TRT for Men: Complete Guide to Testosterone Replacement Therapy in Surrey

Testosterone is often called the "male hormone," though it plays crucial roles in both men and women. For men, testosterone is fundamental to physical health, mental wellbeing, sexual function, and overall quality of life. When testosterone levels decline—whether due to ageing, underlying health conditions, or other factors—the effects can be profound and far-reaching.

At Lambert Medical Practice in Surbiton, we provide comprehensive testosterone assessment and replacement therapy for men across Surrey, Kingston upon Thames, and South-West London. Our approach prioritises thorough diagnosis, evidence-based treatment, and careful ongoing monitoring to ensure both safety and effectiveness.

This guide addresses everything you need to know about TRT: who might benefit, how we diagnose testosterone deficiency, what treatment involves, and why proper medical supervision matters more than ever in an era of online TRT clinics making questionable promises.

Understanding Testosterone: What It Does and Why It Matters

Testosterone is a steroid hormone produced primarily in the testes, with smaller amounts from the adrenal glands. It belongs to a class of hormones called androgens and is responsible for the development of male characteristics during puberty and the maintenance of male health throughout life.

Key Functions of Testosterone

Sexual Function and Fertility: Testosterone drives libido (sex drive), supports erectile function, and is essential for sperm production. Men with low testosterone often experience reduced sexual desire and may have difficulty achieving or maintaining erections.

Body Composition: Testosterone promotes muscle protein synthesis, helping build and maintain lean muscle mass. It also influences fat distribution, with adequate testosterone associated with less abdominal fat. Men with low testosterone often notice declining muscle mass despite exercise and increasing body fat, particularly around the midsection.

Bone Health: Testosterone is crucial for maintaining bone mineral density. Low testosterone accelerates bone loss, increasing the risk of osteoporosis and fractures—conditions often considered "female problems" but increasingly recognised in men with hormone deficiency.

Energy and Vitality: Adequate testosterone contributes to energy levels, motivation, and overall sense of vitality. Fatigue is one of the most common complaints among men with testosterone deficiency.

Mental Health and Cognitive Function: Testosterone influences mood, with low levels associated with increased risk of depression, irritability, and anxiety. It also affects cognitive functions including concentration, memory, and mental clarity.

Metabolic Health: Testosterone plays a role in insulin sensitivity and glucose metabolism. Low testosterone is associated with increased risk of metabolic syndrome and type 2 diabetes.

Cardiovascular System: The relationship between testosterone and cardiovascular health is complex, but adequate levels appear important for heart health. Testosterone stimulates red blood cell production, which is why monitoring haematocrit (blood thickness) is essential during TRT.

Natural Testosterone Decline: What's Normal?

Testosterone levels naturally peak in early adulthood (late teens to early twenties) and gradually decline thereafter. Most studies suggest testosterone decreases by approximately 1-2% per year after age 30. This is a normal physiological process and doesn't necessarily cause symptoms or require treatment.

However, some men experience more significant declines, and when testosterone falls below certain thresholds—particularly when accompanied by symptoms—treatment may be beneficial. The key distinction is between:

• Normal age-related decline: Modest reduction without significant symptoms
• Clinical hypogonadism: Testosterone deficiency causing symptoms and requiring treatment

Making this distinction requires careful clinical assessment combined with accurate laboratory testing—something that online TRT providers often fail to do adequately.

Symptoms of Low Testosterone: Do You Need TRT?

Recognising low testosterone can be challenging because symptoms develop gradually and often overlap with other conditions. Many men attribute their symptoms to "just getting older" or stress, delaying assessment for years. If you're experiencing several of the following symptoms, testosterone deficiency may be worth investigating:

Sexual Symptoms

• Reduced or absent libido (sex drive)
• Erectile dysfunction or difficulty maintaining erections
• Fewer spontaneous erections, particularly morning erections
• Reduced intensity of orgasms
• Decreased sexual thoughts or fantasies

Physical Symptoms

• Persistent fatigue despite adequate sleep
• Decreased muscle mass and strength
• Increased body fat, especially around the abdomen
• Reduced physical endurance
• Gynaecomastia (breast tissue enlargement)
• Loss of body hair
• Hot flushes or sweating (less common)

Psychological Symptoms

• Low mood, irritability, or depression
• Reduced motivation and drive
• Difficulty concentrating ("brain fog")
• Memory problems
• Decreased confidence
• Increased anxiety
• Sleep disturbances

Important Considerations

These symptoms are non-specific—they can be caused by many conditions besides testosterone deficiency. Depression, sleep apnoea, thyroid disorders, chronic illness, obesity, certain medications, and lifestyle factors can all produce similar symptoms. This is why thorough assessment is essential before assuming low testosterone is the cause.

At Lambert Medical Practice in Surrey, we don't simply test testosterone and prescribe if it's low. We conduct comprehensive assessments to identify the true cause of your symptoms and ensure treatment is appropriate and safe.

How We Diagnose Testosterone Deficiency at Lambert Medical Practice

Accurate diagnosis of testosterone deficiency requires both clinical assessment AND biochemical confirmation. Neither alone is sufficient. Our diagnostic process in Surbiton includes:

Step 1: Comprehensive Initial Consultation

Your assessment begins with a detailed 30-minute consultation where we:

• Review your symptoms in detail, including onset, severity, and impact on daily life
• Take a complete medical history including previous conditions, surgeries, and medications
• Assess lifestyle factors: sleep quality, stress levels, alcohol intake, exercise habits
• Discuss sexual health openly and without judgement
• Review family history of hormonal or metabolic conditions
• Perform physical examination including blood pressure, BMI, and relevant clinical signs
• Screen for conditions that mimic or cause low testosterone (depression, sleep apnoea, thyroid disease)

Step 2: Comprehensive Blood Testing

We use venous blood testing (not finger-prick) for accuracy. Tests are performed in the morning (7-11am) when testosterone levels peak, after overnight fasting. Our comprehensive male hormone panel includes:

Core Hormone Tests

• Total testosterone: Primary measure of testosterone status
• Free testosterone or calculated free testosterone: The biologically active fraction
• Sex Hormone Binding Globulin (SHBG): Protein that binds testosterone, affecting availability
• LH (Luteinising Hormone): Pituitary hormone that stimulates testosterone production
• FSH (Follicle Stimulating Hormone): Helps determine primary vs secondary hypogonadism
• Prolactin: Elevated levels can suppress testosterone
• Oestradiol: Testosterone converts to oestrogen; important for symptom assessment

Related Health Markers

• Thyroid function (TSH, T4): Thyroid disorders mimic low testosterone symptoms
• Full blood count: Baseline before TRT (testosterone increases red blood cells)
• Lipid profile: Cardiovascular risk assessment
• Fasting glucose and HbA1c: Diabetes screening (commonly coexists)
• Liver function: Baseline assessment
• PSA: Prostate health baseline for men over 40
• Vitamin D: Often deficient; affects testosterone and overall health

Step 3: Diagnosis and Discussion

At your follow-up consultation, we review all results and discuss:

• Whether biochemical testosterone deficiency is confirmed
• The likely cause (primary vs secondary hypogonadism)
• Whether TRT is appropriate and likely to help
• Alternative or additional treatments if indicated
• Benefits, risks, and monitoring requirements of TRT
• Impact on fertility if relevant to your situation

We believe in shared decision-making. You'll have all the information needed to make an informed choice about whether to proceed with treatment.

Testosterone Replacement Therapy: Treatment Options

If testosterone deficiency is confirmed and TRT is appropriate, several treatment options are available. At Lambert Medical Practice, we prescribe evidence-based treatments and help you choose the option that best suits your lifestyle and preferences.

Testosterone Gel (Transdermal)

How it works: Clear gel applied daily to shoulders, upper arms, or abdomen. Testosterone absorbs through the skin, providing steady hormone levels.

Advantages:

• Maintains stable testosterone levels without peaks and troughs
• Easy to adjust dosage
• Can be stopped quickly if side effects occur
• Self-administered at home

Considerations:

• Must be applied daily at the same time
• Risk of transfer to partners or children if skin contact occurs before gel dries
• Some men don't absorb gel well through skin
• Can be affected by swimming or excessive sweating

Common brands: Testogel, Tostran

Testosterone Injections

Testosterone Undecanoate (Nebido): Long-acting injection administered every 10-14 weeks in clinic.

Advantages:

• Convenient—only 4-5 injections per year
• No daily routine required
• Consistent compliance
• No transfer risk to others

Considerations:

• Requires clinic visits for administration
• Some fluctuation in levels between injections
• More difficult to stop quickly if problems arise
• Injection site discomfort

Testosterone Enanthate/Cypionate: Shorter-acting injections typically every 2-3 weeks, can be self-administered.

Other Options

Testosterone patches: Applied daily, similar to gel but with higher rates of skin reactions. Less commonly used.

Testosterone pellets: Implanted under the skin every 3-6 months. Requires minor procedure. Not commonly used in UK.

Nasal testosterone: Newer option with three-times-daily dosing. Limited availability and experience in UK.

Which Treatment Is Best?

There's no single "best" TRT option—it depends on your preferences, lifestyle, and medical factors. During your consultation at our Surbiton clinic, we discuss the options and help you make an informed choice. Many patients start with gel for its flexibility and switch to injections if they prefer less frequent dosing.

What to Expect: TRT Timeline and Results

TRT isn't instant—different benefits emerge over different timeframes. Understanding this helps set realistic expectations:

Individual responses vary. Some men notice improvements quickly; others take longer. If you're not seeing expected benefits, we reassess your treatment and may adjust dosing or formulation.

"The key to successful TRT is patience and proper monitoring. We optimise your treatment based on both how you feel and your blood test results."

Safety, Monitoring, and Why GP Supervision Matters

TRT is generally safe when prescribed appropriately and monitored correctly. However, it does require ongoing medical supervision—something that distinguishes proper medical care from online TRT mills.

Monitoring Schedule

3 months after starting: First follow-up blood tests to check testosterone levels, haematocrit, PSA, and assess symptom response. Dose adjustment if needed.

6 months: Repeat blood tests. By now, treatment should be optimised and stable.

Annually thereafter: Ongoing monitoring including comprehensive blood panel, symptom review, and health assessment.

As needed: Additional appointments if concerns arise or adjustments are required.

What We Monitor and Why

• Testosterone levels: Ensure adequate but not excessive dosing
• Haematocrit/Haemoglobin: Testosterone increases red blood cells; excessive levels increase clot risk
• PSA: Prostate health monitoring (TRT doesn't cause prostate cancer but can accelerate existing cancer)
• Oestradiol: Excessive conversion to oestrogen can cause side effects
• Liver function: Routine safety monitoring
• Lipid profile: Cardiovascular health assessment
• Symptoms and wellbeing: Ensure treatment is achieving goals

Potential Side Effects and Risks

Common side effects:

• Acne or oily skin (usually mild)
• Increased body hair
• Injection site reactions (if using injections)
• Skin irritation (if using gel)
• Fluid retention (usually mild)

Important risks requiring monitoring:

• Polycythaemia: Increased red blood cells/blood thickness. Regular monitoring allows early detection and dose adjustment
• Fertility impact: TRT suppresses sperm production. Important consideration for men wanting children
• Prostate considerations: TRT is contraindicated in men with prostate cancer. PSA monitoring is essential
• Cardiovascular: Research is mixed; proper monitoring addresses any concerns
• Sleep apnoea: TRT may worsen existing sleep apnoea

The Problem with Online TRT Clinics

The rise of online TRT providers has made testosterone more accessible, but often at the cost of proper medical care. Common concerns include:

• Inadequate testing: Many use finger-prick tests, which are less accurate than venous samples
• Lowered thresholds: Some prescribe TRT to men with normal testosterone, calling it "optimisation"
• Minimal assessment: Questionnaire-based diagnosis without proper clinical evaluation
• Poor monitoring: Inadequate follow-up and safety checks
• No holistic care: Missing other treatable causes of symptoms
• Commercial pressure: Business model depends on prescribing, creating conflict of interest

At Lambert Medical Practice, we take the time to do TRT properly. We only prescribe when genuinely indicated, we use accurate testing, we monitor appropriately, and we provide ongoing care from a GP who knows your full health picture.

TRT and Fertility: What You Need to Know

If you're considering having children in the future, this is a crucial consideration before starting TRT.

Testosterone replacement suppresses the body's own testosterone production and, importantly, suppresses sperm production. Most men on TRT become functionally infertile while on treatment. For some, this can be prolonged even after stopping TRT, and in rare cases, fertility may not fully recover.

Options for Men Wanting to Preserve Fertility

• Sperm banking: Before starting TRT, sperm can be frozen and stored
• Alternative treatments: hCG (human chorionic gonadotropin) can stimulate natural testosterone production while preserving fertility, though it's more expensive and requires regular injections
• Delay TRT: If fertility is an immediate priority, consider addressing symptoms through other means first
• Combination therapy: Some specialists use hCG alongside TRT to maintain some fertility, though this is specialist territory

We discuss fertility implications thoroughly during your consultation. If you're unsure about future family planning, this should factor into your treatment decision.

Cost of TRT at Lambert Medical Practice, Surrey

We believe in transparent pricing. Here's what TRT typically costs at our Surbiton clinic:

First year estimated cost: £1,200-1,800 (including all consultations, testing, and medication)

Ongoing annual cost: £800-1,200 (monitoring and medication)

These costs include proper medical supervision, face-to-face consultations, accurate venous blood testing, comprehensive monitoring, and ongoing relationship with your doctor. While online TRT providers may appear cheaper initially, the value of proper medical care cannot be overstated.

How to Get Started: Booking Your TRT Assessment

If you're experiencing symptoms of low testosterone and would like to explore whether TRT might help, here's how to proceed:

1. Book an initial consultation: Schedule a 30-minute appointment at Lambert Medical Practice, Surbiton
2. Prepare for your appointment: Note your symptoms, when they started, and how they affect your life. List all medications and supplements you take
3. Attend your consultation: We'll conduct a thorough assessment and discuss whether blood testing is appropriate
4. Blood tests: If indicated, we'll arrange morning fasting blood tests
5. Review appointment: Discuss results, diagnosis, and treatment options
6. Begin treatment: If TRT is appropriate and you wish to proceed, we'll start treatment and arrange monitoring