Abstract
Starting Testosterone Replacement Therapy (TRT) in the UK isn’t just about choosing a treatment - it’s about understanding the signs, knowing how to get evaluated properly, and deciding whether to go through the NHS or a private clinic. This guide focuses on the access pathway, rather than the full treatment process, and is designed to help you make confident, informed decisions before you even begin TRT.
If you’re considering TRT and want clarity before committing, this guide is for you. If you're ready to take the next step, book a consultation at Omniya Clinic, the UK’s leading private centre for hormone health.
Opinion: I’ve been managing men with hormonal therapy for many years and have treated a great number of patients in that time. The art to hormonal therapy is not so much following the numbers but listening to patients. Individual responses to hormones can vary significantly and so in my opinion there is no substitute for experience. The more patients one speaks to the the more you can tune in to patient’s stories.
Despite the rapid growth of the TRT industry in the UK, our doctors at Omniya have vast experience of managing low testosterone with excellent results.
Symptoms of Low Testosterone
Low testosterone symptoms can be subtle at first. Many men don’t realise the cause of their tiredness or low mood until symptoms escalate. Here are common signs:
- Persistent fatigue
- Brain fog or difficulty concentrating
- Reduced strength or muscle mass
- Decline in libido or erectile performance
- Weight gain, especially around the waist
- Low mood, irritability, or anxiety
- Disrupted sleep patterns
Not every man experiences all of these, and symptoms alone don’t confirm low testosterone. But if these signs resonate, it’s worth investigating further. Learn more on our Symptoms of Low Testosterone page or read the research paper on the benefits of TRT here.
Where to Get Evaluated for TRT
To begin your TRT journey, you need an accurate diagnosis - and that starts with proper evaluation, not self-diagnosis or assumption.
The Role of Blood Tests
TRT requires clinical confirmation of low testosterone via blood tests. You’ll typically be tested for:
- Total testosterone
- Free testosterone
- SHBG
- LH, FSH
- Oestradiol, prolactin
- PSA (prostate screening)
Tip: Blood should be drawn between 7–10am for the most reliable hormone readings.
If you're unsure what tests to ask for, visit our Check Your Testosterone page - we explain everything you need to know.
Clinical Review
TRT isn't prescribed based on numbers alone. Your doctor should review your symptoms, general health, mental wellbeing, lifestyle, and fertility status. This broader view helps determine whether TRT is both necessary and safe.
At Omniya, we take a holistic approach to evaluation. Hormones never operate in isolation, and identifying whether testosterone is the main issue - or part of a wider imbalance - is essential to effective treatment.
Your Options: GP vs Private Clinics
You can explore TRT through the NHS or via a private hormone specialist. Both have pros and cons.
Through the NHS
- Pros: No cost if you're eligible.
- Cons: Long waits, limited testing, conservative prescribing guidelines. Many GPs will only refer to endocrinology if your testosterone is below NHS reference ranges. Some men report being turned away despite symptoms.
Through a Private Clinic
- Pros: Faster access, advanced testing, longer consultations, and bespoke treatment plans. Ideal for men with borderline or symptomatic cases.
- Cons: Paid privately - initial testing and consultation typically range from £300 to £800. See our TRT Pricing Overview for transparent costs.
Private clinics are often better suited for men with active lifestyles, career stress, or nuanced symptoms not adequately addressed through standard NHS thresholds.
For more information on Private Clinics and the NHS for TRT, please visit our dedicated post.
What Happens After a Diagnosis
If your blood tests confirm low testosterone and your symptoms are consistent, the next step is to discuss your treatment options. These may include:
- Injections (2-3 times weekly to quarterly)
- Transdermal creams or gels (daily use)
- Long-acting implants or pellets
Each method has its pros and drawbacks. Rather than duplicating this discussion, we recommend exploring How Do You Take TRT? for a complete breakdown.
TRT is not a quick fix. If you’re prescribed treatment, it should be part of a long-term plan that includes regular monitoring, dose adjustment, and symptom tracking.
How Long It Takes to Start TRT
If you're going through the private route, here’s a realistic timeline:
- Week 1: Initial consultation +/- blood draw
- If this is your 2nd blood test, results often come back the same day and your medication is either ready for collection from our pharmacy that day or will be posted to you same day
- If you attend your initial consultation already having had 2 low testosterone levels and blood tests completed, you can leave the appointment with medications in hand.
- Week 6: First follow-up blood test and symptom review
- Ongoing: Monitoring every 3 to 6 months, with bloods and consultations - fully tailorable
From consultation to prescription, many men begin TRT within 2–3 weeks. NHS pathways can take significantly longer, depending on GP and endocrinology wait times - sometimes 6–12 months from referral to treatment.
FAQs
Do I need a blood test before TRT?
Absolutely. TRT should never be prescribed without diagnostic testing. This protects your long-term health and ensures treatment is appropriate. It also sets a baseline so future results can be compared and tracked.
Can I get TRT through my GP?
Yes, but it can be difficult. NHS guidelines are strict, and many men with symptoms find their testosterone is considered “normal.” Private clinics offer broader testing, symptom-led assessments, and shorter wait times.
What if my testosterone is 'normal' but I still feel off?
This is common. You may fall into the "normal range" but still feel the impact of suboptimal levels. That’s where a private clinic's broader approach and clinical judgement becomes valuable.
What Else Should You Consider Before Starting?
Fertility Goals
TRT can reduce or suppress sperm production. If you’re planning to have children in the near future, this must be factored into your treatment strategy. Options like HCG or fertility-sparing regimens can be discussed.
Existing Health Conditions
Certain conditions (e.g. untreated sleep apnoea, high haematocrit) may delay or contraindicate treatment. This is why initial evaluation is so important.
Monitoring Commitment
TRT requires a long-term relationship with your doctor. If you're looking for a one-off fix, this isn’t the right approach. Ongoing review, blood testing and health screening are essential.
Conclusion: Making Informed First Steps
TRT isn’t a shortcut - it’s a structured medical process. This guide is designed to help you take that very first step: recognising symptoms, knowing what tests you need, and deciding how to pursue treatment.
To get started:
- Learn more about checking your testosterone
- Understand our step-by-step TRT process
- Book your consultation with Omniya’s hormone doctors
There’s no pressure to start TRT - but the first step is knowing whether it’s even appropriate.
