Updated April 2023
Testosterone replacement therapy, in the form of injections, is a standard treatment for men with low testosterone levels. This article will explore the causes of low testosterone levels, testosterone replacement therapy options, how testosterone injections work and the time they need to start working.
Testosterone is a hormone produced in the male testicles that is responsible for developing male characteristics such as a deep voice, facial hair, and muscle mass. As men grow older, it is natural for the body to experience low testosterone levels. According to the NHS, “male menopause” also referred to as andropause is misleading as it suggests that men will have a sudden drop in testosterone levels.
This isn’t the case as male testosterone levels naturally decrease, typically by around 1% annually after age 30. However, it is also possible to suffer from low testosterone at a younger age. Hypogonadism, or low testosterone, has three categories: primary, secondary and mixed.
Low testosterone, also known as hypogonadism, has three categories:
1. Primary hypogonadism, or primary testicular failure, is caused by a problem with the testes. Common causes include Klinefelter syndrome, mumps, cancer treatment or injury to the testicles.
2. Secondary hypogonadism occurs when the pituitary gland and hypothalamus malfunction. Common causes include Kallman syndrome, pituitary tumours, HIV/AIDS, opiate pain medication, obesity and age (male menopause or andropause).
3. Mixed hypogonadism is caused by a combination of primary and secondary hypogonadism and is often related to age and health.
Hypogonadism or low testosterone has several common symptoms, including:
• Loss of body hair
• Reduced muscle mass and weight gain
• Gynecomastia (breast glandular growth)
• Erectile dysfunction
• Low or nonexistent sex drive
• Fatigue and exhaustion
• Hot flushes
• Disturbed sleep
• Poor concentration and “brain fog”
• Mood swings and depression.
• Weight Lifting and Exercise — Research has shown that resistance training, such as weight lifting and high-intensity interval training (HIIT), can naturally boost testosterone levels.
• Creatine Supplements — A study into testosterone and creatine supplements showed increased testosterone levels after three weeks of taking creatine monohydrate.
• Fish Oil Supplements — Stress that continues for a long time can cause a rise in cortisol and reduce testosterone production. The omega-3 fatty acids in fish oil supplements have been shown to be most effective in reducing cortisol levels.
• Vitamin D — Research has indicated that vitamin D boosts testosterone. You can increase vitamin D levels by spending time in the sun or with vitamin D supplements.
• Zinc — Research has shown that taking zinc supplements for 26 weeks increased sperm count by 74%.
• Sleep — Various studies have indicated that sleeping five or fewer hours a night can reduce testosterone levels.
Hormone therapy for men is not a one-size-fits-all treatment. Although testosterone replacement therapy (TRT) is generally very safe, you should always do comprehensive screening and testosterone tests first.
You may be able to request your GP to provide you with a testosterone test, or you may need to pay to have one taken at a private clinic. Testosterone tests check that your pituitary gland is functioning correctly by measuring your testosterone levels. Two hormone tests, the FSH (Follicle-stimulating hormone) test and the LH (Luteinising hormone) test, are typically used together for more accurate results.
Hormone therapy for men balances hormone levels by boosting testosterone. Various forms of testosterone replacement therapy (TRT) are available in the UK on prescription. The administration of testosterone replacement therapy (TRT) will depend on your own personal preferences and include gels, injections, tablets, patches, gum, nasal, and implantable pellets.
You may be able to obtain TRT through the NHS, or alternatively, you can pay for it privately. The eight most common types and brands of testosterone replacement therapy (TRT) are:
1. Gel: Brand names — AndroGel, Testim, Vogelxo, Fortesta
The gel is applied daily, generally in the morning, to the skin; once applied, you shouldn’t swim, shower or get wet for several hours to allow for optimal absorption of testosterone.
2. Underarm spray: Brand name — Axiron
Apply one pump or one twist action to clean the underarms once a day.
3. Tablets: Brand name — Jatenzo
Testosterone tablets are liquid-filled capsules, and the prescribing physician determines the dose. Typically you will take the capsules twice daily.
4. Injection: Brand names — Depo-Testosterone, Delatestryl, Aveed, Nebido
Depending on the brand, some testosterone injections can be self-administered or given by a family member or friend. Aveed is administered via deep intramuscular injection, which a medical practitioner must do.
5. Patch: Brand names — Androderm
The patch has testosterone impregnated, which is released gradually. You will need to apply a new patch every night.
6. Gum: Brand name — Striant
This is different to regular gum you would chew. You apply the gum onto the gum line under your upper lip two to three times a day.
7. Nasal gel: Brand name — Natesto
This type of testosterone gel is applied inside each nostril three times daily.
8. Implantable pellets: Brand names — Testopel
Surgically implanted, the pellet sits just under the skin and is replaced every three to six months.
At Harley Street Medical, we understand testosterone replacement therapy isn’t a “one-size-fits-all” treatment. When you come to our office for a consultation, we will conduct a comprehensive TRT screening before suggesting a personalised treatment plan.
We take time to understand your concerns and the results you seek from TRT. Whatever symptoms you are experiencing, we’ll always take you seriously.
TRT — physical examinations cover:
• Cardiovascular (heart), respiratory, gastrointestinal, musculoskeletal & nervous systems
• Ears, nose and throat, including thyroid glands and lymph nodes
• Visual fields
• Testicles
• Prostate.
TRT — blood tests cover:
• Anaemia
• Infection and inflammatory markers
• Leukaemia
• Kidney and liver function
• Bone strength,
• Diabetes and gout
• Full cholesterol profile
• Vitamin D levels
• Thyroid function (free T3, free T4 and TSH)
• Prostate Specific Antigen (PSA) screening test (prostate cancer screen)
• Hormone profile test for LH, FSH, testosterone, oestradiol, SHBG, prolactin and free androgen index
• Adrenal Axis test for cortisol levels and DHEA-S (check function of adrenal glands).
We provide various testosterone replacement options at Harley Street Medical, including gels, tablets, and Nebido testosterone injections, administered into the gluteal muscle.
Nebido is not suitable for men with:
• Prostate cancer
• Breast cancer
• Past or present liver tumours.
Nebido is one of the most popular methods of testosterone therapy for men because its slow release provides a steady supply of testosterone directly into the bloodstream. You can expect an injection every ten to fourteen weeks for maintenance. Depending on your testosterone levels, the first interval between injections can be reduced to six weeks if needed.
Nebido testosterone injections are an exceptionally well-tolerated testosterone replacement therapy (TRT), and the slow release of testosterone helps reduce side effects.
Side effects of Nebido testosterone injections tend to be mild and include:
• Mood swings
• Irritability
• Acne
• Weight gain
• Headaches
• Anxiety
• Prolonged erections (rare).
We are always at hand if you have concerns about any side effects you experience during TRT treatment.
It is essential to differentiate between testosterone replacement therapy (TRT) and illegal anabolic steroids. Extensive research has shown that TRT has various health benefits for men provided by a physician who carefully monitors the dose, increasing it by small amounts if necessary.
Anabolic steroids from dealers or online often contain unknown and potentially harmful substances. They also typically have between 10 and 100 times the dose prescribed for TRT. Increasing testosterone levels above what would occur naturally is one of the reasons using illicit anabolic steroids can have numerous dangerous effects on the body.
Once injected, testosterone is slowly released into the bloodstream over time. The testosterone then binds to androgen receptors found in various body tissues, including muscle tissue and bone. This binding process can increase muscle mass, improve bone density and promote physical performance.
Testosterone injections can also improve energy levels, mood, and cognitive function. This is because testosterone plays a crucial role in producing neurotransmitters such as dopamine and serotonin, which regulate mood and motivation.
Results from testosterone injections can vary, and it’s important to have realistic expectations. However, many men report feeling the effects of the injections within a few weeks to a couple of months. Improvements in mood and energy levels are typically the first changes noticed, followed by physical changes such as increased muscle mass and improved sexual function.
According to the research, it can take two to six weeks for testosterone injections to start taking effect. Studies show that Nebido testosterone injections can work within three weeks of the first dose and effectively improve mood and energy levels.
It’s important to note that testosterone injections should only be used under the guidance of a healthcare professional. The dosage and frequency of injections will depend on several factors, including age, weight, and overall health. Monitoring testosterone levels regularly is important to ensure they remain within a safe range.
Don’t let low testosterone levels keep you from living your best life. With the help of testosterone replacement therapy (TRT), you can start to feel more like yourself again. Remember, patience and proper supervision are key to achieving the best results.
If you are suffering from symptoms of low testosterone, make an appointment with us for testosterone replacement therapy in London with a doctor-led men’s health service.
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