Testosterone Deficiency is a medical condition that results in low testosterone. This can be associated with negative symptoms such as low energy, ‘brain fog’, an element of low mood, anxiety, depersonalisation and low libido. Physical complications include cognitive decline, loss of lean muscle mass, decreased bone mineral density, poor cardiovascular health and infertility. In isolation, these symptoms can have several different causes and so the decision to start Testosterone Replacement Therapy (TRT) should always be a considered one.
The British Society for Sexual Medicine (BSSM) has set out national guidelines http://www.bssm.org.uk/wp-content/uploads/2018/09/guidelines-on-adult-testosterone-deficiency-with-statements-for-uk-practice.pdf to help clinicians diagnose and safely manage men with Testosterone Deficiency. Before any treatment is initiated, it is imperative to have thorough diagnostic blood tests, a full medical history taken, a physical examination and further investigations as appropriate to rule out any potential reversible causes. The decision to start TRT should never be made on merely ticking the necessary diagnostic boxes, it’s important for your doctor to consider if commencing TRT is in YOUR best interests.
TRT should be viewed a lifelong therapy. Administering exogenous testosterone suppresses the Hypo-Pituitary Gonadal (HPG) Axis and once treatment has been started, there is no guarantee that stopping therapy will result in your male androgen levels returning to your pre-TRT levels. There are medically supervised restart protocols that can be used to kick-start your HPG axis, but unfortunately there is no statistically significant medical research to validate their use. Saying this, in the past we have successfully normalised male androgen levels in men who had been started on TRT inappropriately by other TRT providers.
As TRT is not a decision to be taken lightly, you should always make a concerted effort to address other areas of your lifestyle, nutrition and physical exercise first. This will not only improve your testosterone levels but will also improve all aspects of your physical and psychological well-being. However, you must have realistic expectations and an appreciation that adopting a dogmatic approach may not feasible. We have witnessed some incredible transformations, ranging from psychological improvements in mental well-being to physical transformations where patients have gone from morbid obesity to a healthy body weight.
TRT is an involved process in both time and money. The TRT Journey is a worthwhile journey to make if you have a confirmed deficiency and have already addressed reversible causes, but the journey is not always smooth sailing. TRT can often be life changing but, irrespective of your newly restored and now healthy male androgen levels, you still need to have a holistic approach to your well-being. If your lifestyle is full of stress, you are sleep deprived, your diet is poor, and/or you don’t appreciate the importance of exercise in making your body work for you, it is unlikely that you will experience the full benefits of TRT. You’ll still always be tired if you have a bad night’s sleep, even with optimal male androgen levels!
It’s very disappointing, yet totally understandable, that due to lack of resources, funding and ‘toxic-overcrowding’ the NHS has had to adopt a firefighting, solution based medical model. I have always believed that we need to adopt a more progressive model that looks to and addresses causation, to affect a sustainable change to health we need to be looking at prevention rather than cure.
The Men’s Health Clinic is a CQC registered private medical clinic that specialises in diagnosing and managing men with Testosterone Deficiency. In November 2017, we put together a guide to help men who were struggling to have their TRT prescribed through the NHS, despite being candidates for treatment according to the BSSM Guidelines – https://themenshealthclinic.co.uk/trt-wars-get-trt-uk. We followed this up in October 2018 with a further guide – https://themenshealthclinic.co.uk/get-trt-uk-update.
It may appear counter-intuitive that a private medical clinic is encouraging men to take responsibility for their own health, and to address areas in their life that may result in them not needing TRT. For the ones who do still need treatment, we are continuously guiding them in how best to be supported by the NHS so that ultimately, they may no longer need to seek treatment privately. Our mission since we first opened in 2016 has always been to increase awareness and understanding surrounding both Testosterone Deficiency and Testosterone Replacement Therapy in the UK. The only way we are going to affect a positive change to the collective is to start with the individual, and so the involvement of your NHS doctor is pivotal to making what is currently gold standard practice, standard practice.
Dr Robert Stevens MBChB MRCGP Dip.FIPT