Testosterone Replacement Therapy (TRT) in the UK

TRT is a medical treatment growing in popularity in the UK after decades of successful use in the US. Our specialist doctors use this hormone therapy on men with low testosterone, also known as testosterone deficiency

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Medically reviewed by Dr Chris Airey
BMBS MMedSc Dip ENDO, TRT Expert
iconLast updated 6th September 2023
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TRT is often surrounded by a lot of stigma from the medical community, but more and more recent evidence is breaking down the common myths associated with this treatment, as it becomes talked about across the UK more and more frequently.

Our goal at MANUAL is to improve men’s testosterone levels safely and effectively by using protocols and medications suited to you as an individual, to improve your quality of life and get you back to your old self.

What is TRT?

TRT is the medical treatment where doctors replace a man’s natural testosterone production when levels are low and causing debilitating symptoms.

TRT can be administered in several different ways to suit the individual, including injections, creams, gels, pellets and patches.

Modern clinics with specialist doctors will also use other medications and adapted protocols to counter some of the side effects that occur when testosterone is taken. This includes HCG to improve fertility, or aromatase inhibitors to reduce oestrogen levels in some men. More frequent injections with lower volumes of testosterone may also be used.

A combination of additional medications and bespoke protocols lead to the best possible results in most men.

How to get TRT in the UK?

It is possible to get TRT on public health services, however the results are rarely very good, and time to treatment is often very slow.

Most men now look to get treatment privately with a clinic such as MANUAL, as we can provide the best medication options, knowledgeable TRT specialists and the best treatment options.

We also offer a combination of the best medications available, including injections, HCG, creams, and tablets, to provide a tailored and personal approach to your care.

A personalised, bespoke treatment is key to TRT as no one responds in the same way to the same dosing and frequency. Whilst most patients start on similar protocols, treatment should be adapted with follow up blood testing on treatment.

Private clinics such as MANUAL can also treat men at higher testosterone levels than the NHS, as the NHS often rely on lab ranges to decide who to treat. This means that a lot of men with low testosterone symptoms will not be offered effective treatment.

The treatment process is easy: you need to have two low testosterone results to start treatment, alongside some more comprehensive blood test results to ensure you are safe and appropriate.

After these two tests, a consultation is performed by a registered GMC doctor who will offer treatment if you are medically appropriate.

Why get TRT with MANUAL?

MANUAL is a convenient and professional option, with remote testing options and top of the line medication. We store our own medications in stock to prevent you running out during your treatment due to shortages.

We have the best portal experience, so you can see your blood test values in detail, and track your results with your doctor, for best results. Our service is unparalleled and we have the best response rates to ensure you get the support you need.

How easy is it to get TRT in the UK?

Getting testosterone replacement therapy in the UK is easy with MANUAL, just follow these steps:

1. Use our ADAM questionnaire to see if you are likely to be suffering from low testosterone and associated symptoms.

2. Order a blood test to check your total and free testosterone levels (free testosterone levels can be low despite a normal total testosterone level).

3. If levels are low then you need a second test to ensure you are safe and appropriate for treatment (a regulatory requirement in the UK). After this, you can move to consultation, which can be done remotely for most men.

4. Following consultation, our doctor will prescribe the appropriate, individual treatment and this is delivered to you directly within a few days! You are then taught how to administer the treatment yourself.

What are the benefits of TRT?

• Higher drive and competitiveness

• Harder erections and reduced erectile dysfunction

• Improved libido/sex drive

• More confidence and assertiveness

• Less anxiety

• Improved sleep quality

• Improved IBS and Crohn’s disease symptoms

• Reduced all-cause mortality including better heart health

• Improved mental clarity and focus

• Increased muscle mass

• Deeper and more stable voice

• Faster and more beard hair growth

TRT has been shown by numerous studies to be extremely effective in treating low testosterone symptoms. (Studies)

There are plenty of benefits of TRT (as you can see above), which mostly treat symptoms associated with low testosterone levels. However, TRT also improves some areas to levels greater than they were previously.

Read more about the benefits of TRT.

What are the main low testosterone symptoms?

• Low sex drive/libido and erectile dysfunction

• Brain fog and poor focus

• Anxiety and depression

• Loss of muscle mass

• Loss of strength

• Low energy

• Reduced drive/competitiveness

• Poor sleep or insomnia

• Reduced fertility/shrunken testicles

ADAM Questionnaire Low testosterone test
The ADAM questionnaire has been shown to have 88% sensitivity in testing for low testosterone.

What causes low testosterone in men?

Low testosterone can be caused by several different factors or causes.

Men’s testosterone levels are on average 20% less than they were 20 years ago. In fact, 1 in 4 men over the age of 30 now have low testosterone (this is 1 in 3 men in the US)!

This may be due to any of these factors, some of which have better evidence than others:

Environmental or chemical exposure – plastics and fertilisers leaking chemicals into the water supply/food

• Obesity – body fat levels lead to higher conversion of testosterone into oestrogen which suppresses testosterone production

Hormones – the contraceptive pill contains hormones which can disrupt the male hormonal system and may be found in drinking water

Anabolic steroid use – often a full recovery of natural testosterone levels does not occur after it is suppressed by steroid use

• Soya consumption – phytoestrogens from some foods such as soy and mint may reduce testosterone levels

• Stress – chronically increased cortisol production reduces testosterone levels in men and women

• Genetic issues – genetic conditions can severely reduce testosterone production

• Age-related decline/andropause – testosterone levels often decrease with age

Although some of the factors above are more controversial and have less evidence than others. However, it is likely that most of these factors can lead to suppressed hormone levels and symptoms of low testosterone.

Male testosterone levels are reducing year upon year in western societies and this is likely linked to factors from the list above.

Which blood tests do I need before starting TRT in the UK?

If you have already had blood tests then please share them with us, we can use blood tests from other sources, but we usually need some extra values to make sure you are safe to start treatment.

UK regulations state that you need to have two results showing low total testosterone and/or free testosterone before starting TRT therapy.

Your doctor will also want to ensure you have these tests before you can start your treatment safely:

• Sex Hormone Binding Globulin (SHBG) – This protein binds to your total testosterone making it less available to the body. If you have a raised SHBG level, you could suffer from the symptoms of low testosterone despite good total testosterone levels.

This value isn’t mandatory but it is useful to indicate certain issues and ensure the treatment is effective.

• Oestradiol (Oestrogen) – Oestradiol is the main type of oestrogen in the body. It is produced in the male body from testosterone when it is converted by aromatase (an enzyme).

If Oestradiol is too high, or too low, it can affect male libido, erection quality, fat levels and growth of breast tissue (which can lead to gynaecomastia) This is extremely important to test when on treatment as well as before hand.

• Prolactin – If your levels are high it can affect your mood and sexual health. High levels can reduce testosterone production. If your Prolactin level is very high, it may be associated with a prolactinoma, a tumour in the pituitary gland that can lower your testosterone levels. If over a certain range then the doctor may recommend that you have an MRI scan before starting treatment.

• Follicle Stimulating Hormone (FSH) – A hormone produced by the pituitary gland that stimulates the testes to produce sperm and testosterone in healthy men.

• Luteinising Hormone (LH) – A hormone produced by the pituitary gland that stimulates the production of testosterone in the testicles. 

• Prostate-Specific Antigen (PSA) – PSA is an indicator of prostate health. The most recent research suggests that TRT does not increase the risk of Prostate Cancer, but it is still important to check before starting TRT to ensure you don’t have prostate cancer.

This value is required for men over the age of 45 as well as a prostate examination or US scan.

• Lipids – Lipids can be affected by certain medications.

• Full Blood Count – This test looks at how many blood cells you have per ml of blood as well as the other parts that make up your blood.

If haematocrit is too high, this indicates that your blood is thick which may be a problem on treatment.

• Thyroid hormones – some thyroid problems are present with the same symptoms as testosterone deficiency.

• Cortisol – this can indicate whether there are other issues with your pituitary gland.

• Liver function tests – Certain medications can make these worse, they can also indicate other issues.

• Renal (kidney) function – We need to check these levels before starting treatment, if they are abnormal we may avoid certain medications or treatments.

• Iron studies – These can indicate certain issues such as haemochromatosis, which will need investigation before starting TRT.

• HbA1C – This checks for signs of prediabetes or diabetes.

Any good doctor will want to see the above test results before starting you on treatment with TRT.

Testosterone Blood Tests
Order an at-home test kit to get started.

How much does TRT Cost with Manual?

With MANUAL the initial consultation is only £149.99 and can be done remotely for men under 45 or those who don’t need a prostate exam. If you want to transfer from the NHS or another clinic the consultation is only £99.99.

Face to face consultations are £179.99, these are good for men who need a prostate exam, although we will take results that you have done elsewhere.

TRT subscriptions vary based on the medication used. Ours start at £79.99 per month for medication and support with MANUAL. HCG as an add-on to a TRT plan is £35 per vial which lasts from 4 to 10 weeks depending on your dosage.

Blood tests are an additional cost on treatment but we don’t have any hidden costs for postage, letters, consultation reviews or medication changes, unlike a lot of clinics in the UK.

You can read more about costs on our Costs of TRT page.

What is the best type of TRT treatment in the UK?

The most popular and most effective form of TRT in the UK is injections of testosterone. 98% of our patients use this route, and we specialise in providing this treatment effectively and safely. However, we do have other options for men who would prefer not to inject.

The most popular injections are with cypionate and enanthate.

HCG is also used in most men as it is important to maintain fertility and natural testosterone production. It also helps to regulate other hormonal pathways.

• Testosterone gels or creams – the testosterone cream is generally very effective, however there is a risk of transmission of testosterone to women and children.

• Monthly or Quarterly testosterone injections such as nebido

• Patches- these are not a popular option.

• Pellets which are inserted every 6 months – these may have issues with side effects and it is difficult to adjust the dose so they are not preferred.

You can read more on the best approach to treatment in our article ‘What is the Best TRT protocol?’


Testosterone replacement therapy in the UK is growing in popularity every year. Whilst it is a treatment that requires careful monitoring and specialist support to get the best results, it can also be a life changing medical intervention.

There are some risks and side effects associated with testosterone replacement therapy, but if the treatment is carefully monitored and managed by a specialist clinic such as MANUAL, these issues are generally minimal.

If you think that testosterone deficiency could be causing your symptoms then get in touch for more information, or buy a blood test to check your levels.

While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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