TRT treatments

TRT medication can give you a whole new lease of life. Our experts provide the personalised, life-changing treatment you need to feel your best.

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Medically reviewed by Dr Chris Airey
BMBS MMedSc Dip ENDO, TRT Expert
iconLast Updated December 30, 2023

What are normal testosterone levels in men?

After the age of 30, testosterone levels naturally start to decline with age by roughly 1 to 2% each year. Scientific studies show that 1 in 4 men over the age of 30 may have abnormally low testosterone levels.

Levels of total testosterone higher than 12 nmol/L or free testosterone higher than 0.225nmol/L are considered normal. Although studies have shown men may be symptomatic of low testosterone with levels below 15nmol/L. A simple blood test can determine whether your testosterone levels are within a normal range.

Exploring individuality in TRT protocols

Each person’s experience with low testosterone is entirely unique - we believe their treatment should be too. Lifestyle and genetic factors affecthow each individual should be treated. Men also have different naturally occurring levels of sex hormones and molecules, like SHBG, which influence how certain medications act in the body - but we’ll get to those later.

As you can see, there’s no one-size-fits-all treatment protocol for low testosterone, the best protocol is one that’s tailored to your specific circumstances and that you can stick to consistently. Our TRT doctors will conduct a comprehensive diagnosis so that they can design a personalised, sustainable protocol for you which results in real improvements.

Here’s how the diagnostic process works:

  • Initial blood test: An initial at-home, finger-prick blood test measures 4 biomarkers including your total and free testosterone levels. You can access your results in as little as 48 hours via your MANUAL account.
  • Enhanced blood test: If the results of your first test indicate low testosterone levels, a comprehensive venous blood test (which measures 43 biomarkers) is required to confirm the initial blood test result, learn more about your health, and assess whether it’s safe to start TRT.
  • Doctor consultation: You’ll have an in-depth discussion with one of our TRT doctors covering your medical history and lifestyle, your blood test results, your symptoms, the risks and benefits involved in TRT, treatment options (including costs), monitoring, and what to expect when you start treatment.

Treatment starts: Your doctor will design a personalised treatment plan that works specifically for you, including the right medication at just the right dose to suit your individual needs.

TRT medication options

We’ve put together a rundown of the different TRT medication options, explaining their pros and cons. It’s also worth mentioning that if you’re planning to start a family you should start fertility treatment before starting TRT.

How do injectables work?Injectables are a popular choice, in fact, 98% of our patients use this method! Not only are they convenient - taking around 10 minutes to administer, Two or three per week - they’re also highly effective as they maintain steady testosterone levels over time. Having said that, not everyone likes the idea of having to inject themselves with medication, so they aren’t for everyone.
This is a prescription-only medication. You cannot purchase this medication over the counter.
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Topical Topical testosterone treatments are a great option for those who prefer a needle-free approach, as they come in the form of a cream or gel. They’re applied daily and although they work well for some men, the overall outcome of the treatment can be affected if they’re not absorbed properly. Topical treatments tend to have a moderate impact on your lifestyle as it’s important to adhere carefully to your application schedule.
This method carries the risk of testosterone transmission to women and children, posing potential dangers such as changes to women’s menstrual cycles. For this reason, this form of treatment may not be suitable for a lot of men.
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Oral In cases where injections or topical treatments aren’t suitable, oral testosterone treatments might be prescribed. This method of treatment is incredibly convenient since it involves taking just one daily tablet, and has the added perk of not requiring any injections.
This form of treatment helps to maintain fertility whilst increasing testosterone levels, but isn’t effective for some men.
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Treatment adjustment & monitoring

You’re probably starting to see that low testosterone is a tricky condition to treat. There are a lot of physiological factors at play, plus your lifestyle has to be taken into careful consideration when choosing the right protocol.

A personalised, bespoke treatment is key to TRT as no one responds in the same way to the same treatment method, dosing or dosing frequency. Whilst most patients start on similar protocols, it’s essential that treatment is adapted to your unique needs. That’s why regular follow-ups and blood analysis are so important.

After you’ve started your TRT protocol, we’ll test your blood at 6 weeks, 3 months, 6 months, and 12 months, and you’ll receive direct feedback and counselling from a doctor after each test. These test results will allow your doctor to effectively monitor your progress and make incremental adjustments to your protocol (adding different medications if required) to ensure that your body gets the right amount of testosterone to put your levels within a healthy physiological range. Patience is key here. It can take a few months up to a year in some cases, but it’s important to trust the process to achieve the best results.

Understanding physiological factors in TRT

Aside from your individual testosterone levels, there are other physiological factors at play that can influence the response of TRT. Sex hormone binding globulin (SHBG) levels, oestrogen levels, and androgen receptor type vary between men, so it’s important to tailor treatment with these in mind.

Sex Hormone Binding Globulin (SHBG)

SHBG is a protein which binds to three hormones – testosterone, oestrogen, and dihydrotestosterone (DHT) – in order to transport them through the bloodstream. When SHBG binds to testosterone it reduces the amount of the hormone available in the blood.

SHBG levels are affected by age, insulin sensitivity, liver health, and alcohol consumption, among other things. Using different dosing strategies (including adding certain medications alongside TRT) can help to treat men with high or low SHBG levels.

Oestrogen (oestradiol)

Oestrogen (specifically oestradiol) levels vary in men due to the amount of aromatase found in their bodies. Aromatase is an enzyme which shears off part of the testosterone molecule, converting it into oestrogen. Factors such as genetics, body fat, diet, and alcohol intake contribute to these variations.

Androgen receptors

Androgen receptors are proteins which play a crucial role in shaping male sexual characteristics and the regulation of muscle and bone growth. When sex hormones such as testosterone activate them, they bind to specific DNA regions and essentially regulate the activity of certain genes.

Androgen receptor type is probably more important than the levels of testosterone in your body – two men with the same testosterone levels can see variations in the effect on things like muscle mass or bone density.

These variations in physiology highlight the importance of tailoring TRT protocols to each individual.

Complementary therapies in TRT

Successful hormone therapy involves administering the right medications at just the right doses for your individual needs. Additional treatments, such as human chorionic gonadotropin (HCG) and aromatase inhibitors work in tandem with TRT to optimise your hormone balance.


Human chorionic gonadotropin (HCG) is often administered to men on TRT as it plays an important role in maintaining fertility and natural testosterone production. It’s a luteinising hormone (LH) analogue, so it replicates the LH’s role in hormone regulation, preventing testicular shrinkage and sustaining testosterone production in men on TRT.

Those with primary hypogonadism will produce less testosterone when using HCG compared to those with secondary hypogonadism. It is, however, difficult to predict the effect that HCG will have on an individual’s testosterone production so adjusting HCG and testosterone doses based on follow-up blood tests is essential.

Aromatase inhibitor

Aromatase inhibitors are commonly used during TRT to limit the conversion of testosterone into oestrogen. They work by binding to the aromatase enzyme, reducing oestrogen production.

While generally best avoided due to potential side effects which affect bone density, joint health, epithelial health, and lipid profile, they may be necessary for men with excess body fat or a genetic susceptibility to raised oestrogen levels (which can be identified through blood or genetic testing). Adjusting the dosage offers an alternative for managing oestrogen levels in other cases.

Worried about your testosterone levels?
Take a quick online assessment to see if your symptoms are related to low testosterone and if you are suitable for treatment.

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