the cause of Strokes) needs to be assessed and if elevated a full management plan be put in place BEFORE TRT is initiated.
Kidney issues
The kidneys are crucial for maintaining fluid and electrolyte balance in the body. When testosterone is metabolized by the body, the kidneys help to filter and excrete the waste products, including conjugated testosterone, through urine. Its important to know before starting if your kidneys are healthy.
Liver issues
TRT enters the bloodstream. The liver is a major site for the metabolism of testosterone, breaking down testosterone through a process known as biotransformation. This involves converting testosterone into more water-soluble compounds that can be easily excreted from the body. It is vitally important that we check the health of the liver before commencing TRT.
TRT options
Each man is different, which is why a personal consultation with an expert is so important.
At Harley Street TRT, we don’t have protocols that say everyone must get the same treatment. We look at the individual, their medical history, and their other medications and then decide with them what is the best treatment for them.
However, we have provided this summary based on our extensive clinical experience.
| Capsules | Injections | Gels | |
|---|---|---|---|
| Ease of use | Easy | Moderate | Difficult |
| Frequency of dosing | 1 -2 tablets, once or twice daily. | Inject yourself 2 – 3 times a week. | Apply gel to your arms and shoulders once a day. |
| Efficacy and speed of action | Patients report impact within 1 – 2 weeks. Dosing can be changed to reach peak testosterone. | Rapid onset of effect. | Varied responses. |
| Advantages & disadvantages | Ease of taking and consistent levels. | Rapid onset but can lead to peaks and troughs. | Can be messy to apply. |
| Provides consistent mimicking of the body's natural testosterone production. | Bruising on upper arm due to injection puncture. | After gel application, contact with others must be avoided for at least one hour. |