An investigation reveals how private UK clinics are aggressively marketing testosterone replacement therapy (TRT) to men with vague symptoms like fatigue, often misdiagnosing low testosterone and overlooking serious health risks including infertility, heart disease, and stroke. Despite NHS guidelines restricting TRT to cases of hypogonadism with specific symptoms, private providers readily prescribe based on questionable blood tests, exposing men to unnecessary medicalisation and potential harm.
Are you often fatigued? Struggle to sleep? Suffer from aches and pains? Plagued by stubborn belly fat that won't shift?
These might sound like the inevitable signs of ageing, but if you're a man over 35, private clinics may have another diagnosis: low testosterone. Adverts telling 'tired' men this could explain their symptoms have been appearing across the London Underground and social media feeds - with influencers offering discounts if you click on an affiliate link for a testosterone blood test at a private clinic.
Based on your results, for around £150 a month, you'll get your treatment - testosterone jabs - delivered to your door. One clinic boasts that it has sold more than 200,000 testosterone blood tests in the UK, with around 30,000 men currently on its treatment programme.
However, leading experts argue these clinics are medicalising vague symptoms such as fatigue - that everyone experiences at some point - to sell testosterone replacement therapy (TRT) to men who don't need it. And worse, giving otherwise healthy men TRT may affect their fertility and increase their risk of heart disease and stroke. That's because testosterone stimulates red blood cell production and if levels are too high, the risk of blood clots increases.
Blood pressure and 'bad' cholesterol levels can also rise. In the long-term TRT poses a risk to men's fertility because the brain, detecting testosterone arriving from outside, switches off the signals telling the testes to make testosterone and sperm. With no job left to do, the testes shrink and sperm production falls - sometimes, according to a number of experts, with lasting effects. It's not therefore something men should take without good reason, they say.
Indeed in this country, TRT is only licensed to treat hypogonadism, where the sex glands produce barely any of the sex hormones, including testosterone. One expert, Professor Richard Quinton, a consultant endocrinologist at the Royal Victoria Infirmary in Newcastle and senior author of Society for Endocrinology's testosterone guidelines, said the growing use of TRT via private clinics is 'the worst instance of medicalising normal biology that I have encountered'.
Indeed as this investigation found, it's worryingly easy to get hold of TRT based on test results of questionable accuracy. Some private clinics offered me unlicensed drugs and upsold libido boosters with minimal checks.
At 54, I am in the target audience, but there's nothing to suggest I might have low testosterone: I have no erection problems and no loss of libido - the two key symptoms for prescribing TRT, according to guidelines from the British Society of Sexual Medicine (BSSM). I regularly exercise and can dance with my kids, aged six and eight, without breaking a sweat: I have an abundance of energy and am the ideal weight for my height.
Yet when I had my testosterone levels checked, I was told I need TRT - despite an NHS check on the same day showing my testosterone levels were so high that my GP gave me further tests to check I didn't have a tumour in my testicle (thankfully I didn't). At the heart of all this is the level at which the private clinics judge whether a man's testosterone is low.
Testosterone blood tests measure both 'total' testosterone - i.e. how much there is in the blood - and free testosterone, how much is actually available to use for muscle growth and energy. On the NHS, TRT is only prescribed after two separate fasting morning blood tests show total testosterone below around 8nmol/L (the BSSM set it at 12), combined with specific symptoms - new erectile dysfunction and loss of morning erections.
Fatigue and poor sleep on their own won't lead to TRT on the NHS. Under BSSM guidelines, treatment is considered even if your total testosterone is normal but only if you also suffer from severe erectile dysfunction and no morning erections, plus your free testosterone is below 0.22 (again, on the basis of two morning blood tests, more on this later).
However, private clinics are willing to prescribe testosterone at varying levels. With around 30 UK clinic websites offering testosterone prescriptions, I go on to five of the most prominent providers. For each I fill in an online questionnaire - then I can order a blood test (usually a fingerprick test). If the test indicates low testosterone, following a second blood test to confirm the results, an online consultation with a doctor can be arranged.
I list my symptoms as low energy, muscle aches and lack of sleep and take my first blood test (for £34) with Voy, which says it's 'treated more men for testosterone deficiency than any other UK clinic'
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