MEN’S HEALTH
TRT in the UK: Private Review, Diagnosis, and Appropriate Next Steps
Why testosterone replacement therapy should follow proper clinical assessment, not the other way around.
Testosterone replacement therapy is not the first step for every man with tiredness or lower libido. Before treatment is considered, there needs to be a clear assessment of symptoms, relevant blood testing, and a discussion of risks, benefits, alternatives, and practical monitoring.
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Why assessment comes before treatment
Some men who enquire about TRT have not had a proper clinical assessment. Others have had a single testosterone reading without repeat testing, without morning timing, or without the broader hormone panel needed to interpret the result properly. A responsible service should establish whether symptoms are genuinely consistent with testosterone deficiency, whether repeat blood results confirm the finding, and whether there is an identifiable cause — such as a pituitary issue, medication effect, or functional suppression from obesity or chronic illness.
Fertility is a critical consideration. Exogenous testosterone suppresses spermatogenesis — meaning TRT can significantly reduce or eliminate sperm production. Men who are currently trying to conceive, or who may want children in the future, need to understand this before starting treatment. Alternative approaches to managing low testosterone without compromising fertility do exist and should be discussed.
Private review versus rushing to a prescription
A private route can be useful when you want more time, a clearer explanation, or faster access to assessment. It should still remain clinically grounded — not a shortcut to a prescription.
Treatment
What TRT involves
TRT is delivered via gel applied daily to the skin, injection typically every few weeks, or less commonly via patches or implants. The choice depends on patient preference, lifestyle, and clinical factors. Treatment is ongoing — testosterone replacement is not a short course but a long-term commitment that requires regular monitoring. Patients should understand this before starting.
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Monitoring during treatment
Responsible TRT prescribing requires regular monitoring — typically blood tests at 3 months, 6 months, and then at least annually. Monitoring includes testosterone levels to confirm the dose is appropriate, haematocrit and haemoglobin as testosterone can increase red blood cell production, PSA in men over 40, liver function, lipid profile, and symptom review. The aim is to ensure treatment is effective, safe, and still clinically warranted — not simply to repeat prescriptions without review.
Safety
Side effects and risks
Potential side effects include acne, mood changes, fluid retention, increased haematocrit, changes in libido, and sleep apnoea in predisposed individuals. The fertility impact — suppression of sperm production — is one of the most important risks to discuss upfront. These risks are manageable with proper monitoring, but they are the reason TRT should not be prescribed casually. At Basuto, the starting point is usually a men’s health appointment with baseline blood tests.
Common questions
What does a private TRT review actually involve?
A TRT review starts with a detailed history, symptom assessment, and baseline blood testing including morning fasting testosterone, SHBG, LH, FSH and often thyroid, prolactin, HbA1c and lipids. Repeat testing is usually needed. Only after a full picture is established is treatment discussed — TRT is a clinical treatment where clinically appropriate, not a wellness enhancement.
Who is TRT clinically suitable for?
TRT is considered for men with consistently low testosterone on appropriate testing alongside symptoms that fit, where other causes have been reviewed. Patients with fertility goals, prostate cancer history, certain cardiovascular conditions, uncontrolled sleep apnoea, or raised haematocrit require particular care and in some cases should not be prescribed. Suitability is assessed individually.
What monitoring is required once TRT is started?
TRT requires ongoing monitoring: repeat bloods at set intervals, symptom review, and assessment of haematocrit, PSA, and cardiovascular markers. It is a clinical treatment with a follow-up structure, not a prescription to be collected repeatedly without review.
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