In short
- Only for confirmed deficiency. Symptoms plus low morning testosterone on separate occasions, not a lifestyle upgrade.
- Several routes. Weekly injection into muscle or under the skin, or a daily gel. Each suits a different life.
- The target is mid range. Around 400 to 700 ng/dL, not the top of the scale.
- Fixed monitoring. Testosterone and haematocrit at three months, PSA where age requires it, then every 6 to 12 months.
- It suppresses fertility. That conversation happens before you start.
Treatment Overview
Who this is actually for
Adult men with symptoms and signs of androgen deficiency together with a subnormal morning testosterone confirmed on separate occasions. Where that is the case, the benefits are clear.
In men whose baseline levels are normal, pushing them above the normal range carries risk without a corresponding benefit. That is not treatment, and it is not done here.
Which preparation
| Route | How it behaves | Suits |
|---|---|---|
| Intramuscular injection, enanthate or cypionate | Peaks a day or two after the injection, drifts down before the next | Men who prefer a weekly or fortnightly routine and tolerate the swing |
| Subcutaneous injection by autoinjector | Weekly, with levels staying within the normal range across the week | Men who want steadier levels and self injection without a deep needle |
| Transdermal gel | Daily, no injection, but levels vary and transfer to others is possible | Men who dislike needles, with care where there are young children at home |
Longer intervals with larger injections raise the peak and drop the trough, which is why weekly or fortnightly dosing is generally preferred over three or four weekly.
Pellets implanted under the skin are available but are not recommended here, because insertion is a minor procedure and the data on resulting levels are limited.
What the dose is aiming at
A serum testosterone well within the normal range, typically 400 to 700 ng/dL. Not the upper limit, and not above it.
- With injections, the level is measured midway between doses. If it is higher than the target, the dose comes down.
- With a gel, levels vary unpredictably, so two measurements are taken before any dose change.
- In primary hypogonadism, a normalised LH is a further sign the dose is right.
What should improve, and when
- Within weeks. Libido, energy and mood, if those were the symptoms of deficiency.
- Over months. Muscle mass and strength, and fat mass.
- Over years. Bone density.
If your testosterone is restored to normal and the symptoms do not improve, that is important information: it suggests the symptoms had another cause, and the treatment is reconsidered rather than escalated.
Before you start
- Prostate. Men over 50, or over 40 with a first degree relative who had prostate cancer, have a PSA and examination first. A nodule, or a PSA above 4, or above 3 in a high risk man, means urology before anything else.
- Haematocrit, as a baseline.
- Clot history, personal and family. In one series, nearly every case of venous thromboembolism on testosterone occurred in men with a previously undiagnosed clotting tendency.
- Fertility. Treatment suppresses sperm production, so plans are discussed before the first dose.
Who Is a Good Candidate?
- You have symptoms of androgen deficiency plus low morning testosterone confirmed on separate occasions.
- The look alike causes have been excluded or treated and the symptoms remain.
- You accept regular blood tests and a fixed review schedule.
- You have completed your family, or you understand and accept the effect on fertility.
- You have a history of prostate cancer, or an untreated prostate abnormality.
- You have breast cancer. Testosterone converts to oestradiol, so it is not used.
- You have severe lower urinary tract symptoms that have not been assessed.
- You are trying to conceive now. Testosterone suppresses sperm production and a different approach is needed.
- Your testosterone is normal and you want it raised for performance or physique.
What Happens During the Consultation
-
1
Confirming the diagnosis
The morning fasting values, LH and FSH, and whether primary or secondary. If the diagnosis was made elsewhere, the original basis is checked before treatment continues.
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2
Safety work up
PSA and prostate examination where age or family history requires it, baseline haematocrit, blood pressure, lipids, and a careful personal and family history of blood clots. Lower urinary tract symptoms scored where relevant.
-
3
Choosing the route
Injection into muscle, injection under the skin by autoinjector, or daily gel. The choice is made around your travel, needle tolerance, who else lives in your home and how steady you want the levels to be.
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4
Starting and scheduling
The dose, how to inject or apply it, what to expect in the first weeks, and the review dates. The first check is at two to three months, and it is booked before you leave.
Program Structure & Follow-Up
The monitoring schedule
| When | What is checked |
|---|---|
| 2 to 3 months after starting, and after any dose change | Serum testosterone, symptoms, haematocrit |
| 3 to 6 months | Haematocrit again, and PSA at 3 months in men over 50 or over 40 at higher risk |
| At 1 year | Prostate reassessment where indicated |
| Every 6 to 12 months once stable | Testosterone, haematocrit, symptoms, blood pressure |
Roughly half of men prescribed testosterone have no blood monitoring at all in the first six months. That is the standard this schedule exists to avoid.
How the level is measured correctly
- On injections, midway between doses, aiming for 400 to 700 ng/dL.
- On a gel, two samples taken on separate days before any dose adjustment, because single values correlate poorly.
- On a patch, at any time, remembering that levels peak six to eight hours after application.
What triggers a change
- Haematocrit above the normal range. The dose is reduced, and treatment is stopped if it reaches 54 percent, then rechecked two months later.
- PSA rising by more than 1.4 ng/mL in a year, or above 4, or a palpable nodule. Urology referral.
- Levels above target. The dose comes down.
- No symptom improvement despite normal levels. The diagnosis is revisited rather than the dose pushed.
Benefits, Limits & Safety
What the evidence supports
- Sexual function, energy and mood improve when genuine deficiency is corrected.
- Muscle mass and strength increase substantially, and fat mass falls.
- Bone density improves over years.
- Anaemia associated with low testosterone improves.
The risks, stated properly
- Erythrocytosis. A rise in red cell concentration is the most common adverse effect, defined as a haematocrit above 54 percent, and it matters because it is linked to clot risk. It is far less common when the dose is kept within the normal range.
- Blood clots. In a large trial, venous thromboembolism rates were 46 percent higher on testosterone, short of statistical significance, with twice as many pulmonary emboli.
- Atrial fibrillation and fractures were increased in that same trial, while major cardiovascular events were not.
- Prostate. Prostate volume and PSA rise towards the values expected for your age. Cancer rates were low and similar to placebo in that trial, though men at high risk were excluded from it.
- Fertility. Sperm production is suppressed, and recovery after stopping is not guaranteed to be quick.
- Gel transfer. Testosterone gel can transfer to a partner or child through skin contact, so application sites are covered and hands washed.
Contraindications
- History of prostate cancer, in most cases.
- Breast cancer.
- Severe untreated lower urinary tract symptoms.
- Active desire to conceive.
What treatment achieves
Improved libido, energy and mood within weeks where deficiency is genuine, with substantial gains in muscle mass and strength over months and better bone density over years.
The fixed schedule
Testosterone and haematocrit at 2 to 3 months and after any dose change, PSA at 3 months and 1 year where age requires it, then every 6 to 12 months once stable.
When it is not used
History of prostate cancer in most cases, breast cancer, severe untreated urinary symptoms, and men actively trying to conceive. Normal testosterone is not raised for performance.
Cost & Program Investment
Cost depends on the preparation, the dose and the monitoring your case requires, so a single number on a website would be misleading. You get the full figure in the consultation before treatment starts, and there are no charges you have not been told about. The reviews and blood work are part of the treatment, not an optional extra.
Frequently Asked Questions
It depends on your life. Weekly subcutaneous injection gives the steadiest levels. Intramuscular injection is well established but produces a peak and a trough. Gel avoids needles but levels vary and it can transfer to other people through skin contact.
Well within the normal range, typically 400 to 700 ng/dL. Not the top of the range and not above it. On injections the level is measured midway between doses; if it is higher than target, the dose comes down.
Libido, energy and mood usually respond within weeks. Muscle mass and strength take months. Bone density takes years. If nothing improves once levels are normal, the diagnosis is reconsidered rather than the dose increased.
At two to three months after starting and after any dose change, haematocrit again at three to six months, then every 6 to 12 months once stable. Around half of men on testosterone get no monitoring at all in the first six months, which is what this schedule prevents.
Because testosterone raises red cell concentration, and a haematocrit above 54 percent is linked to clot risk. If it rises above normal the dose is reduced, and treatment is stopped at 54 percent and rechecked two months later.
Prostate volume and PSA rise towards the values expected for your age. In a large recent trial, prostate cancer rates were low and similar between testosterone and placebo, although men at high risk were excluded. Monitoring is done for exactly that reason.
In that same large trial, major cardiovascular events were not increased. Atrial fibrillation, pulmonary emboli and fractures were. Venous thromboembolism rates were 46 percent higher, which fell short of statistical significance. Those risks are part of the conversation before you start.
Yes. Testosterone suppresses sperm production, and recovery after stopping is not guaranteed to be quick. If you want children, that is discussed before the first dose and a different approach may be appropriate.
You can, but the deficiency does not usually resolve, so symptoms return. Where a reversible cause was found and treated, stopping is genuinely possible and that is planned deliberately.
It can transfer through skin contact, which matters with partners and young children. Application sites are covered, hands are washed, and where there are small children at home an injection is often the better choice.
Then testosterone was not the cause and pushing the dose higher will not fix it. The work up continues, looking at sleep, thyroid, iron, glucose, mood and medication.
It depends on the preparation, the dose and the monitoring required, so a single figure would be misleading. You get the full cost in the consultation before treatment starts.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.