Testosterone Replacement Therapy (TRT) medication can give you a whole new lease of life - helping you feel happier, stronger, and more normal again. After talking to you and carefully assessing your symptoms, your doctor has designed a personalised treatment plan that incorporates medication that will work specifically for you.

You have been prescribed Testosterone Sustanon as per your treatment plan.

So that you can feel confident and comfortable using your medication, it is important that you take the time to read through this leaflet, watch the relevant videos, and book yourself in for an Injection Training Consultation.

How does Testosterone Sustanon work?

By giving you testosterone, the treatment works to boost your levels of this hormone in the blood, reversing the symptoms of low testosterone you are experiencing. Testosterone is the primary androgen in males and has an impact on many biological processes that are necessary for health and wellbeing. TRT works to bring your body back to a healthy range for testosterone.

How effective is TRT?

The treatment can provide benefits in all aspects of your life. 90% of patients see an improvement in their symptoms as early as the 3 month mark. In specific symptoms, those on TRT saw an 87% improvement in their libido and 86% saw improvements in their energy levels. The treatments can allow for over a 239% average increase in Total Testosterone levels.

When will I see results?

Most men on testosterone see results within the first 2-10 weeks after injecting. You may notice improved mood, energy, libido and sleep after a few weeks, with increases in muscle mass and memory from 6 weeks onwards.

The 6 week check-in questionnaire and 3 month blood tests are really important to ensure that your treatment is having the desired effect, and it allows your doctor to make changes to your dosage to ensure your testosterone and oestrogen levels are in the right ranges.

What is my dose?

This plan does not include your specific dose.

After your consultation, your doctor will send you a message with your dosage information in the support section of your account.

It is important to note that your dose may change depending on your response to the treatment but you will be informed for any changes.

Blood test monitoring

Once you start treatment, you will have blood tests at different points in your journey. These tests are required, extremely important for your safety, and help us ensure your treatment is effective.

Whilst under our service, you have access to our specialist team and will have review consultations with your doctor to monitor your progress. At the start of treatment these monitoring tests and reviews are more frequent. You can find our monitoring test schedule below.

We will notify you via email and SMS when your next monitoring test is due, and you can purchase them directly from the tasks/actions section of your account homepage.

We suggest you complete your monitoring blood tests as quickly as possible after notification to ensure continuity of treatment. If you do not complete the test within 5 weeks of being notified we will not be able to prescribe further medication until the tests are completed.

You can contact us at anytime if you need help purchasing or organising your tests, or with any help whilst reordering medications or supplies.

What do I need to inject Testosterone?

In your Testosterone delivery, you should have received the following:

• 1ml vials of Sustanon
• 1ml syringes
• 25G needle heads (used to inject Sustanon)
• 18G needle heads (used to draw up Sustanon)
• Alcohol wipes
• Sharps bin

How do I inject Testosterone?

Sustanon is administered via intramuscular injections, you will have the option of injecting into your quad (thigh) or glute muscle).

Your testosterone can be drawn up and pre-loaded into individual syringes with your dosage ready to do.

When preloading your syringes, always draw up 0.05mls extra to account for the changes in needle head. If your dose is 0.2mls, preload your syringe to 0.25mls.

As the Testosterone is oil-based, you may find that it takes time to draw up your dose and inject. This is completely normal and you will find that it will be more comfortable if you take your time when injecting.

You may find that you have some tenderness or pain at the injection site, this is common, and nothing to worry about. You may feel lumps under the skin but this should not cause any discomfort.

If you find that the pain and discomfort persists, please get in touch so we can review your injection technique and potentially adjust your chosen method of administration.

Additional treatments

Alongside your testosterone Sustanon, you may be prescribed other medication to form your individual testosterone plan.

This could include but is not limited to HCG, Aromatase Inhibitors (also known as Oestrogen blockers) such as Anastrozole/Exemestane, Clomifene or Tadalafil.

Storage and injection hygiene

• Your Sustanon vials or preloaded syringes should not be stored in the fridge, we recommend keeping your vial or preloaded syringes in a cool dry location, ideally away from direct sunlight - such as a bedroom cupboard.
• If your Sustanon gets too cold, you may find that it crystallises, if this is the case you can warm up the vial in your hands or in warm water to allow the crystals to settle.
• Always use alcohol wipes to clear the injection site and the tops of vials before inserting a needle.
• Please make sure you use a fresh needle each time you are injecting. This means ideally changing the 25G needle that you used to store your preloaded syringe.
• Once the guard has been removed from the needle, do not place it down on any surface. The guard does not need to be replaced before the syringe goes into the sharps bin.
• Always dispose of needles, glass vials and ampoules in the sharps bin provided.

How do I order more medication?

When you are running low on your medication or injection supplies, you will need to put in a request for top-ups and this will be reviewed and approved by your consulting doctor as long as your monitoring is up to date.

Medication is not dispatched automatically, but the form below can be used to order when needed:

What are the potential side effects?

As with all medication, there are side effects that you should be aware of before starting your TRT plan. It is important to note that you are monitored closely when you are taking your plan under our service and we have the ability to manage side effects under our service.

If at any point you have any questions about your plan or think you may be experiencing side effects, please get in touch and we can offer advice and support.

Most of the side effects of TRT are temporary and it can just be your body adjusting to a new treatment plan.

Hair loss

When testosterone levels are increased with TRT, levels of dihydrotestosterone (DHT) - a byproduct of testosterone - can also increase. This may cause shrinking of your hair follicles which causes hair thinning, as well as increased prostate size (this is not linked to prostate cancer).

If you do experience hair loss, it may be possible to manage this side effect by administering smaller doses of testosterone more frequently. There are also treatments that can be used to block the DHT at their receptors in the hair and prostate. Your doctor can prescribe topical or oral medication that prevent hair loss from increased DHT levels.

In areas other than the scalp, you may find that you see excess body hair growth due to the increase in Testosterone. This is usually temporary and will stabilise once your levels have reached a new baseline.

Increased spots or acne

This is due to your increase in Testosterone causing an increase in sebum production. It is more common if your levels elevate too high and can be managed by an adjustment in your dosage and inclusion of skin hygiene alongside your plan.

Injection site reaction

Typically tenderness or irritation due to the injection or the preservative in the oil.

The reason for the injection site reaction can be multifactorial. It can be due to the method of administration or the needle used. You have the ability to book in for an injection training video call when you start your plan - which we highly recommend. 

Localised reactions can be managed with the appropriate adjustment in your medication, method of administration or education on injection technique.

Increased Oestrogen

Your Oestrogen levels may increase when you start treatment, which can result in the following side effects:

• Water retention
• Increased blood pressure
• Depression or low mood
• Erectile dysfunction
• Reduced libido
• Reduced energy levels
• Gynecomastia or nipple itchiness

An increase in oestrogen can be safely managed by our team, however it is important to flag any symptoms to us early.

Reduced Fertility

When patients are treated with externally administered testosterone (TRT), this can cause a reduction in your body’s natural production of both testosterone and sperm, which in turn could lead to reduced fertility.

As part of your individualised treatment package, you may be prescribed HCG or clomifene (clomid) with the primary focus to maintain fertility, whilst also maintaining testicular size, normal testosterone production and the production of other hormones which are inhibited by TRT.

If you are keen on maintaining your fertility, ensure you highlight this to your TRT doctor. The doctor will assess your individual case and may ask you to undertake a baseline sperm count and monitor this whilst on treatment. Further details on this test will be provided by our team.

Cardiovascular risks

Testosterone treatment can increase the thickness of your blood as it causes your body to produce more red blood cells. As a safety measure, we closely monitor blood thickness using a test called haematocrit throughout your treatment journey.

There is some evidence that TRT may slightly increase your risk of clots. This is likely related to the increase in haematocrit levels from extra red blood cells which is why monitoring and managing this is important whilst on treatment. There is currently no evidence to suggest that it increases your risk of major cardiovascular events such as heart attacks or strokes and large major studies demonstrate that men on TRT live longer and healthier lives than men with low testosterone levels with a lower prevalence of heart conditions.

It is advised that you monitor your blood pressure whilst you are on treatment, as a raised oestrogen or haematocrit may increase it. The British Heart Foundation provides helpful information about how to effectively monitor your blood pressure and provides a template for you to use to log your readings. If your blood pressure is greater than 140/90 mmHg, we recommend letting us know. If your blood pressure is greater than 180/110 mmHg, we recommend you seek immediate medical attention.

Your doctor may also advise that you register to become a blood donor and it can be recommended to donate blood every three months. Some TRT users choose to wait until their first 3-month blood test to see how the treatment is affecting them.

If for any reason, you cannot donate blood, you may be advised to undertake a therapeutic venesection (removing blood without donating).

If you wish to speak to our Specialist TRT Pharmacist about side effects or your plan, you can book a call with us at any time included for free in your subscription.

How does the subscription and payment work?

Importing medication such as HCG, and doctor fees are expensive. We have broken down these costs into a monthly subscription to make them more affordable for you.
Your monthly All-in-One subscription covers the cost of our systems, support teams, doctor consultations, your core medication, blood tests, clinic visits, injection supplies and travel letters.
Other addons for supportive medication are changed as extras should you need them.

What if your medical status changes?

If you start taking any new medications or if there are any significant changes to your medical history, please inform our clinicians/doctors via your patient account messaging facility. If you experience any significant side-effects or want any further advice on your treatment, please do let us know.

It is important that you inform your GP about the medicines you take to ensure they have an accurate medication history. If you do not share this information with your GP it could result in the healthcare professional not having enough information to make informed clinical decisions about your care, increasing your risk of injuries or side effects. On your account page, you can download a letter to share with your GP that contains all the relevant information about your treatment plan.

Please note that some of the TRT treatment plans may include off-label and unlicensed use of medication. This may include how the medication is injected or the dosage frequency. All medication prescribed is supported by research and years of clinical experience, which has demonstrated this to be a more effective method of treatment.

We're dedicated to continually improving our understanding of the medications we prescribe, including their side effects, to provide the highest level of care, guided by the latest medical insights. If you experience any side effects, please discuss them with your TRT Team.
You can also report side effects, no matter how minor, through the government-run Yellow Card reporting scheme at https://yellowcard.mhra.gov.uk/. Your input is vital for enhancing medication safety for all.