Guides > TRT
Testosterone replacement therapy (TRT) – everything you need to know.
Symptoms
What is low testosterone?
Low testosterone, or hypogonadism, is a condition in which the body cannot produce enough testosterone.
Primary vs secondary hypogonadism
Primary hypogonadism originates in the testes, while secondary hypogonadism stems from issues with the pituitary gland or hypothalamus.
How common is low testosterone?
Approximately 2 in 100 men aged 40–79 are affected by low testosterone.
Age and testosterone
Prevalence rises sharply with age — from around 0.1% in men in their 40s to 5.1% in men in their 70s.
Main causes of low testosterone
The most common causes include ageing, illness, chronic health conditions, and obesity.
Common symptoms of low testosterone
Symptoms include erectile dysfunction, low libido, fatigue, muscle loss, and mood changes.
Benefits of healthy testosterone levels
Healthy levels support muscle mass, bone density, sexual function, mood stability, energy, and cognitive performance.
Importance of testosterone for longevity
Testosterone is a foundational hormone for long-term vitality and overall health.
Is more testosterone always better?
No. The normal range is 300–1000 ng/dL, and pushing levels above normal carries significant health risks.
Negative impacts of low testosterone
Low testosterone can cause physical, psychological, and sexual health problems.
Low testosterone and fertility
Low testosterone can disrupt sperm production. Do not start TRT without consulting a doctor if fertility is a concern.
The link between low testosterone and ED
Erectile dysfunction and low testosterone are closely linked, but one does not always directly cause the other.
Obesity, diabetes, and testosterone
Obesity and diabetes form a self-reinforcing cycle with low testosterone, each making the other worse.
Do erections mean healthy testosterone?
No — getting erections does not guarantee that your testosterone levels are healthy.
What should I do if I suspect low T?
Speak to your GP and request blood tests to check your hormone levels.
Can low testosterone be cured?
Primary hypogonadism typically requires lifelong treatment, while secondary hypogonadism may be reversible.
Impact of untreated low testosterone
Left untreated, low testosterone can affect physical and emotional health, and may shorten lifespan.
Diagnosis
How is low testosterone diagnosed?
Diagnosis involves a medical history review, symptom assessment, blood tests, and a physical examination.
Do I need a doctor?
Yes — low testosterone requires a proper medical diagnosis and cannot be self-diagnosed.
What initial blood tests are needed?
Key tests include total testosterone, SHBG, free testosterone, and albumin levels.
Booking a consultation
Your results are available online with notifications so you can book your consultation promptly.
What happens during the consultation?
Your clinician asks targeted questions to build a root-cause picture of your symptoms.
Why are two rounds of blood tests needed?
Two rounds are needed to confirm a consistent testosterone deficiency rather than a temporary fluctuation.
Treatment
What is the best treatment for low T?
TRT is the gold standard treatment. Clomiphene may be considered when fertility preservation is needed.
What treatment options does Heracles offer?
Heracles offers Testogel, Tostran, and Testosterone Cypionate.
How long before I see results?
Libido improvements can appear around 6 weeks, with muscle and body composition changes from 8 weeks onward.
Is TRT safe?
TRT is generally safe when properly monitored by a qualified clinician.
What are the side effects of TRT?
Possible side effects include erythrocytosis, infertility, acne, and mood changes.
Who cannot have TRT?
TRT is contraindicated for men with prostate cancer, significantly raised hematocrit, or untreated sleep apnoea.
TRT and prostate cancer
TRT may increase PSA levels, so prostate health must be monitored during treatment.
TRT and fertility
TRT can lower sperm count within weeks, so discuss fertility plans with your clinician before starting.
TRT and hCG
The use of hCG alongside TRT is not strongly evidence-based at this time.
Can I drink alcohol on TRT?
Yes, alcohol in moderation is generally acceptable while on TRT.
How long will I need TRT?
Primary hypogonadism requires lifelong treatment. Secondary hypogonadism may allow tapering off over time.
Lifestyle factors and testosterone
Maintaining a healthy weight, regular exercise, balanced diet, quality sleep, and stress management all support testosterone levels.
Diet and testosterone
Reduce excess body fat and inflammation by avoiding processed foods and eating a nutrient-rich diet.
Mindset and testosterone
Building healthy routines, setting realistic expectations, and managing stress are key to a successful TRT journey.
Is TRT addictive?
TRT is not addictive, but you should never stop treatment abruptly without medical guidance.
Adverse reactions to TRT
Serious reactions like chest pain require immediate attention. Contact your clinician for issues such as persistent acne or mood changes.
Ongoing monitoring on TRT
Blood tests should be repeated every 3–6 months to ensure safe and effective treatment.
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