In short
- For men already diagnosed. This is the long term management layer, not the diagnostic appointment.
- The target is mid range. Around 400 to 700 ng/dL, measured midway between injections, not chased upward.
- Half of men on testosterone get no blood monitoring in the first six months. This programme exists so that is not you.
- Dose is only part of it. Sleep, visceral fat, alcohol and training load move testosterone in their own right.
- Function over numbers. The measure is how you feel and perform, not a figure on a report.
Treatment Overview
What this programme is
It is the layer that comes after diagnosis and initiation. For men whose deficiency is established and who want a defined rhythm of reviews instead of appointments booked whenever something feels wrong.
The problem it solves is documented and unflattering: around half of men prescribed testosterone have no biochemical monitoring at all in their first six months.
What each cycle covers
| Element | What is done |
|---|---|
| Testosterone level | Measured midway between injections, targeting 400 to 700 ng/dL. On a gel, two samples before any dose change, because single values correlate poorly |
| Haematocrit | Checked regularly. Dose reduced if it rises above normal, treatment stopped at 54 percent |
| Prostate | PSA at three months and one year in men over 50, or over 40 at higher risk, then periodically |
| LH, in primary hypogonadism | A normalised LH is a further sign the dose is right |
| Symptoms and function | Libido, energy, mood, training response, sleep |
| Body composition | Muscle and fat measured rather than assumed |
Why the dose is not pushed upward
Higher is not better. Erythrocytosis is far less common when levels are kept within the normal range, and the risks that do exist scale with supraphysiological dosing.
Where a level comes back above target, the dose comes down. That is not conservatism, it is how the risk profile stays acceptable.
The half of the programme that is not the prescription
These move testosterone and function independently, and they are frequently the reason a man on a stable dose still feels flat.
- Visceral fat. Lowers testosterone through the binding protein and through the pituitary signal, and it is reversible.
- Sleep, and untreated sleep apnoea in particular.
- Alcohol.
- Training load and recovery. Both too little and too much cause the same complaints.
- Blood pressure and glucose, treated on their own merits.
What this programme does not do
It does not raise a normal testosterone for performance, it does not chase supraphysiological levels, and it does not continue a prescription that is not producing a clinical benefit.
If your level is normal and the symptoms have not improved, that finding is acted on rather than ignored.
Who Is a Good Candidate?
- Your diagnosis is established and you want structured long term management.
- You started treatment elsewhere and are not being monitored properly.
- You want body composition and function tracked, not just a hormone level.
- You travel and need review dates set in advance rather than booked reactively.
- You want a repeat prescription without appointments or blood tests.
- You want your level pushed above the normal range.
- You have not yet been properly diagnosed. The TRT consultation is the right starting point.
- You are trying to conceive, where the approach has to change.
What Happens During the Consultation
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1
Where you actually stand
Current preparation and dose, how long you have been on it, what monitoring has been done and what it showed. Symptoms now versus before treatment, honestly compared.
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2
A proper baseline
Testosterone timed correctly for your preparation, haematocrit, PSA where age requires it, blood pressure, lipids, HbA1c, and body composition with strength markers.
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3
Dose and route review
Whether the level sits mid range, whether the route suits your life, and whether swings between doses explain how you feel through the week. Adjustments made with a reason, not by feel.
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4
The schedule
Review dates set in advance, what is measured at each, and what triggers an earlier appointment. Plus the non hormonal targets for sleep, training, alcohol and weight.
Program Structure & Follow-Up
The rhythm
- Two to three months after any dose change, with testosterone and symptoms.
- Every 6 to 12 months once stable, with testosterone, haematocrit, blood pressure and symptoms.
- PSA at three months and one year after starting, then periodically, in men over 50 or over 40 at higher risk.
- Bone density reassessed after two years where it was low at baseline.
- Between appointments, direct access through the membership programmes.
What triggers a change
- Haematocrit above the normal range, or reaching 54 percent.
- PSA rising by more than 1.4 ng/mL in a year, or above 4, or a palpable nodule.
- A level above target midway between injections.
- No clinical improvement despite a normal level.
- New symptoms such as swelling in a leg or sudden breathlessness, which need same day attention because of clot risk.
Measuring function, not just hormones
Body composition and strength markers are recorded at reviews. A man whose testosterone reads perfectly while his muscle mass falls and his waist grows is not being managed well, and the hormone level alone will never show that.
Benefits, Limits & Safety
What structured management changes
- Dose kept in the range where benefit is real and risk is lowest.
- Haematocrit and prostate problems caught early rather than discovered late.
- The non hormonal drivers addressed, which is often why someone on a correct dose still feels flat.
- Treatment that is not working gets identified and stopped rather than escalated.
The limits
- Optimisation does not mean maximisation. There is no benefit above the normal range, only risk.
- Testosterone does not improve energy, cognition or blood sugar in the way it is marketed to.
- Some symptoms will have another cause, and continuing hormone therapy will not reveal it.
Safety points
- Erythrocytosis is the most common adverse effect and is dose related. It is the main reason for regular blood counts.
- Clot risk. Pulmonary embolism was more common on testosterone in the largest trial. Sudden breathlessness or leg swelling needs urgent assessment.
- Fracture risk was raised in that trial despite better bone density, so men at high fracture risk are also treated for osteoporosis.
- Gel transfer to partners and children is avoidable with covered application sites and hand washing.
- Fertility remains suppressed for as long as treatment continues.
What good management looks like
A mid normal testosterone around 400 to 700 ng/dL, stable haematocrit, prostate monitored, body composition holding, and the symptom that brought you in actually improved.
The schedule
Testosterone and symptoms 2 to 3 months after any dose change, then every 6 to 12 months with haematocrit and blood pressure. PSA at 3 months and 1 year, then periodically where age requires it.
What is not done here
Raising a normal testosterone, chasing supraphysiological levels, or continuing repeat prescriptions without appointments and blood tests.
Cost & Program Investment
Cost depends on how often you are seen, the preparation and the monitoring required, so a single number on a website would be misleading. You get the full figure in the consultation, and there are no charges you have not been told about. What you are paying for is continuity and the monitoring that most men on testosterone never receive.
Frequently Asked Questions
Well within the normal range, typically 400 to 700 ng/dL. On injections it is measured midway between doses. Higher is not better: the adverse effects scale with supraphysiological levels while the benefits do not.
Two to three months after starting or after any dose change, 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 exactly what this schedule prevents.
Because injected testosterone peaks a day or two after the dose and drifts down before the next one. A sample taken at the peak looks high and one taken at the trough looks low. Midway is the value the dose is judged on.
Usually because something else is driving it: sleep, untreated sleep apnoea, visceral fat, alcohol, training load, blood pressure or glucose. Raising the dose is not the answer and adds risk without benefit.
Yes, and it is common. The original diagnosis is verified, current monitoring reviewed, and the dose and route reassessed. Where the diagnosis was never properly established, that is addressed first.
Haematocrit, PSA where age requires it, blood pressure, lipids and HbA1c, plus body composition and strength markers. In primary hypogonadism a normalised LH also helps confirm the dose is right.
Testosterone raises red cell concentration. A haematocrit above 54 percent is linked to clot risk, so the dose is reduced if it rises above normal and treatment is paused at that threshold.
Possibly, if the weekly pattern of how you feel suggests level swings, or if there are young children at home given the transfer risk with gel. It is reviewed rather than left as whatever you started on.
Where the deficiency is permanent, yes, and symptoms return if you stop. Where a reversible cause is found and treated, coming off is planned deliberately with monitoring afterwards.
It depends on how often you are seen, the preparation and the monitoring required, so a single figure would be misleading. You get the full cost in the consultation before anything 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.