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Hormone Therapy

Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy (TRT)
Be the best version of yourself, whatever your age, with Testosterone Replacement Therapy (TRT)

At Harpal Clinic, you can expect Testosterone replacement therapy (TRT) – or more appropriately, testosterone optimisation therapy – with a difference.

Unlike most TRT clinics, we take a holistic, integrated approach to care – incorporating longevity and functional medicine practice.

Our medical team not only prescribes testosterone; we also make sure that your other hormones, and the components of the hormonal cascade – the gut, nutrition, stress, lifestyle and immune system – are all in sync and optimised for the very best results. And we do so while providing you with unrivalled support from our health coaches and patient care team.

Jump to:

Do I have low testosterone?
How we compare to other clinics
Testosterone: The basics
What patients say
TRT treatment
Timeline of patient journey
FAQs
Fees

Get in touch to find out more

Are you one of the 24%* of men with low testosterone?

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Have you noticed low libido, loss of muscle mass, fatigue and anxiety? These are just a few of the more common low testosterone symptoms in men.

Many clinics use the ADAM score as a factor in determining low testosterone. However, our experience tells us that there are far more factors at play. We prefer to use the AMS scale which gives a deeper insight into an individual’s testosterone status.

Complete the AMS scale below to get an idea of your testosterone status.

Get results in under 2 minutes. No need to give us any of your details!

*The Journal of Clinical Endocrinology & Metabolism

    Rate the severity of your symptoms below on a scale of 1-5 using the following guide:

    1 = None
    2 = Mild
    3 = Moderate
    4 = Severe
    5 = Extremely severe

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    Calculate score

    A score of 0-26 indicates

    You have no significant symptoms consistent with a low testosterone level

    However, that doesn’t take away from the fact that you may be experiencing symptoms that are impacting your life. And if you have symptoms, this shows us that there is clearly something related to your health that needs addressing.

    As our scope of practice is so wide, our functional medicine doctors can determine and treat those symptoms, whether that is dysregulated hormones or something else entirely.

    For a no obligation chat with our Health Care Specialist to answer any questions, including whether you’d be a good fit for TRT and how we might be able to help you, book below.

    A score of 27-36 indicates

    You have mild symptoms consistent with a low testosterone level

    We understand that symptoms, however mild, can impact your quality of life. And where there are symptoms, there is something with your health that needs addressing. As our scope of practice is so wide, we can determine and treat those symptoms, whether that is low testosterone production or something else entirely.

    We see a surprisingly high number of younger people who have low T but don’t want to go on TRT yet. If this is you, we can work with you to address the core drivers of low T, optimising your internal production of testosterone and overall health.

    For a no obligation chat with our Health Care Specialist to answer any questions, including whether you’d be a good fit for TRT and how we might be able to help you, book below.

    A score of 37-49 indicates

    You have moderate symptoms consistent with a low testosterone level

    If your symptoms are having a significant impact on your quality of life, it’s understandable that you’ll want to address them. And where there are symptoms, there is clearly something with your health that needs attention; our functional medicine doctors can do just that, addressing the underlying cause (whether that is low testosterone production or something else entirely) and help to take your health to the next level.

    Testosterone optimisation therapy may or may not be the right answer for you. Our doctors will assess your hormonal health and other factors that we know contribute towards low testosterone levels and design a plan to fit your needs over the longer term. For some this may mean TRT, but for others different measures may be more beneficial. This will all be addressed during your detailed consultation.

    For a no obligation chat with our Health Care Specialist to answer any questions, including whether you’d be a good fit for TRT and how we might be able to help you, book below.

    A score of 50+ indicates

    You have severe symptoms consistent with a low testosterone level

    Our functional medicine doctors are highly experienced at determining and treating the symptoms associated with low testosterone (whether they are caused by low testosterone production or something else entirely). We can help restore your vitality.

    You will likely benefit from testosterone optimisation therapy and we will also assess other related hormones which may contribute to your symptoms and manage them at the same time. Your doctor will talk you through the best options for therapy depending on your preferences, habits, budget and longer term plans to find a solution bespoke to you.

    For a no obligation chat with our Health Care Specialist to answer any questions, including whether you’d be a good fit for TRT and how we might be able to help you, book below.

    Hear what our patient has to say about his experience of TRT with Harpal Clinic

    How we are different to prescription-only TRT clinics (and why free testosterone measurements matter)

    We are different from the average TRT clinic. We don’t just normalise, we optimise!

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    Our upfront costs are a little more than other TRT clinics, this is due to our thorough evaluation of your overall health.

    Taking a deeper dive into your health with a hormone specialist from your initial consultation is a more effective use of time (and money). With years of experience under our belts, we find it to be the most logical – and successful – way of optimising your health, ensuring that the direction of your care and health journey is correct from the outset.

    The cost of ongoing meds starts from just £2.20 per day – that’s less than a cup of coffee!

    If you are coming to us with symptoms, this shows us that there is clearly something related to your health that needs addressing. As our scope of practice is so wide, we can determine and treat those symptoms, whether that is low testosterone or something else entirely – meaning your initial consultation, and investigative work is not in vain!

    Our doctors will address the underlying cause and help take your health to the next level – without you needing to sign up to a membership.

    We also see a surprisingly high number of younger people who suspect they have low T but don’t want to go on TRT yet. If this is you, we can work with you to address the core drivers of low T, optimising your internal production of testosterone and overall health.

    Comparing us to other clinics?

    Medical consultation with doctor specialising in hormones, longevity and functional medicine

    Optimisation of other hormones (incl. thyroid, human growth hormone, melatonin, DHEA)

    Preventative medicine

    Consideration of other body systems; e.g., cardiovascular, immune, and gut health

    Personalised lifestyle recommendations

    Pharmacy processing fee

    Health coaching sessions

    Unlimited support from patient care team

    Costs for testing and medication vary based on your individual needs. Our medical team will help you prioritise our recommendations based on your budget.

    Book a call with our Health Care Specialist for a no-obligation chat about your goals and to see if we’d be a good fit.

    Book

    TRT at Harpal Clinic - what's it really like?

    Testosterone: The basics

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    What is testosterone + what does it do in the body?

    Testosterone is a hormone found in both men and women. It is most often associated with sex drive, but testosterone actually has many important functions in the body, influencing bone and muscle mass, fertility, and red blood cell production. It also contributes to skin quality, metabolic function, bone strength, muscle strength, mood, and cognitive function – which can help to support healthy ageing. When our testosterone levels are optimal, we generally feel really good and healthy. When the levels are too low or too high, we can start to notice symptoms.

    Causes of low testosterone

    Testosterone levels naturally start to decline slowly from age 30. Some will start to notice symptoms of low testosterone around the age of 35. There are also other factors can contribute to low T, they can exacerbate or be the cause of low testosterone, including:

    • Anabolic steroid use
    • High levels of, or chronic stress
      Poor sleep
    • Smoking
    • Obesity
    • Certain medications
    • Chronic underlying health issues
    • Environmental factors like pesticides and/or chemicals in food and water

    To learn more about how these factors can affect your testosterone levels, book a discovery call.

    What can low testosterone treatment help with?

    TRT can help to with:

    • Anxiety
    • Libido and sexual function
    • Erection quality
    • Energy levels
    • Skin health
    • Fat distribution
    • Muscle mass gains whilst reducing fat mass
    • Mood
    • Sleep quality
    • Bone strength

    The testosterone we use for TRT is biologically identical to what we produce naturally in the body.

    Does the NHS treat low testosterone?

    You can get TRT on the NHS, though this is susceptible to long wait times and treatment is usually only provided if testosterone levels are extremely low. At Harpal Clinic, we don’t only normalise testosterone levels, we look to optimise.

    We also don’t just focus on one area, we instead take a much broader look at your health; considering factors that influence a person’s cardiovascular health, digestive health or adrenal health, as well as considering longevity medicine and preventative healthcare strategies, providing a more well-rounded approach to hormone optimisation.

    The TRT patient journey with Harpal Clinic

    Discovery Call

    Our unique understanding of hormones as part of health optimisation will be apparent from the moment you contact us.

    Book a discovery call with our Health Care Specialist to get the answers to any questions you may have, including the best pathway for you.

    Book an appointment

    Book a Focussed or Comprehensive consultation pathway either online or over the phone with our team.

    The cost of the Focussed and Comprehensive pathways can be found on our Fees page.

    Initial consultation

    Discuss your medical history, symptoms, any recently conducted test results and your goals with one of our doctors who will be with you through your journey with us.

    Our consultations take place either at our clinic location or we can complete your entire journey remotely.

    Blood tests for low testosterone

    Complete your blood test in-clinic or we can arrange them local to you at a Superdrug anywhere in the UK. Samples are sent directly to our preferred accredited lab.

    When it comes to testosterone levels, everyone is different but what is considered ‘normal’ ranges from 300 to 900 ng/dL. If you go to your GP with concerns about low testosterone they will usually give you a blood test for total testosterone. As the name suggests, this gives an idea of the total amount of testosterone in the body. Whilst this can certainly be an indicator of low testosterone, without taking a bit of a deeper dive it often shows normal levels, despite the patient having symptoms.

    Our blood tests use the most accurate measure of free testosterone. Where other clinics measure free testosterone using the ‘calculated’ method, we test for ‘free measured’ testosterone.

    Why is this significant?

    Total: All clinics do this test. It gives an idea of all bound and unbound testosterone. However, this frequently does not correlate with symptoms as only the unbound, ‘free’ testosterone can be used. So you could have high or “normal” levels but still have all the symptoms of low T as your free testosterone levels could still be low.

    Free calculated: Costs less but not especially accurate as it is only an estimate of free testosterone based on a mathematical equation using SHBG and total testosterone levels. It can be misleading. It’s a bit like taking a calculated guess, which in our experience, has ranges from being similar to the actual free measured levels, to completely different, irrelevant and hence unusable.

    Free measured: Costs slightly more but is a true and accurate measurement of the amount of free testosterone that is bioavailable in the body – no guessing involved!

    Other TRT clinics tend to look at testosterone levels in isolation, but we pair it with other testing parameters, like cardiovascular and longevity testing. This will be based on what is most relevant to you, your goals, and what works within your budget.

    Treatment plan

    Your doctor will provide a bespoke treatment plan based on your consultation and test results.

    This could incorporate any of the following testosterone replacement treatments:

    • Injectables – Cypionate, Sustanon, Enanthate, Nebido
    • Liposomal gels
    • Testosterone implants – coming soon
    • HCG (Human Chorionic Gonadotropin), where relevant
    • Clomid, where relevant

    We take a much wider view of your health which sets us apart from other, typically single direction, TRT clinics. Alongside prescribing TRT, we also look at the underlying reason(s) for low T and address those to best support your internal production and your overall health.

    Your treatment plan may also include:

    • Advanced hormone optimisation such as; precursor hormones (DHEA and pregnenolone), thyroid hormones, human growth hormone (HGH), or melatonin
    • A supplement plan to best compliment your regime, one that not only considers your hormone plan, but also your wider health
    • Dietary recommendations if required

    Depending on your chosen consultation pathway, we can also take a deeper dive into your:

    • Cardiovascular health - which can include your arterial age and as well as blood markers such as; cholesterol parameters, advanced blood pressure screen, Apolipoprotein A1, Apolipoprotein B, Lipoprotein (a), and an omega analysis
    • Stress or adrenal health - as we look to support cortisol regulation and optimise you to deal with stress more effectively
    • Gut health and nutritional therapy
    • Longevity medicine

    We tailor every treatment regime to the individual.

    We also have a very clear understanding that many other factors must be considered, including personal habits, lifestyle, preferences, fertility, age, and of course budget. Our medical team will always work within your personal budget and help you prioritise your recommendations.

    There is something that will be the right fit for everyone, and we try our best to work with you to find that exact fit.

    Prescription

    We will organise your hormone prescriptions (body identical or bioidentical), from placing an order to receiving the delivery. Each order is carefully processed by our patient care team through our preferred specialist or compounding pharmacy.

    TRT self-administration consultation

    We want you to be confident when administering your medication. You will spend 30 minutes 1-2-1 with one of our clinicians (via video or telephone) to learn the best techniques for injecting or using your medications.

    Health coach

    After starting your treatment you’ll spend some time with your health coach. Our team of health coaches are incredibly well versed in all things TRT and hormones! They will be there to answer any questions you may have and are bookable as and when it is needed. Typically you’ll have your first session once you have been on your TRT for a few weeks to allow time for your regime to begin.

    Patient care team support

    A key component of what sets us apart is the patient care team support we provide all of our patients. This team provides support for the duration of your care with us.

    Most members of this team have a clinical background, meaning that they are able to understand and converse in a productive way regarding your healthcare.

    Where needed, they will liaise with your doctor on any questions and come back to you with clinical insight.

    A unique service, one which patients report as being invaluable, and one we are incredibly proud to boast as part of our patient support!

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    FAQs

    Some symptoms of low testosterone are similar to other conditions. Some of the most common signs of low testosterone include:

    Physical

    • Low libido
    • Poorer quality of erection or inability to maintain an erection
    • Loss of morning erections
    • Lack of energy
    • Feeling sluggish and tired
    • Changes to skin and hair
    • Fertility issues
    • Poor muscle tone and not getting the same results in the gym
    • Hair loss

    Mental

    • Anxiety
    • Difficulty coping with stress
    • Irritability (grouchy old men – ask the people around you!)
    • Concentration and memory issues (brain fog)
    • Depression or feeling low
    • Insomnia or disturbed sleep
    • Aggression (this is seen in both high and low levels; not at optimal levels)
    • Loss of drive and motivation

    You can get TRT on the NHS, though this is susceptible to long wait times and treatment is usually only provided to those with extremely low total testosterone levels.

    At Harpal Clinic, we don’t only aim to normalise testosterone levels, we look to optimise them. We also don’t just focus on one area. Instead we take a much broader look at your health; considering factors that influence a person’s cardiovascular health, digestive health or adrenal health, as well as applying longevity medicine and preventative healthcare strategies. This allows us to provide a more well-rounded approach to hormone optimisation.

    We don’t offer testing on its own or before the doctor consultation for a few reasons:

    • Without an understanding of your symptoms, medical history and health goals, we cannot recommend the most suitable tests for you. Running any tests without having a deeper understanding of your personal situation can be a waste of your money.
    • Test results require doctor interpretation. The consultation with our doctors holds equal value when it comes to formulating a robust and personalised treatment plan for you.
    • Test results without context or understanding of your wider health can be misleading.

    Once you’ve had your initial consultation, testing, and your prescription, the next step is to purchase any medications and supplements that have been recommended.

    Medications may not be as costly as you expect, starting from as little as £2.20 a day – that’s less than a cup of coffee!

    Follow-ups are required 3 months after your initial consultation and then 9 months after your initial consultation. The purpose of this is to ensure everything is going as expected and to see if your treatment plan needs any adjustments.

    The cost of the Focussed and Comprehensive pathways cover: your initial doctor consultation, lab interpretation time for your doctor to review testing, your medical report with recommendations and treatment plan, a second doctor consultation, prescription processing fees, an allocated health coach and patient care team support between doctor visits.

    Testing and medication are an additional cost. This is because everyone is unique and you may require completely different tests and medications to another person.

    You may be a good candidate for TRT if:

    • You are beginning to feel the effects of ageing. Whilst previously this would be someone in their 40s onwards, these days due to excessive stress, we are seeing changes in much younger patients.
    • You think that you are doing most things right but still can’t lose that last bit of weight; are still more tired than you think you should be; or your anxiety levels and ability to handle stress is less robust.
    • You are curious and want to understand your body better at a time when you are relatively well – for those looking at longevity medicine or are a health optimiser who’s more interested in prevention than cure.

    Both injectable and topical testosterone are popular with us, though what works best for you will depend on many factors including lifestyle, budget, and preferences. Our specialist doctors will work with you to find the best fit for you.

    The different types (or esters) of testosterones (Cypionate, Sustanon, Enanthate, Nebido) all have different injecting schedules, these will also be further tailored to what works best for you. Some patients also find that our liposomal gels are also great for travelling with and are also good for those not wanting to inject.

    Even if you don’t like injections, you may be surprised how straight-forward and painless they can be. You may also decide with your doctor to choose an injectable testosterone that you inject less frequently.

    Taking hormones can also be injection-free. Our doctors can talk you through what other options are available; such as our specialist liposomal testosterone gels.

    Although the majority of our TRT patients prefer injectables, testosterone gels are also a great choice – with a significant percentage of our TRT patients choosing this as their preferred option as the absorption of our liposomal gels are superior to other gels available.

    We prefer to carry out our own blood tests as our medical team has collectively developed and decided upon our blood panels. Our doctors prefer that your blood markers give us a deeper insight into your health than tests performed for other clinics. We not only look at free measured testosterone, but other important hormone health markers for a wider view of your health. Because looking at testosterone in isolation is a bit like only having one piece of the puzzle.

    You don’t need to be on testosterone forever. However, as TRT replaces what your body is not naturally producing, when you stop treatment you will begin to notice the symptoms of low testosterone again.

    Alongside TRT we would address the underlying cause of why their testosterone is low to begin with, for our younger patients. For this group of people TRT can be a good way to support symptoms whilst we work on other health factors in the background.

    Yes, absolutely. However, it’s worth bearing in mind that your symptoms may return as your hormone levels return to their natural state.

    We often get questions about ‘man boobs’ (gynecomastia) and if TRT can cause this. This is something we are very experienced in dealing with. When TRT is done right (i.e. correct dose and schedule), in our experience, it simply does not happen as much as people think. In some people however, due to their personal genetics and metabolic pathways, this is unfortunately unavoidable. In these rare cases, it can simply be managed – something our doctors are experienced at.

    Absolutely! We find many TRT patients are particularly interested in cardiovascular health and other hormone optimisation (HGH, DHEA or melatonin) and other aspects of longevity medicine. Simply mention this to your doctor during your appointment. In the meantime, you can read more about longevity medicine here.

    When travelling outside the UK:

    • Carry medication in the original packaging in your hand luggage
    • Pack the medication’s literature
    • Check your medication fits liquid restrictions
    • If your medication needs to be kept at a certain temperature, you may want to use an insulated bag
    • Bring your travel letter with you (we can provide this for you at no additional cost)

    For the most up-to-date official guidance on taking medication outside of the UK, it’s essential to check the entry requirements of the embassy of the country you are travelling to. Please check this well in advance of travel to ensure you are prepared.

    Fees

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    We don’t offer membership at Harpal Clinic, giving you the freedom to order medications and hormones as and when you like within our follow-up schedule parameters. It also means we can tailor your care as much or as little as you like according to your budget, needs, and goals.

    The cost of testing and medications are separate to the cost of the consultation pathway. This is because everybody’s testing and medication needs are unique. The cost of medication starts from as little as £2.20 per day. To discuss this further, please book a discovery call.

    You can find out more about the cost of our consultation pathways at Harpal Clinic on our Fees page.

    Aaliyah, Harpal Clinic

    Let's talk about how we can help you

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