Testosterone Replacement Therapy (TRT)

Testosterone is more than a sex hormone. It influences body composition, bone density, red blood cell production, mood and sexual function. In men, testosterone levels tend to decline by around one to two percent per year from middle age. Some men develop hypogonadism, meaning consistently low testosterone (typically below 300 ng/dL) together with symptoms, and many of them are never assessed.

Low testosterone is linked with poorer health, but the direction of cause is not always clear. A 2011 meta-analysis of observational studies (Araujo AB et al., Journal of Clinical Endocrinology and Metabolism) found that low testosterone was associated with higher all-cause and cardiovascular mortality, although the studies differed widely and the link may partly reflect poorer underlying health. Low testosterone is also associated with increased visceral fat (which can lower testosterone further through conversion to oestrogen), insulin resistance, reduced muscle mass, lower bone density and depressive symptoms. These problems are worth taking seriously, and worth diagnosing properly.

Our TRT Protocol begins with diagnosis, not prescription. We require a comprehensive hormone panel (total testosterone, free testosterone, SHBG, LH, FSH, oestradiol, prolactin, DHEA-S, thyroid cascade, PSA, and complete blood count) drawn in the early morning when testosterone levels peak. If results confirm hypogonadism and clinical symptoms align, our physician discusses treatment options, expected benefits, potential risks, and monitoring requirements before initiating therapy.

Treatment is individually titrated. We use testosterone cypionate or enanthate administered via intramuscular or subcutaneous injection, with dose and interval set to keep levels steady and dosing adjusted based on follow-up labs at 6 weeks, 3 months, and quarterly thereafter. We monitor haematocrit (testosterone stimulates erythropoiesis, and polycythemia is the most common side effect requiring management), PSA, oestradiol, liver function, and lipid panels throughout.

This is a medical treatment for a diagnosed condition, not a performance enhancement service. We do not prescribe testosterone to men with normal levels. For patients who qualify, symptoms and blood results are reviewed on a fixed schedule, and therapy is stopped if it does not help. Book a consultation with our longevity physician to have your hormone levels assessed.