Low Testosterone on the NHS: What’s Available and What to Expect

Introduction

Testosterone is an important hormone in the human body, especially for men. It plays a key role in many functions, such as building muscle, maintaining bone strength, supporting mood and energy levels, and helping with sex drive. Testosterone also supports the development of male features like facial hair and a deeper voice. As men age, their testosterone levels naturally drop. However, in some cases, this drop can be more than expected and may lead to a condition called low testosterone, or hypogonadism.

Low testosterone is a medical condition where the body does not make enough of the hormone. This can lead to many symptoms that affect quality of life. These may include tiredness, low mood, loss of muscle mass, weight gain, poor sleep, and reduced interest in sex. Some men may not realise they have low testosterone, as the signs can be slow to appear and may seem like common signs of getting older or stress. That is why it is important to be aware of the condition and know when to speak to a doctor.

In the UK, many people turn to the NHS for help when they start to notice health problems. The NHS, or National Health Service, is the publicly funded healthcare system. It provides a wide range of services to people who live in the UK, usually free at the point of use. When it comes to hormone problems like low testosterone, the NHS offers help with testing, diagnosis, and treatment. The level of support can depend on a few things, including the person’s symptoms, test results, and location in the UK.

The number of men being diagnosed with low testosterone has gone up over the years. Some experts think this is because more people are now aware of the condition and are more likely to ask for help. There are also better tools to test hormone levels today than in the past. At the same time, social media and online health information have helped more men understand their symptoms and seek answers.

However, many men still have questions about what the NHS can offer for low testosterone. Some want to know how to get tested, what kinds of treatments are available, and how long they may need to stay on treatment. Others want to understand the risks or costs linked with therapy. It is also common to ask about how private care fits with NHS services, or what happens after a diagnosis is made. These questions are often searched online by people who are looking for clear and trusted answers.

This article will help explain the process of getting help for low testosterone through the NHS. It will give a clear and simple guide on what to expect, from first noticing symptoms to starting treatment and getting follow-up care. It will also explain the rules and steps doctors follow to make sure treatment is safe and right for each person.

For people who think they might have low testosterone, this information can help them feel more prepared and confident about speaking to a doctor. For those already diagnosed, it can explain what the journey might look like over time. Understanding the process can help make things feel less confusing or stressful. Having the right facts also means that men can make informed choices about their health.

By the end of this article, readers will have a better understanding of how low testosterone is handled by the NHS. It will cover the most common concerns and give helpful facts based on medical guidelines and NHS practice. Knowing what support is available can make a big difference in getting the right help at the right time.

What Is Low Testosterone?

Testosterone is a hormone made mostly in the testicles. It plays a key role in the health and development of the male body. It helps with muscle growth, bone strength, sex drive, and the making of sperm. It also affects mood and energy levels. While women also produce some testosterone, men make much more of it.

Low testosterone, sometimes called testosterone deficiency or hypogonadism, happens when the body does not make enough of this hormone. This condition can affect many parts of a person’s life, including their physical health, mental health, and sexual wellbeing.

What Counts as Low Testosterone?

Doctors usually find low testosterone by testing blood levels of the hormone. Normal testosterone levels in adult men usually fall between 300 to 1000 nanograms per deciliter (ng/dL), though exact numbers can differ slightly between labs. On the NHS, levels are measured in nanomoles per litre (nmol/L), with a normal range usually considered to be between 10 to 30 nmol/L.

Low testosterone is usually diagnosed when the level is below 8 nmol/L, especially if the person also has common symptoms. Levels between 8 and 12 nmol/L may be considered borderline. In these cases, more tests and a review of symptoms are needed before making a diagnosis.

It is important to know that a single test result is often not enough. Testosterone levels can change throughout the day and are usually highest in the early morning. That is why doctors often ask for more than one blood test done early in the day to confirm the diagnosis.

Types of Low Testosterone

There are two main types of testosterone deficiency: primary and secondary.

• Primary hypogonadism happens when the testicles themselves are not working properly. This can be due to injury, infection, surgery, or a genetic condition like Klinefelter syndrome. Even if the brain sends the right signals to make testosterone, the testicles cannot respond correctly.

• Secondary hypogonadism starts in the brain, especially the hypothalamus or the pituitary gland. These areas help control how much testosterone the testicles make. If they do not send the right signals, testosterone levels drop. Causes may include pituitary tumors, certain medicines, or being overweight.

Sometimes, both the testicles and the brain areas involved are affected. This is called mixed hypogonadism.

What Can Cause Low Testosterone?

There are many possible causes of low testosterone. Some are short-term and can be treated. Others may lead to long-term hormone problems. Common causes include:

• Aging: Testosterone levels slowly drop with age, starting around 30 years old. This decline is normal, but in some men, it leads to symptoms that may need treatment.

• Injury or surgery to the testicles: Trauma or removal of a testicle can reduce hormone production.

• Infections: Some infections, like mumps in adulthood, can damage the testicles.

• Chemotherapy or radiation: Cancer treatments may harm hormone-producing glands.

• Obesity: Excess body fat, especially around the belly, is linked with lower testosterone.

• Long-term illness: Conditions such as type 2 diabetes, liver disease, or kidney failure can affect hormone levels.

• Steroid use: Anabolic steroids can shut down the body’s natural testosterone production.

• Medications: Certain drugs, including opioids and antidepressants, may lower testosterone.

In many cases, more than one factor may be involved. This is why a full medical review is often needed to find the root cause.

Who Gets Low Testosterone?

Low testosterone can affect males of any age, but it becomes more common with age. Studies suggest that about 1 in 200 men under 60 have clear symptoms and low blood levels. In older men, the number may be higher. Men with chronic illnesses, those who are overweight, and those taking certain medications are at higher risk.

Even though testosterone naturally drops over time, not every man will feel the effects. Treatment is not based on age alone—it depends on both hormone levels and symptoms.

Understanding what low testosterone is—and what causes it—is the first step toward finding help and support. Testing and treatment can make a big difference, especially when symptoms are getting in the way of daily life.

What Are the Symptoms of Low Testosterone?

Low testosterone, also called low T or testosterone deficiency, can affect the body and mind in many ways. Symptoms may appear slowly and are often mistaken for signs of aging or stress. These symptoms can affect different areas of health, including physical strength, sexual function, and mental well-being. It is important to understand the different signs, especially if they last a long time or affect daily life.

Physical Symptoms

One of the most common physical signs of low testosterone is tiredness. Many people with low T feel tired even after a full night’s sleep. They may find it hard to stay active or feel like they have less energy for work or exercise. This tiredness does not usually go away with rest and can make it hard to keep up with daily tasks.

Another sign is loss of muscle mass and strength. Testosterone helps build and maintain muscle. When levels are low, muscles may shrink, and lifting objects or doing physical activity can feel harder than before. Some people also notice weight gain, especially around the belly. This can happen even without changes in diet or exercise. Extra body fat can make testosterone levels drop further, creating a cycle that is hard to break without medical help.

Bone strength may also be affected. Testosterone helps keep bones strong. When levels are too low for a long time, bones may become weaker and more likely to break. This is called osteoporosis. Although it is more common in women, it can happen in men with low testosterone, especially as they get older.

Low T may also affect the skin and hair. Some people notice their skin becomes drier or thinner. Hair may thin out, especially on the arms, legs, or face.

Sexual Symptoms

Testosterone plays a key role in sexual health. One of the main symptoms of low T is a drop in sex drive. A person may feel less interest in sex or find it harder to become aroused. This can happen slowly or all at once. A lower sex drive can affect relationships and self-esteem.

Another common issue is erectile dysfunction. This means having trouble getting or keeping an erection. Testosterone is not the only hormone involved in this process, but it does help. Low levels can make it harder to have a firm or lasting erection, even if there is still interest in sex.

Some people with low testosterone also notice a drop in sperm count or fertility. The body may produce less sperm, which can make it harder to have children. This is especially important for people trying to start a family and should be discussed with a doctor.

Mental and Emotional Symptoms

Low testosterone can also affect the brain. A common problem is low mood or depression. People with low T may feel sad, hopeless, or lose interest in activities they once enjoyed. This can happen even if there is no clear reason for feeling down.

Some people also experience trouble concentrating. They may feel mentally foggy or find it hard to focus on tasks. Memory may be affected, especially short-term memory. These changes can affect work or daily decision-making.

Irritability or mood swings are also linked to low testosterone. A person may feel angry or upset more easily than before. Small problems may seem bigger, and emotions may be harder to control. This can affect relationships at home and at work.

In some cases, people feel more anxious or nervous. They may worry more or feel on edge. These feelings may come with sleep problems, such as waking up during the night or trouble falling asleep.

All these symptoms can build over time. It is common for more than one symptom to happen at the same time. These signs do not always mean testosterone is low, as they can also be caused by other health problems. But when several of these issues appear together and last for weeks or months, it may be a sign of testosterone deficiency. A healthcare provider can check hormone levels and help find out what is causing the symptoms.

How Is Low Testosterone Diagnosed on the NHS?

Low testosterone, also called hypogonadism, can cause a range of symptoms that may affect daily life. Before any treatment can begin, the condition must be properly diagnosed. The NHS follows a clear process for testing and confirming low testosterone. This process includes a physical check-up, blood tests, and sometimes a referral to a specialist. Understanding how low testosterone is diagnosed helps patients know what to expect and when to ask for help.

Step 1: Visiting a GP

The first step usually begins with a visit to a general practitioner (GP). A GP will listen carefully to symptoms and ask about general health, lifestyle, and any medical history. Symptoms that may raise concern include tiredness, low sex drive, trouble with erections, mood changes, and loss of muscle mass. Sometimes, these symptoms can also be caused by other health problems like stress, poor sleep, or thyroid issues. That’s why it is important for the GP to look at the full picture before doing any tests.

The GP may also check for physical signs. These can include reduced body hair, smaller testicles, or increased body fat. A physical examination helps rule out other conditions and gives more information before ordering blood tests.

Step 2: Blood Tests

If the symptoms and examination suggest that testosterone may be low, the next step is a blood test. This is the most important part of diagnosing low testosterone. The blood test looks at the level of testosterone in the body. It is usually taken early in the morning between 7 a.m. and 10 a.m. This is because testosterone levels are highest in the morning and can drop later in the day.

For the test to be accurate, it is usually recommended that the patient has not eaten for several hours beforehand. A fasting blood test helps avoid changes in hormone levels caused by recent food intake.

The key measurement in the test is total testosterone. This shows the overall amount of testosterone in the blood. If the level is lower than normal, the GP may ask for another test on a different day to confirm the result. This is because hormone levels can change from day to day. A single low result is not enough to diagnose the condition.

If total testosterone is borderline or low, more blood tests may be needed. These extra tests look at luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These are hormones from the brain that control how the testicles make testosterone. Testing LH and FSH helps to find out what type of hypogonadism is present. If LH and FSH are high, the problem is likely in the testicles (called primary hypogonadism). If LH and FSH are low or normal, the problem may be in the brain or pituitary gland (called secondary hypogonadism).

Other tests may also be ordered, including:

• Sex hormone-binding globulin (SHBG) – this binds to testosterone in the blood. It helps work out how much “free” or active testosterone is available.

• Prolactin – high levels can affect testosterone.

• Thyroid function – thyroid problems can mimic low testosterone symptoms.

• Iron levels and blood count – to check for other possible causes of tiredness or weakness.

NHS and NICE Guidelines

The NHS follows guidance from NICE (National Institute for Health and Care Excellence) and other clinical standards. According to these guidelines, low testosterone is usually defined as a total testosterone level below 8 nmol/L (nanomoles per litre). Levels between 8–12 nmol/L are considered borderline. If levels are borderline and symptoms are present, the GP may still consider further testing or referral.

The guidelines also say that testosterone should only be prescribed if both blood tests and symptoms point to a clear problem. This is because testosterone treatment is not risk-free. Giving it to someone without a clear need can do more harm than good.

Specialist Referral

If the test results are unclear or if there may be an underlying health condition, the GP may refer the patient to an endocrinologist or urologist. These are doctors who specialize in hormones and male health. Specialists can do more detailed tests, including scans of the pituitary gland or testicles, and help decide the best treatment.

Diagnosing low testosterone through the NHS is a careful process. It includes looking at symptoms, checking hormone levels at the right time of day, and ruling out other causes. Only after these steps are complete can treatment be considered.

Who Is Eligible for Testosterone Treatment on the NHS?

Testosterone replacement therapy (TRT) is not available to everyone who feels tired or has low mood. Treatment through the NHS is only given to people who meet specific medical requirements. Doctors follow national guidelines to make sure testosterone is only offered when it is safe and clearly needed. These rules help protect patients and make sure NHS resources are used fairly.

Clear Diagnosis Required

To qualify for treatment, a man must first be diagnosed with low testosterone, also called hypogonadism. This diagnosis is made using blood tests and a review of symptoms. The NHS requires more than just low energy or mood changes. There must be medical evidence of low testosterone levels in the blood.

Blood tests must usually be done early in the morning, between 7 and 10 a.m., when testosterone levels are at their highest. The test should be done while fasting, because food can lower testosterone levels for a short time. More than one blood test is often needed to confirm the diagnosis. The total testosterone level usually needs to be below 8 nmol/L. If the level is between 8 and 12 nmol/L, doctors may consider other test results and symptoms before deciding if treatment is appropriate. If levels are above 12 nmol/L, NHS doctors usually do not recommend TRT.

In addition to testosterone levels, doctors may check levels of other hormones like luteinising hormone (LH) and follicle-stimulating hormone (FSH). These help to find out whether the low testosterone is caused by a problem in the testicles or in the brain’s hormone control centres. A full medical history and symptom check is always part of the process.

Symptoms Must Match Blood Test Results

Low testosterone must cause ongoing and serious symptoms to qualify for treatment. Common symptoms include low sex drive, erectile problems, tiredness, depression, loss of muscle, or trouble concentrating. Mild symptoms or symptoms that can be caused by many other things, such as stress or poor sleep, may not be enough on their own.

Doctors also check if another health problem might be the real cause. Low testosterone symptoms can be similar to signs of other conditions like diabetes, thyroid problems, or depression. These must be ruled out or treated first before starting TRT.

Other Health Conditions May Prevent Treatment

Even if a man has low testosterone and strong symptoms, treatment is not always given. There are some health problems that can make TRT risky. For example, men with prostate cancer or breast cancer should not have testosterone treatment. TRT can make these cancers grow faster.

Other conditions that may prevent treatment or require close monitoring include:

• High red blood cell count (called polycythaemia)

• Severe heart or liver disease

• Obstructive sleep apnoea (breathing problems during sleep)

• Uncontrolled high blood pressure

Doctors also check prostate health before starting TRT. A blood test called PSA (prostate-specific antigen) may be done, and a prostate exam may be needed. These tests help make sure the prostate is healthy before treatment begins.

Referral May Be Needed

In many cases, GPs can begin the investigation into low testosterone. But for treatment to begin, a referral to a specialist such as an endocrinologist or urologist may be needed. This depends on local NHS policies. Some areas allow GPs to manage TRT directly, while others require approval from hospital specialists.

Endocrinologists are doctors who specialise in hormone problems. They may carry out further tests, review any risks, and decide on the best type of treatment. Urologists deal with male reproductive health and may be involved if there are issues with sexual function or fertility.

NHS Guidelines and Local Differences

The NHS follows national guidance from the National Institute for Health and Care Excellence (NICE), but decisions can also depend on local policies. Each Clinical Commissioning Group (CCG) or Integrated Care Board (ICB) manages healthcare for its area. These groups may have slightly different rules about who can get TRT, when it can start, and what checks are needed.

This means access to treatment may not be exactly the same everywhere in the UK. Some patients may face longer wait times or stricter requirements depending on where they live.

Eligibility for testosterone treatment on the NHS depends on confirmed low levels, serious symptoms, and a safe medical background. Doctors follow strict rules to make sure that treatment is needed, safe, and monitored properly.

What Treatments for Low Testosterone Are Available Through the NHS?

The NHS provides treatment for men who have low testosterone, also called hypogonadism, when it is confirmed by blood tests and symptoms. Treatment is only given when it is medically needed. The main goal is to raise testosterone to a normal level and help reduce symptoms like low energy, poor mood, and problems with sex drive.

Testosterone replacement therapy, or TRT, is the most common treatment. It replaces the hormone that the body is not making enough of. The NHS offers several types of TRT. These include gels, injections, and sometimes tablets or patches.

Testosterone Gels

One of the most used treatments is a daily gel that is applied to the skin. A common brand used in the NHS is Testogel. The gel is rubbed on the shoulders, arms, or stomach. The testosterone is then absorbed through the skin into the bloodstream.

Gels are easy to use and give a steady level of testosterone each day. They are a good choice for men who do not like injections. However, the gel must be applied every day, and the skin must be dry and clean before putting it on. It is also important to wash hands after use and let the gel dry before touching others. This prevents the hormone from rubbing off on another person.

Not all men respond well to gel, and some may find it messy or forget to use it daily. If that happens, another treatment may be better.

Testosterone Injections

Injections are another common way to give TRT. There are two main types used in the NHS:

• Nebido: This is a long-acting injection given every 10 to 14 weeks. A nurse or doctor usually gives it into a muscle in the buttock. Because it lasts a long time, it only needs to be given a few times a year. This makes it easy for men who do not want to take medicine daily.

• Sustanon: This is a shorter-acting injection. It is given every 2 to 3 weeks. It is also injected into a muscle. Some men may notice mood or energy changes between doses as the hormone level rises and falls. For this reason, some doctors prefer long-acting injections.

Injections are a good choice for men who need a more steady or stronger dose of testosterone. They are also useful when the gel does not work or causes skin problems.

Tablets and Patches

Tablets that contain testosterone are rarely used on the NHS. They may be available privately, but they are not often prescribed by NHS doctors because they can be harder on the liver and may not work as well as other forms. If they are used, they are closely monitored.

Patches are another option, though less common. A testosterone patch is worn on the skin, often on the back, thighs, or stomach. It slowly releases the hormone during the day or night. Patches can sometimes cause skin irritation. Like gels, they need to be applied daily and kept away from contact with others.

Choosing the Right Treatment

The type of treatment given depends on several factors. These include the man’s age, general health, how low the testosterone level is, and what is easiest to use. A doctor will also think about any other health conditions or medicines being taken.

Before starting treatment, the doctor will explain how it works, what results to expect, and how to use the treatment safely. Some men may try one type first and then switch if it does not help or causes side effects.

All forms of testosterone therapy on the NHS are designed to help men feel better by bringing hormone levels back to normal. These treatments are carefully prescribed and monitored by doctors to make sure they are safe and working as they should.

It is important to remember that testosterone therapy is not a cure for all problems. It works best when combined with a healthy lifestyle, including good sleep, regular exercise, and a balanced diet.

What Can Patients Expect During Testosterone Treatment on the NHS?

Testosterone treatment, also called testosterone replacement therapy (TRT), is used to help men with low testosterone levels feel better and improve their health. When the NHS prescribes TRT, it follows strict medical guidelines to make sure it is safe and effective. Patients can expect a step-by-step process once they begin treatment. This includes how fast they may feel better, how often they will need check-ups, and what changes might happen during treatment.

How Fast Does Treatment Start to Work?

Testosterone replacement does not work instantly. Some symptoms improve within a few weeks, while others take months. Energy levels and mood may improve in the first 3 to 6 weeks. Sexual function, such as interest in sex and erectile strength, may take 6 weeks to 6 months to get better. Changes in body fat, muscle strength, and bone density take even longer—sometimes up to a year or more.

Not every man notices the same changes. Some men may feel better quickly, while others take more time. If there is no improvement after several months, the NHS doctor may check if the dosage is correct or if another health problem is affecting the treatment.

Regular Check-Ups Are Part of the Plan

Testosterone treatment on the NHS includes regular monitoring. This means the patient will have routine visits and blood tests to make sure the treatment is safe and working. NHS guidelines suggest follow-up visits every 3 to 6 months during the first year of treatment. After that, once a year may be enough, unless there are side effects or other issues.

During follow-ups, doctors will:

• Check testosterone levels to make sure they are in the healthy range

• Measure red blood cell count (hematocrit), because testosterone can increase it too much

• Test prostate-specific antigen (PSA), to watch for prostate problems

• Ask about symptoms, mood, energy, and sexual health

• Look for side effects like acne, swelling, or mood changes

• Review overall health, including weight, blood pressure, and cholesterol

If any test results are outside the normal range, doctors may adjust the dose or suggest stopping treatment for a short time.

Changing the Dose or Form of TRT

The NHS offers different types of testosterone therapy, such as gels, injections, and sometimes patches. The starting dose is based on the form used and how low the testosterone level is. For example, some men begin with a daily testosterone gel applied to the skin, while others may get injections every few weeks or months.

If the patient finds one form of TRT hard to manage—for example, skin irritation from a gel or pain from injections—the NHS doctor may switch to another option. It may take time to find the best dose and method. Dose changes are common in the first 6 to 12 months of treatment.

Other Health Habits Matter Too

Testosterone therapy works best when combined with healthy lifestyle habits. Doctors often encourage men on TRT to improve their diet, exercise more, and reduce alcohol and smoking. These changes help increase energy, improve mood, and support heart and bone health.

Sleep is also important. Poor sleep can lower testosterone levels and block some of the benefits of treatment. Men with sleep problems may be referred for further tests, especially if sleep apnoea is suspected.

Being Patient With Progress

It is normal for treatment results to happen slowly. Men on TRT should keep track of how they feel, any side effects, and how their body changes over time. It is important to attend all follow-up appointments and report any problems early.

TRT is not a quick fix. It helps restore testosterone to a healthy level, but the effects build up over time. The goal is to bring lasting improvements in energy, mood, sex drive, muscle strength, and overall quality of life. Regular check-ups, safe use of medication, and healthy habits all play a key role in getting the best results.

Are There Side Effects or Risks with Testosterone Therapy?

Testosterone Replacement Therapy (TRT) is used to treat men with low testosterone levels when symptoms affect quality of life. While TRT can be effective in restoring hormone levels and easing symptoms, it is not without possible side effects and health risks. These must be carefully managed, especially when treatment is offered through the NHS.

Common Side Effects

Some side effects of TRT are mild and temporary. These can include:

• Acne and oily skin: Higher testosterone levels can increase oil production in the skin, which may cause acne or make existing acne worse. This is more common with gel or injection treatments that raise testosterone levels quickly.

• Fluid retention: Some men may notice swelling in the ankles, feet, or hands. This happens because testosterone can cause the body to hold on to more water and salt. It may feel like bloating or puffiness.

• Mood changes: Although TRT often improves mood in men with low testosterone, it can sometimes lead to increased irritability or mood swings, especially if hormone levels rise too quickly or become too high.

• Increased red blood cell count: Testosterone can stimulate the production of red blood cells. While this can be helpful for men with low red blood cell levels, too many red cells can thicken the blood and increase the risk of blood clots. This condition is known as polycythaemia.

Serious Risks

TRT also comes with more serious risks that must be watched closely. These include:

• Cardiovascular risks: There is ongoing research into whether testosterone therapy affects heart health. Some studies suggest a possible increased risk of heart attack or stroke, especially in older men or those with existing heart problems. Other studies have not found the same results. Because of this uncertainty, the NHS follows strict guidelines and checks when starting and monitoring treatment.

• Prostate health concerns: Testosterone does not cause prostate cancer, but it can make an undiagnosed prostate cancer grow faster. It may also cause benign prostate enlargement to worsen. This can lead to problems with urination, such as a weak flow or needing to urinate more often, especially at night. Before starting TRT, men usually have a PSA (Prostate-Specific Antigen) blood test and sometimes a prostate exam to check for any issues. These checks are repeated during treatment.

• Reduced fertility: One of the most important long-term side effects of testosterone therapy is its effect on fertility. TRT can reduce sperm production by lowering the brain’s signal to the testicles to make sperm. In some men, this may lead to temporary or even permanent infertility. NHS doctors usually advise men who wish to have children in the future to consider other options or to delay starting TRT.

• Sleep apnoea: Testosterone therapy may make sleep apnoea worse. This is a condition where breathing stops and starts during sleep. Men with known or suspected sleep apnoea should be tested and treated before starting TRT.

NHS Monitoring and Safety Measures

To keep treatment safe, the NHS follows national guidelines and provides regular checks. These include:

• Blood tests to check testosterone levels, red blood cell counts, liver function, and PSA

• Blood pressure checks, especially for older men

• Regular follow-ups with a GP or specialist to discuss any new symptoms

Doctors adjust the dose or type of TRT if problems arise. For example, if a man develops high red blood cell levels, the dose might be lowered, or the treatment might be paused.

Balancing Benefits and Risks

TRT can help improve energy, mood, and sexual health in men with low testosterone, but treatment is only started after a clear medical diagnosis. NHS doctors work to balance the benefits of therapy with its risks by using the lowest effective dose and regular health checks.

It is important for patients to report any side effects or changes during treatment. These reports help doctors decide whether to adjust the treatment or carry out further tests.

While risks exist, many men tolerate testosterone therapy well under proper medical care. With NHS support and careful monitoring, TRT can be a safe and useful option for men with confirmed testosterone deficiency.

Can You Get a Private TRT Diagnosis and Then Get Treatment on the NHS?

Some people choose to have private blood tests to check their testosterone levels. These tests are easy to order online or through private clinics. After getting results that show low testosterone, they may hope to take the test results to their NHS doctor to start treatment. But the NHS has rules about this process, and it may not be as simple as it seems.

Private Blood Tests and NHS Acceptance

Private clinics often offer full hormone panels, which include total testosterone, free testosterone, sex hormone-binding globulin (SHBG), and other related hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These tests can give helpful information. However, just having low numbers on a private test is not enough to start treatment through the NHS.

The NHS usually requires that blood tests are done at an NHS-approved lab. This is because test methods can differ between private and NHS labs. The NHS must be sure that the results are reliable and meet the standards used in the national guidelines.

So even if a private test shows low testosterone, the GP may ask for new tests through the NHS. This is to confirm the results before making a diagnosis. GPs also need to follow National Institute for Health and Care Excellence (NICE) guidelines and local policies when diagnosing and treating low testosterone.

Why NHS Testing Matters

There are clear steps the NHS follows to diagnose testosterone deficiency. These include testing in the morning, when testosterone is usually at its highest. Patients are often asked to fast before the test. The blood sample must be taken before 10 am to meet medical guidelines.

Two separate low readings are usually needed, taken on different mornings, along with signs and symptoms of testosterone deficiency. This is part of a careful process to avoid wrong diagnoses or unnecessary treatment.

GPs also need to check other hormones and health markers, such as LH, FSH, and prolactin, to see if there is another reason for the low testosterone. If tests are not done correctly, or if they miss important checks, the cause of the problem may be overlooked.

Transferring to NHS Care After Private Diagnosis

Even if someone starts treatment privately, they may later want to move to NHS care. This could be because of the cost of private treatment or a desire for long-term follow-up with an NHS doctor. But switching from private to NHS care is not automatic.

First, the NHS doctor must review the patient’s medical history and test results. If the doctor is not confident about the private test quality, they may ask for new NHS blood tests. Also, not all GPs will continue private prescriptions unless they are sure the treatment is needed and safe.

Some local NHS areas, called Clinical Commissioning Groups (CCGs), have strict rules about prescribing testosterone. They may not allow NHS doctors to continue care that began privately unless it meets all their criteria. This can cause delays or even refusals.

Importance of Medical Safety and Coordination

Testosterone replacement therapy (TRT) is a medical treatment that must be managed carefully. It needs regular blood tests, monitoring for side effects, and proper follow-up. If a person starts treatment privately without regular checks, they may face health risks.

The NHS must make sure that treatment is safe, needed, and backed by good evidence. That is why doctors may not always accept private test results or continue a private prescription without doing their own checks first.

Clear communication between private doctors and NHS doctors is important. Some private clinics send full reports to the patient’s GP, which can help. But even with this, the NHS may still need to follow its own testing and treatment rules.

While private tests can help people learn about their hormone levels, they do not guarantee NHS treatment. The NHS has its own rules to make sure treatment is safe and correct. If private tests are used, patients should be ready to repeat them through the NHS. Starting treatment privately does not always mean it can be continued on the NHS. NHS doctors must follow medical guidelines and local policies before offering TRT.

How Long Can You Stay on Testosterone Treatment?

Testosterone replacement therapy (TRT) is often used to treat men who have low testosterone levels and ongoing symptoms. For many men, this treatment may continue for a long time, sometimes for life. The decision to stay on TRT depends on several important factors, including how well the treatment is working, the person’s age, other health problems, and how well the body handles the medicine over time.

Testosterone Replacement as Long-Term Therapy

Low testosterone is often a long-term condition, especially when caused by aging or permanent damage to the testicles or pituitary gland. If the cause cannot be fixed, testosterone levels may not return to normal without ongoing treatment. Because of this, many people who start TRT will need to continue taking it for many years.

Doctors on the NHS may continue prescribing testosterone as long as the treatment is helping and is not causing harm. This means that a person’s symptoms should improve, and regular blood tests should show that testosterone levels are in a healthy range.

Regular Reassessment Is Important

Even though TRT may be long-term, it does not mean that treatment continues without any changes. NHS guidelines recommend that patients receiving TRT should have regular reviews with their GP or specialist. These reviews are important to check that the treatment is still needed and that it is safe.

During reassessments, the doctor may ask about symptoms such as energy, mood, sex drive, and overall wellbeing. Blood tests are also done to check testosterone levels and to look for side effects. These tests may include:

• Testosterone blood level: To confirm the treatment is working

• Hematocrit (red blood cell count): High levels can increase the risk of blood clots

• PSA (prostate-specific antigen): To monitor prostate health, especially in older men

• Liver function tests and cholesterol levels

If the tests are normal and the patient feels better, treatment usually continues. If the results show a problem, the doctor may change the dose or stop treatment for a time.

When Treatment May Be Stopped

There are some cases when TRT may be stopped or paused. This may happen if:

• The person has side effects that outweigh the benefits

• Blood test results show a risk to health (such as high red blood cell count or PSA level)

• The person develops a condition like prostate cancer or heart disease

• The person no longer has symptoms and testosterone levels stay normal

Some people may also choose to stop TRT for personal reasons. If treatment is stopped, the body’s natural testosterone may drop again, and symptoms can return. In this case, doctors may discuss whether to restart therapy.

Doctors usually advise slowly reducing the dose rather than stopping all at once. This helps the body adjust and reduces the chance of sudden symptoms returning. It also allows time to monitor hormone levels without treatment.

Monitoring After Stopping Treatment

After stopping TRT, doctors may check testosterone levels every few months to see if they remain stable. If symptoms come back or levels drop again, treatment may be restarted. Some men may only need TRT during certain times of life, such as during andropause (age-related hormone decline), but others may need long-term therapy.

Individual Plans Based on Health and Age

How long a person stays on TRT also depends on their general health. For younger men, doctors may look for the cause of low testosterone and consider treatments that may boost natural hormone levels. For example, in men who want to have children, doctors may avoid long-term TRT because it can lower sperm count. In these cases, other hormone treatments might be used instead.

In older men, TRT may be more common as hormone levels naturally decline. Doctors will watch closely for signs of prostate issues or heart problems during treatment. If the benefits continue and there are no major health risks, TRT can often be continued for many years.

Clear and Ongoing Communication with Healthcare Providers

NHS care for low testosterone includes regular contact with doctors, blood tests, and a clear plan for ongoing or long-term treatment. Patients are encouraged to report any side effects and discuss how they feel. This helps doctors adjust treatment in a safe and helpful way.

Testosterone therapy can improve quality of life when used correctly. While some men stay on it for life, others may only need it for a short period. Each treatment plan is different and is guided by medical tests and how the person responds. Regular review is key to making sure treatment is working and staying safe.

How Much Does TRT Cost on the NHS?

Testosterone replacement therapy (TRT) can be expensive when paid for privately. However, many people in the UK are able to get it through the NHS. This section explains the cost of TRT when prescribed by the NHS, how much patients usually pay, and what kind of financial help may be available.

Standard NHS Prescription Costs

In England, most people who get medicine from the NHS pay a flat fee per prescription. As of 2025, the standard prescription charge is £9.90 per item. This means that no matter what type of testosterone treatment is given—whether it's a gel, injection, or patch—the cost at the pharmacy is £9.90, if it is prescribed as one item.

However, some forms of testosterone therapy might be prescribed in multiple items. For example, a box of syringes for testosterone injections could count as a separate item from the testosterone itself. In such cases, patients may be asked to pay more than one prescription charge per month. It depends on how the GP or hospital doctor writes the prescription and how it is dispensed.

Cost of Different Forms of TRT on the NHS

There are several types of TRT available through the NHS. The cost to the patient does not change based on the type of treatment, but the NHS pays different amounts behind the scenes. Here are the most common types:

• Testosterone Gels (e.g., Testogel, Tostran): These are usually used once daily and come in individual sachets or pumps. Patients apply the gel to their skin. For patients, the cost is the same standard prescription charge. Gels may be more expensive for the NHS to supply, but this does not affect the patient directly.

• Testosterone Injections (e.g., Nebido, Sustanon): Injections can be given every few weeks or every few months. Some injections must be done in a clinic or GP surgery, while others can be given at home after training. The patient still pays only the standard charge, but the NHS covers the cost of the drug, syringes, and nurse time if needed.

• Testosterone Patches or Tablets: These are less commonly prescribed but are sometimes used. Like other forms, the prescription cost is the same for the patient. However, these forms are not always available at all pharmacies and may not be the first choice of treatment.

Prescription Prepayment Certificates (PPCs)

For people who need regular prescriptions, the NHS offers something called a Prescription Prepayment Certificate (PPC). This can help save money. A PPC lets patients pay once and get as many prescriptions as needed for a set period of time.

• A 3-month PPC costs £32.05.

• A 12-month PPC costs £114.50.

Anyone who expects to have more than 12 prescription items in a year would save money by using a PPC instead of paying each time. Many people on TRT get regular prescriptions for their testosterone, as well as blood tests or other related items. For them, a PPC can reduce costs over time.

Exemptions from Prescription Charges

Some people in England do not have to pay prescription charges at all. They are exempt. Reasons for exemption include:

• Being under 16, over 60, or aged 16–18 and in full-time education

• Having certain medical conditions (such as diabetes or cancer)

• Receiving income-based benefits, like Income Support or Universal Credit

• Holding a NHS Tax Credit Exemption Certificate

• Being pregnant or having had a baby in the last 12 months (with a valid maternity exemption certificate)

In Scotland, Wales, and Northern Ireland, all NHS prescriptions are free. This means TRT is provided at no cost to the patient in those areas, no matter how often it is prescribed.

Private TRT vs NHS TRT Costs

While the NHS provides TRT at a low, fixed cost, private treatment can be expensive. Private clinics often charge hundreds of pounds for consultations, blood tests, and monthly supplies of testosterone. Some people begin TRT privately and later ask to move their treatment to the NHS. This is possible in some cases, but the NHS must first confirm the diagnosis and agree that treatment is needed.

TRT from the NHS offers a lower cost, safety checks, and regular monitoring. It is a good option for eligible patients who want affordable, long-term treatment.

Help for People on Low Income

Patients who struggle to pay for their medicine may be able to get help through the NHS Low Income Scheme (LIS). This can reduce or even remove the cost of prescriptions. People can apply online or with a paper form. If accepted, they will receive a certificate showing they can get prescriptions for free or at a reduced cost.

Understanding these options can help patients make informed choices about treatment and avoid unexpected expenses. It also allows more people to access the care they need for low testosterone.

Conclusion

Low testosterone is a medical condition that can affect many areas of health, including energy, mood, sex drive, and physical strength. For men in the UK, the NHS provides a structured process to diagnose and treat low testosterone, also known as testosterone deficiency or hypogonadism. This support is based on medical guidelines and focuses on safety, proper care, and long-term health.

The NHS begins by checking for symptoms and confirming the diagnosis through blood tests. Not every man who feels tired or low in mood has low testosterone, so it is important to use the right tests. Testosterone levels must be measured in the morning, and sometimes more than one test is needed. This helps doctors make sure the low level is not just a one-time result. Other blood markers such as SHBG, LH, and FSH may also be tested. These tests help doctors find out if the problem is in the testicles, the brain, or somewhere else in the body.

Once low testosterone is confirmed, the NHS looks at whether treatment is suitable. Not every case of low testosterone leads to treatment. A man must have both low levels and clear symptoms that affect daily life. The NHS also checks for other conditions before starting treatment, such as prostate issues or high red blood cell counts, because testosterone therapy can make these worse.

If treatment is approved, the NHS can offer different kinds of testosterone replacement therapy. The most common types are gels and injections. Gels are applied to the skin once a day, and injections may be given every few weeks or every few months. The choice depends on the patient’s health, preferences, and how the body responds to treatment. Some treatments, like tablets or patches, are less common but may still be used in certain cases.

Starting testosterone treatment is only the beginning. Regular check-ups are important to make sure the treatment is working and to keep an eye on side effects. Blood tests are done to check testosterone levels, prostate-specific antigen (PSA), red blood cell counts, and sometimes cholesterol levels. Doctors use this information to adjust the dose if needed. Follow-up appointments usually happen every few months at first, then once or twice a year.

Testosterone treatment can improve energy, sex drive, muscle strength, and mood. But it also comes with risks. Some men may have side effects like acne, mood swings, or swelling. There are also concerns about heart health and prostate problems. The NHS takes these risks seriously and monitors patients carefully. Treatment may be paused or changed if problems occur.

Some men start testosterone therapy through private clinics and later ask to move their care to the NHS. The NHS may accept private test results, but the decision is up to each doctor and local health area. In many cases, the NHS will repeat tests or ask for more information before taking over treatment. This is to make sure the care is safe and follows national guidelines.

Testosterone replacement is often a long-term therapy. It may last for many years or even for life. Over time, doctors may reduce the dose or stop treatment if there are changes in health or if the benefits are no longer clear. Long-term care includes regular testing and a full review of health risks and benefits.

NHS treatment costs are generally low. If prescribed by a GP or specialist, testosterone therapy is covered under normal NHS prescription charges. In England, this is usually a flat fee unless the patient is exempt. This makes treatment more affordable than private care, which can cost hundreds of pounds each month.

Managing low testosterone is not just about taking medicine. Healthy lifestyle changes, like staying active, eating well, and getting enough sleep, can support the effects of treatment. The NHS encourages patients to take part in their care by asking questions and attending follow-up visits.

Low testosterone can affect life in many ways, but safe and effective help is available through the NHS. With the right diagnosis, careful treatment, and regular check-ups, most men with low testosterone can manage the condition and improve their quality of life. Speaking with a GP is the first step for anyone who may have symptoms and wants to find out more.