Question 1

What are common symptoms of low testosterone?

Accepted Answer

Common symptoms include persistent fatigue, reduced drive, difficulty concentrating, low mood, reduced libido, fewer morning erections, loss of muscle and strength, increased abdominal fat and slower recovery. These symptoms can have many causes, so they must be assessed together with blood tests and your general health.

Question 2

Can I have symptoms with a ‘normal’ total testosterone?

Accepted Answer

Yes. Total testosterone does not show how much hormone is available to the tissues. If SHBG is high, free testosterone may be low even when total testosterone is within the laboratory range. Symptoms, total testosterone, SHBG and calculated or measured free testosterone should therefore be assessed together.

Question 3

What is the grey zone?

Accepted Answer

Total testosterone around 8–12 nmol/L is often described as a grey zone. It is not a diagnosis by itself. Persistent symptoms, repeated morning measurements, free testosterone, SHBG, LH, FSH and possible contributing conditions help the physician decide whether further investigation or treatment is appropriate.

Question 4

Do I need my doctor to approve the blood test?

Accepted Answer

No. You order the panel yourself. Men typically come here for reasons like these: their doctor said no, they will not wait, or they want a hormone specialist in the EU this week. Your own doctor can still see the result. That is your choice, not the way in. A prescription follows a consultation, and only when treatment is indicated.

Question 5

Have the lab methods just changed?

Accepted Answer

No. In the Janus Serum Bank, blood from men aged 40–49 had been frozen for up to 29 years. Gislefoss et al. (2012) ran it on both an immunoassay and LC-MS/MS. The oldest samples were substantially higher than fresh ones. Storage breaks hormone down, so it would have made the old numbers lower, not higher.

Question 6

I have a number. What now?

Accepted Answer

Put it next to your symptoms, not next to a laboratory’s “normal for your age.” Zitzmann et al. (2006) saw the first symptom links around 15 nmol/L. Sexual symptoms become more common below about 11–12 (EMAS, Wu et al. 2010). A specialist reads the two together.

Question 7

Finger-prick or venous blood — and why not saliva?

Accepted Answer

A blood-based finger-prick test can provide an initial indication. A venous morning sample is normally preferred when low testosterone must be confirmed and treatment is being considered. Saliva testing is not used here to diagnose testosterone deficiency or make treatment decisions.

Question 8

When should testosterone be measured?

Accepted Answer

Testosterone should normally be measured in the morning, preferably between 07:00 and 10:00, after a normal night’s sleep and when you are not acutely ill. A low or borderline result should usually be confirmed with a second morning measurement before treatment.

Question 9

Which markers should be included?

Accepted Answer

Our recommended minimum panel includes total testosterone, SHBG with calculated free testosterone, LH, FSH, oestradiol, haematocrit, HbA1c and vitamin B12. Depending on symptoms, age, medical history and current treatment, the physician may recommend additional markers such as prolactin, PSA, thyroid, liver, kidney or lipid tests.

Question 10

How does the process work?

Accepted Answer

You can begin with the free symptom test and relevant morning blood tests. A physician then reviews your symptoms, results, medical history and goals. Treatment can be started only when it is medically indicated, followed by agreed clinical and laboratory monitoring.

Question 11

Is online TRT legal?

Accepted Answer

Yes. TRT can legally be assessed and prescribed through telemedicine when a licensed physician carries out an appropriate medical assessment, documents the decision and issues a valid prescription. The prescription and dispensing must follow the rules in the country where treatment is provided and the medicine is dispensed.

Question 12

Can a prescription from another EU country be used?

Accepted Answer

A prescription issued by a licensed clinician in an EU country can generally be used in another EU country when it contains the required information. National rules for controlled medicines, available products and dispensing still apply, so the receiving pharmacy must confirm that it can dispense it.

Question 13

How quickly can treatment begin?

Accepted Answer

Timing depends on whether the necessary morning tests are complete and whether the physician needs further information or repeat measurements. A prescription is issued only after the assessment is complete and treatment is considered medically appropriate.

Question 14

Do I have to attend in person?

Accepted Answer

The medical consultation can be completed online. Blood testing may be done with an appropriate home kit or as a venous sample at a collection site. The physician will tell you if an examination or additional testing is needed.

Question 15

Can you review my current treatment?

Accepted Answer

Yes. Bring your latest blood results, current medicine and dose, treatment history, symptoms and the changes you would like to achieve. The physician reviews the complete picture with fresh eyes and explains whether the current plan is appropriate, should be adjusted or needs updated tests before the next decision.

Question 16

Who is TRT for?

Accepted Answer

TRT may be appropriate for men who have compatible symptoms and repeatedly low testosterone confirmed with reliable morning blood tests. A number alone is not enough. The physician also considers possible causes, other health conditions, fertility plans, sleep, weight, medication and alcohol before recommending treatment.

Question 17

What are the benefits of TRT?

Accepted Answer

Men whose symptoms and low testosterone are properly diagnosed often report meaningful improvements in quality of life. Depending on the individual, these may include more energy and motivation, improved libido and sexual function, a brighter mood, greater muscle mass and strength, less abdominal fat, better recovery, improved bone density and better metabolic markers. The response varies, and improvement is assessed through both symptoms and follow-up measurements.

Question 18

When will I notice improvements?

Accepted Answer

Some notice changes in libido, energy or mood within the first few weeks. Strength, muscle mass, body composition and metabolic changes usually develop over several months, while bone density takes longer. The timing varies with the symptom, preparation, dose, starting level and general health, so treatment is adjusted from symptoms and follow-up blood tests rather than a fixed timetable.

Question 19

Does TRT affect fertility?

Accepted Answer

Exogenous testosterone can suppress sperm production when the testes are no longer receiving the signals needed to maintain their own production. Some patients who want to preserve testicular function choose hCG together with TRT, while other options may be more appropriate for others. Fertility plans and the available approaches should always be discussed with the physician during the consultation.

Question 20

Which side effects can occur with TRT?

Accepted Answer

Possible side effects include acne or oily skin, increased haematocrit, fluid retention, breast tenderness, reduced sperm production and reduced testicular volume. Existing sleep apnoea or urinary symptoms may also require closer attention. With correct medical follow-up, symptoms and blood values are monitored and the physician can adjust the dose, preparation or interval, or pause treatment, to prevent or reduce side effects.

Question 21

Is TRT lifelong?

Accepted Answer

It can be long-term when the underlying testosterone deficiency persists. If treatment is stopped, testosterone levels and symptoms may return to their previous state. Whether to continue, adjust or stop should be decided with the physician and not by changing the treatment on your own.

Question 22

Gel or injection?

Accepted Answer

Both gels and injections are established options. Gel is applied daily and can provide relatively stable exposure, while injection profiles depend on the preparation and interval. The physician chooses with you based on response, preference, availability, monitoring and the products licensed where the prescription is dispensed.

Question 23

What about the prostate?

Accepted Answer

Prostate symptoms and age-appropriate PSA assessment are considered before and during treatment. Known or suspected prostate cancer requires specialist assessment before TRT. Follow-up is adapted to age, symptoms, risk factors and the physician’s clinical judgement.

Question 24

Do you assess testosterone in women?

Accepted Answer

Yes. Women are assessed with symptoms, medical history and female reference ranges. The MRS questionnaire can support the symptom assessment. Testosterone treatment for women, when indicated, uses female physiological targets and much lower doses than treatment for men.

Questions about low testosterone, blood tests and treatment

Symptoms

Blood tests

Assessment and prescription

Treatment

Women