In short
- Testosterone is a prescription hormone, not a supplement. One low reading proves nothing.
- Two morning tests. Fasting, between 8 and 10, repeated, with LH, FSH, thyroid, prolactin and iron alongside.
- Genuine deficiency is uncommon. In 2966 men aged 40 to 79 it affected about 2 in 100.
- The look alikes are the usual answer. Sleep apnoea, obesity, alcohol, thyroid disease and depression.
- Treatment has real risks. More clots, more atrial fibrillation, more fractures, and fertility suppressed.
Who This Service Is For
Who this is for
- Men with reduced libido, fewer morning erections, persistent fatigue, low mood or loss of muscle despite training.
- Men who were started on testosterone elsewhere and want the diagnosis verified.
- Men with type 2 diabetes, osteoporosis or a low trauma fracture, where deficiency is genuinely more common.
- Men taking long term opioids or high dose steroids, both of which suppress testosterone.
- Men who want the whole endocrine and metabolic picture measured, not one number.
Who it is not for
- Anyone wanting a prescription based on a single afternoon blood test.
- Anyone wanting a normal testosterone raised for physique or performance.
- Men currently trying to conceive, where treatment suppresses sperm production and a different approach is needed.
- Men who are acutely unwell, where hormone testing gives a temporarily low and misleading result.
Treatment Programs Under This Pillar
Why Physician-Led Care Matters
Why this needs a doctor
Testosterone is a prescription hormone, not a supplement, and a single low reading proves very little. Levels vary through the day, drop after poor sleep, fall after eating and drop during any acute illness.
That is why a diagnosis needs symptoms together with at least two low morning total testosterone measurements, plus tests that look for other explanations such as thyroid, prolactin, iron and blood count problems.
How rare genuine deficiency actually is
In a study of 2966 men aged 40 to 79, the combination of low testosterone and three sexual symptoms was present in only 2.1 percent. Severe deficiency was present in 0.9 percent.
Most men who suspect low testosterone have something else, and most of those things are more treatable.
What testing correctly means
| Rule | Why |
|---|---|
| Between 8 and 10 in the morning | Levels peak then and fall to about 70 percent by evening |
| Fasting | Glucose lowers testosterone acutely |
| Repeated on a separate day | Values fluctuate, and one sample is not a basis for lifelong therapy |
| Not during illness | Acute illness produces a temporary functional drop |
| Free testosterone by equilibrium dialysis only | The analog assay most laboratories offer is inaccurate and misleading |
Why starting testosterone wrongly does harm
It masks the real problem. A man whose fatigue comes from untreated sleep apnoea, and who is put on testosterone instead, keeps the apnoea, gains a therapy he now depends on, and loses fertility while he is on it.
Treatment also carries measurable risk. In the largest trial, pulmonary emboli, atrial fibrillation and clinical fractures were all more common on testosterone, although major cardiovascular events were not.
What honest treatment looks like
- Prostate assessment before starting, in men over 50 or over 40 at higher risk.
- Baseline haematocrit, and a careful personal and family history of blood clots.
- A dose aimed at the middle of the normal range, around 400 to 700 ng/dL, not the top.
- Review at two to three months, haematocrit at three to six, PSA at three months and one year, then every 6 to 12 months.
- If levels are normal and symptoms have not improved, the diagnosis is revisited rather than the dose increased.
How the Consultation Works
-
1
Your symptoms and goals
We start with what has actually changed for you: energy, libido, erections, mood, sleep, training response, body composition and concentration. We also cover work pattern, alcohol, stress and whether you plan to have children, because that changes the options.
-
2
Medical review and examination
Dr. Felix reviews your medical history, medication, previous results and family history, then examines you. Blood pressure, weight, waist and a targeted physical examination help separate hormonal causes from metabolic, thyroid or sleep related ones.
-
3
Blood tests and diagnosis
You have blood taken in the morning, when testosterone is highest, and a second morning sample on a separate day if the first is low. Alongside this we check the markers needed to interpret the result and to exclude other causes.
-
4
Your plan
Once the picture is complete, Dr. Felix explains what your results mean and recommends a plan. That may be testosterone therapy with a defined monitoring schedule, or treatment of another cause, or a period of lifestyle and metabolic work first.
Frequently Asked Questions
Yes, where the diagnosis is properly established: symptoms plus at least two low morning fasting values, with the look alike causes excluded. What will not happen is a prescription based on one convenient sample or on symptoms alone.
Because testosterone fluctuates, drops after poor sleep and after eating, and falls during any illness. A single low value is not a sufficient basis for committing someone to long term hormone therapy.
Less likely than most men expect. In a study of 2966 men aged 40 to 79, low testosterone with three sexual symptoms was present in 2.1 percent. Sleep apnoea, obesity, alcohol, thyroid disease and depression are all more common.
Low libido, fewer morning erections, loss of body hair, small testes and low bone density are the specific ones. Fatigue, low mood, reduced strength and increased body fat are common but non specific.
In the largest trial, pulmonary emboli, atrial fibrillation and clinical fractures were more common on testosterone, while major cardiovascular events were not increased. Red cell concentration rises, and fertility is suppressed. Those are discussed before you start.
Yes, testosterone suppresses sperm production and recovery after stopping is not guaranteed to be quick. If you may want children, that conversation happens before anything is prescribed.
Yes, and the first step is verifying the original diagnosis. Where the evaluation before treatment does not support it, the recommendation is to stop and re-evaluate about two months later, because continuing can mask a treatable cause.
Well within the normal range, typically 400 to 700 ng/dL, measured midway between injections. Higher is not better: adverse effects scale with supraphysiological levels while benefits do not.
Then the symptoms still need explaining and the work up continues into sleep, thyroid, iron, glucose, mood and medication. A normal hormone panel is not the end of the conversation.
If you are over 50, or over 40 with a first degree relative who had prostate cancer, yes, before treatment and again at three months and one year.
Two to three months after starting or after any dose change, haematocrit at three to six months, then every 6 to 12 months once stable. Around half of men on testosterone receive no monitoring at all in their first six months.
It depends on the tests, whether treatment follows, the preparation and the monitoring, so a single figure would be misleading. You get the full cost in the consultation before anything is arranged.
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.