Testosterone Replacement Therapy in London

If you are tired, flat in mood, losing muscle or noticing a drop in sex drive, low testosterone is one possible explanation among several. Our London clinic assesses men properly before any treatment begins: a face-to-face consultation with a consultant urological surgeon, early morning fasting blood tests, and a frank conversation about whether testosterone replacement therapy is the right answer for you. If it is, we guide you through it and monitor you throughout. If it is not, we say so and help you find the real cause.

What testosterone replacement therapy is

Testosterone is the main male hormone. It plays a part in muscle growth, bone health, mood, energy levels and sexual function. Levels fall slowly in most men as they get older, and can fall further because of certain medical conditions, some medicines, carrying excess weight, poor sleep or heavy drinking.

Testosterone replacement therapy, usually shortened to TRT, is an established medical treatment that brings a genuinely low testosterone level back into the normal range. For men who need it, and who are properly assessed and monitored, it often improves energy, mood, libido and physical strength.

The important word there is genuinely. Tiredness, low mood, weight gain and low libido are common complaints, and testosterone is only one of several possible causes. Not every man with these symptoms needs TRT. We assess you fully first, start treatment only if the history and the tests support it, and then keep you under review.

Signs and symptoms of low testosterone

Low testosterone affects men in different ways, and the picture is rarely confined to one part of life. The symptoms men describe most often fall into three groups.

• Physical: fatigue, loss of muscle, increased body fat, weaker bones.
• Sexual: low libido, erectile dysfunction, fewer spontaneous erections.
• Psychological: mood swings, low mood, poor concentration, low motivation.

These overlap heavily with thyroid disease, depression, sleep apnoea, anaemia, diabetes, alcohol and plain overwork. That overlap is precisely why a single blood test, taken without a proper history and examination, is not enough to justify starting long-term hormone treatment.

When TRT is not the answer

A great many online men’s health services start TRT without ever seeing a man in person, without excluding other causes for his symptoms, and without discussing the drawbacks. We work differently. Some men who come to us tired or with a low sex drive turn out to have a normal testosterone level, and we say so plainly. In that situation the right answer is to find and treat the real cause, not to begin a hormone you do not need.

TRT also calls for caution in particular groups. Men who still hope to father children should not start it without specialist input, because it suppresses the body’s own sperm production. Men with a history of prostate cancer, a raised blood count, untreated sleep apnoea or significant heart disease need an individual assessment before any decision is taken.

Assessment before treatment starts

Our process is deliberately unhurried, and every step exists for a reason.

Initial consultation

You see one of our consultants in person. We go through your symptoms, your general and sexual health, your medicines, your sleep and lifestyle, and whether you want children now or later. You are examined where that is relevant.

Blood tests

Testosterone follows a daily rhythm and falls after eating, so the sample is taken early in the morning after an overnight fast, and a low result is confirmed on a repeat test. We also check the related pituitary hormones, which show whether the problem lies in the testicles or higher up, together with your blood count, prostate-specific antigen where appropriate, and other markers of general health and of safety on treatment.

Your treatment plan

We then talk through what the results mean, whether TRT is the right step for you, which preparation suits your life, and what the alternatives are. If treatment is not indicated, we tell you, and we explain what to do instead.

Types of TRT we offer

Several preparations are available. The choice depends on your circumstances, your preference and how your body responds.

Gels

An easy-to-apply daily gel, absorbed through the skin. Gels are usually the starting point, because the dose can be adjusted quickly and treatment stopped quickly if a problem arises. They call for a little care in the household: the gel can transfer to a partner or child through skin contact until it has dried and the area is covered.

Short-acting injections

Injections given weekly or every two weeks. They suit men who would rather not think about a daily routine, and they still allow a fairly quick change of course if needed.

Long-acting injections

Depot injections that can last around three months. They are convenient, but because the effect cannot be withdrawn quickly, we normally reserve them for men who have already tolerated testosterone well on a shorter-acting preparation.

What to expect once treatment starts

Improvement is gradual, and it varies from man to man. In broad terms, and without any promise about your own case:

• One to three months: many men notice more energy, a steadier mood and better concentration.
• Four to six months: changes in muscle and body composition often become visible, along with improved libido, sexual function and stamina.
• Seven to twelve months: effects on bone density and general wellbeing continue to develop, and the overall picture usually settles.

The benefits men report most often are improved mood and mental clarity, better muscle mass and strength with more capacity for training, improved libido and sexual function, and healthier bone density and metabolism. If little has changed after several months at an adequate level, that is useful information in itself: it suggests testosterone was not the whole explanation, and we will look again at the other possible causes rather than simply increasing the dose.

Monitoring, safety and fertility

TRT is a safe therapy when it is administered carefully and monitored properly. Taken without monitoring, it is not. Testosterone acts on the prostate, on the blood count and on the cardiovascular system, and those effects need to be watched rather than assumed to be harmless.

We arrange a check at about four weeks to confirm that your level is rising safely and as expected. Every man on TRT with us then has a three-month review, and continuing reviews after that, covering symptoms, testosterone level, blood count, prostate assessment and general health.

On fertility, the answer is straightforward: TRT can reduce sperm production and impair fertility, sometimes for a prolonged period. Younger men who are still hoping to start or extend a family should not be put on TRT without specialist assessment, and other approaches to male fertility may be more appropriate.

On the prostate, safe replacement of testosterone does not cause prostate cancer. Raising a low level can, however, wake up a cancer that was already present but dormant, which is one of the main reasons monitoring is not optional. Men who have been successfully treated for prostate cancer can have TRT, but only under close specialist supervision.

Seek urgent medical attention if you develop chest pain, sudden breathlessness, or a painful, swollen calf, or if you become unable to pass urine at all. Contact us or your GP promptly if you notice visible blood in your urine (haematuria), new breast tenderness or swelling, ankle oedema, a marked change in mood, or a persistent skin reaction where the gel or injection is given.

Seeing a specialist in London

The Andrology Centre is led by three specialists who all practise at Guy’s & St Thomas’, named by Newsweek in 2025 as the number one urology service in Europe. Mr Maj Shabbir is a Consultant Urological Surgeon, Clinical Lead of The Andrology Centre and a past National Chair for Andrology at BAUS. Ms Raveen Kaur Sandher is a Consultant Urological Surgeon. Ms Elsie Mensah is a Urology Specialist whose work covers bladder cancer, benign prostatic enlargement and prostate diagnostics.

We see patients at HCA at The Shard (SE1 9BS), HCA at Canary Wharf (E14 5NR) and HCA at Guy’s Hospital (SE1 9RT). If you are funding your own care you do not need a referral from your GP. If you are claiming on private medical insurance, your insurer will usually require one, so it is worth checking before you book.

To arrange a consultation, call +44 7889 318584 between 8am and 4pm, Monday to Friday, or email contact@theandrologycentre.co.uk.

Frequently asked questions

References and further reading