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Experience with Testosterone Replacement Therapy in the UK

This is a guest post from a current Propane Athlete and Performance coach about his experience with Testosterone Replacement Therapy (TRT). People are usually pretty cloak and dagger talking about this kind of stuff, so it’s an honour to see such a candid account here.

If you’ve considered TRT in the past, or worried that you had low testosterone, read on.

This guy has in transformed his body, and discovered while losing 26kg that he had low Testosterone. He discusses how Testosterone affects you physically, emotionally and psychologically and how TRT has radically transformed his body and his life.

He has become an ‘accidental expert’ on TRT as result of his own diagnosis, research and therapy and also just by diving in and really figuring out some of the pitfalls and some of the stigma that are associated with TRT, particularly in the UK.

Before my fat-loss journey and diagnosis, I was a typical sedentary office worker working in the IT sector for over 27 years. Arriving in midlife, 40-something and overweight, I sensed that a lot of things needed to change in my life, culminating in a revelation while on holiday in the Canaries at 47 years old: I had a lot of good things going on in my life, but my body was that of a decrepit old man.

At that moment, I set myself the 3 year goal of getting into the shape of my life.

The thought I had on the beach was:

‘How much longer do I have in which I can reverse this trend of being sedentary and overweight?’

Nothing like the ruthless sense of time running out to get you going. I subsequently lost over 26kgs, dropping from 30% bodyfat to 10%.

I instantly felt a whole load better. Energy levels increased, confidence increased and for the first time in a long time in my life, I felt confident about taking his shirt off on the beach.

Unfortunately, the 26kg weight loss had inevitably resulted in a degree of muscle loss too. Now I was just skinny.

Here was the true challenge: Building some lean mass and strength, the physique I had always dreamed about.

Despite my nutrition being on point, working consistently with a personal trainer and staying in a moderate caloric surplus, I just couldn’t gain any muscle: I simply regained fat.

I resisted the first gentle prompt from my trainer, who suggested I should look into whether I had low testosterone. Fuck you dude, don’t question my masculinity.

The seed had been planted though. It didn’t take me long to observe the consistent relationship in the evidence that aggressive fat loss can have a detrimental (and poorly reversible) effect on testosterone.

In addition to the inability to gain muscle, I was feeling increasingly depressed, anxious and brain-foggy with libido through the floor — all of which I had simply attributed to old age.

I thought.. maybe this is just what happens when you get older? Your libido drops off, and your brain doesn’t work?

After eventually convincing my doctor to test my serum testosterone, it flagged up 7 nanomoles per litre of testosterone. To put this in perspective, the NHS standard for “normal” range testosterone is between 12 and 30, with the level for the average 80 year old male being 11. A healthy adult male between the ages of 25 to 35 would have a testosterone level of around 20.

I had the testosterone levels of a fucking octogenarian.

I think if you are a male of a certain age profile, you’ve come from being fat, and you’re experiencing some of these symptoms, it’s worth pushing back a bit with your doctor and just explore whether they could be down to low testosterone.

It is strange to think that if you are a woman and you go into a GP and describe certain symptoms, they will automatically be having a conversation with you about hormone replacement therapy. But for men, it’s relatively unheard of. Apparently, it does go in cycles. Some years, they’re more likely to talk about it than others, but certainly in the UK, the NHS GPs are currently on a pro-HRT wave at the moment.

If you’re going to a doctor as a male and say that, “Well, you know, my libido’s suffering,” or, “I’ve got erectile dysfunction,” or, “I’m a bit foggy and …” they’re probably maybe they will prescribe you some sort of Viagra.”

Either that or maybe stick you on some antidepressants.

“Cheer up, old man. Have something to tranquilize you a bit. Have an SSRI. Get on the Prozac.”

SSRI’s may even be implicated in low testosterone.

Diagnosing low T is really simple. GPs typically won’t do it because they haven’t been taught to do it. In becoming a GP, you have a million and one things to learn about and, at the moment, male hormone health is pretty much at the bottom of the palm, considering how many men it potentially could affect.

At the end of the day, TRT involves them prescribing a Class C drug. It’s a controlled drug, and that is something that I think would, potentially, scare off the GP from sticking their head above the parapet.

The headline is, if you walk into your GP and say, “I think I have these symptoms of low testosterone,” generally, you are not going to be listened to. They’re probably going to try and treat the symptoms that you’ve got in other ways, whether that’s with Viagra or whether that’s with SSRIs.

The other possibility is that you go to the doctor as somebody who clearly takes care of themself, someone who lifts, and you say, “I think I may have low testosterone,” they’re just going to say, “Oh, well, that’s just a gym goer that wants to become a sanctioned steroid user.”

So: there I am, with terrible sex life, no progress in the gym, limited ability to gain muscle, and low zest for life. These are big things. I mean if you’re somebody who trains, you’re training for all sorts of reasons. You’re training for aesthetics. You’re training for health. You’re training for endorphins. You’re training for socializing. You’re training for making progress and stuff. Once THAT starts suffering then it really sucks.

The irony is that low testosterone doesn’t stop you from losing fat, and I demonstrated that to myself. It DOES however, stop you from then building up to have the sort of physique most men want.

If you are lean but you have very little muscle mass to speak of, then you’re not going to look very impressive in OR out of clothes.

In having done quite a bit of research and realizing that my GP wasn’t going to be much good to me, I used an online pharmacy: Pharmacy2U. I got an initial testosterone test from them, which was a finger-prick sample that you take, you bleed all over your kitchen, and then you send it back in the post. That was when I got my first reading, and then got a second reading done. As soon as that happened, they prescribed me some testosterone gel called Tostran.

I started applying that, and what they ask you to do is like a follow-up test. Well, the follow-up test came back as something like 50. The maximum healthy value is like 30.

At that point, they said, “Right. You’ll have to reduce the dose,” so then reduced the dose and spent several months spinning my wheels at applying this reduced amount of gel and not getting anywhere.

I felt marginally better at the time. Only marginally, because there is a strange phenomenon that happens with topically-applied testosterone treatment that gives artificially high readings when taken from finger capillaries. So in fact, the reading of 50 was actually to do with the limitation of the testing equipment more than anything else.

The answer is that once you’ve started applying testosterone gel topically, you should switch to venous blood samples, so get a sample taken with a needle. They did that, and my testosterone was now 11. Woo-hoo.

Still off the bottom of the scale, still that of an 80-something-year-old man, but marginally better than that of a really, really ill 80-something-year-old man. I very quickly got tired of this, and looked for alternatives, and found a GP in Doncaster called Dr. Doug Savage (great name) who runs The Leger Clinic.

He’s the nicest man you could hope to meet. I brought all my paperwork, and I explained what I’ve been trying. He said, “You don’t want to mess about. What you need is to be considering injecting testosterone intramuscularly.”

After various physical examinations, he privately prescribed me Sustanon 250 on the spot and administered my first shot.

I even felt that even on the train on the way back I was starting to feel better. Of course, that was placebo because it takes a while for this stuff to kick in, but eventually my sex drive started to pick up. Everything else started to work a lot better at the 8–12 week mark.

Having seen that that was working, he then decided to switch me to the other main treatment in the UK, which is called Nebido, which is injected every 10–12 weeks. It’s a long ester, a slower released form.

Everything worked well. Gaining strength, not gaining fat. All my lifts have gone up dramatically.

Mentally I’m so much better. I wasn’t in bad place before, but there’s something about really waking up feeling on top of your day before it’s begun.

One of the side effects of TRT is that you don’t put up with other people’s bullshit as much as you might do before. Not to be confused with roid rage. It was simply just not putting up with any nonsense, which is sort of a few notches down. Recognise that if you’re been operating on low testosterone, a lot of your thought processes that might naturally be more male than female are likely to have been subdued. It’s not a personality change, it’s an unveiling of existing latent processes within you.

A common outcome from TRT is that all sorts of other things can change: whether that’s your job situation, relationships and other big life choices. There is a correlation with sorting out your hormonal health and feeling able to make and act on decisions that you’ve been mulling over for a while.

For me, I changed career, and I changed my relationship status.

When someone starts any kind of major self-improvement undertaking, whether it’s spiritual and emotional upheaval work, or they start taking their diet and their training seriously, it’s going to have a cascade of effects in the rest of their life. If their local network are not on board with that, then it’s going to either isolate them from it, or it’s going to cause them to have to transcend that network.

It might just help you see relationship status in a different and clearer light and ask yourself whether you still want that. It’s not necessarily a question of your lifestyle becoming incompatible with the other person, but maybe now you have some more clarity as to where you’re at in your relationship, and you choose to act on it because you have that much more confidence.

Be careful what you wish for, but this is true for transformations in general. I’m doing some work with some of my own clients on transformations and, of course, on the surface, they’ll say, “Well, I just want to lose a few pounds so I’ll look good on the beach.”

Once you start digging, there’s other stuff that they want, and this is a way to get it. The caterpillar may not know everything about what it’s like to be a butterfly, but it goes through its transformation knowing that a butterfly it shall become. It doesn’t suddenly pop out of the chrysalis and go, “Yikes. What happened? I’ve got these wings now?”

The somatic self holds the keys to a lot of things. If you sort the somatic self, the body and the connection of the body and the mind, and the connection of body, mind and spirit together, that unlocks new states. The way you hold yourself, the way you carry yourself can determine whether you’re in a good mood or a bad mood. It stands to reason that the way you are in your body is going to determine how you show up in life.

When you combine a physical transformation and all the things that happen with that and also a hormonal transformation, that’s rocket fuel. I now feel more towards my truer self than I ever was. I see old photographs of me, and I don’t just not recognize me in terms of how I looked, but also, I recognize that that wasn’t me as a person.

As for libido: that dramatically improved, maybe to the point of being too improved. This is one of the sort of the side effects that actually maybe you’d need to consider if you were going to start TRT. If you are in a relationship where that libido is not going to be fulfilled, then it could create a problem for you. If your libido is low for several years, in a relationship where that has become the established baseline, then suddenly doubling or tripling the amount of sexual advances that you make towards your partner may not be best received.

It’s important to discuss it candidly with your partner. “If my libido improves to the point where it’s too much for you, what are we going to do?”. It is an awkward question to broach, but it’s going to be the reality.

Haematocrit: An important consideration

Your haematocrit is the total amount of cells relative to fluid in your blood. If this becomes too high, you are at higher risk of clogging things up: i.e. stroke, pulmonary embolism, heart attack. If you’re on TRT, your prescriber should be arranging regular monitoring for you.

TRT is something you’re going to take for life: as soon as you start taking exogenous testosterone, any natural production that you might have is going to shut down.

If you stop taking exogenous testosterone, natural production may or may not restart. So you should consider this as a lifelong decision. This is not something you’re just going to take for a few years and then sort of drop off it again. If you do, you’re suddenly going to feel like that 80-year-old man again.

It’s why taking steroids recreationally carries so much more risk. Do you want to be injecting something with no quality control of dosages, which has been either carried across the country in someone’s bum or brewed in their bath?

Taking something in a haphazard way is going to maximise your risk of gonadal shutdown:

As for natural age-related decline, the good news is that resistance training can offset a lot of the age-related decline in androgen synthesis. So one of the ways that you can naturally maintain your testosterone levels with age is simply to lift weights three times a week.

Can you naturally increase testosterone?

I did do some research into this, and it was pretty inconclusive. I mean you can buy a whole load of herbal supplements which are alleged to increase testosterone, but they are either poorly clinically evaluated, or have negligible effects. If they worked, why wouldn’t we all be taking horny goat weed?

If you’re carrying a load of excess fat, then losing that fat will help you as long as it doesn’t tank your testosterone from losing it too fast.

The key message, I think, is that, first of all, that if it’s natural for female hormones to fall off with age, why is it not a concern for men? If you’re carrying excess fat, you are, as you said much earlier in this conversation, yeah, you are more likely to aromatize testosterone into estrogen, which is more likely to precipitate these effects. Some of these symptoms of low testosterone also are symptoms of higher estrogen (which is directly produced by fat cells), and that can make it quite confusing.

So the first line solution, as boring as it is, is: don’t be fat, reduce your stress and alcohol intake, sleep more, and eat more eggs. That will optimize what you naturally have. If what you naturally have isn’t enough, then think about getting tested for low testosterone.

How to go about getting tested?

They’ll send you a test kit, and you do it yourself, a finger-prick test, and you send the blood back off in the post, and a few days later, you get your results. Do the first test. If it comes out low or borderline, repeat the test. If you’ve then got two sets of low or borderline results, then you are in a better position to go and talk to a GP about it who will probably refer you to an endocrinologist because most GPs won’t prescribe directly without guidance from an endocrinologist.

Most endocrinologists’ experience is focused around insulin and diabetes. TRT is not a massively common thing in their training or a big part of their training. Of course, in terms of their patient base, they don’t see many TRT patients. There are some endocrinologists who are more clued up than others, and I can point you to some forums where you can ask questions about how to find those people.

Once you’ve seen the endocrinologist, you may get prescribed. These days, it would probably be Nebido on the NHS, administered every 10 to 12 weeks by your GP.

If you want to go privately, there are all sorts of male hormone clinics who will charge you varying amounts. Again, if you go to Medichecks and get two sets of test results and then go and see one of these clinics, the chances are they will treat you straight away. If they insist on having their own bloods again, then maybe be a bit cautious.

I mentioned Doug Savage at the Leger Clinic in Doncaster. He is a fantastic guy. He’s well worth getting on a train to go and see because he knows his stuff. He’s one of a gang of five in the UK who really are on top of this. Once he’s understood exactly what’s going on, he’ll be very quick to sort of help you, and actually, it’s quite affordable. Nebido is about £100 a go for 12 weeks. So around £500–600/year, plus very modest appointment and blood test charges.

Once we established that the Nebido was working, I then went to my NHS GP with a letter from Dr. Savage, saying this is what we’ve been doing, and it seemed to be working. The GP still referred me to an endocrinologist, who wanted to perform their own tests. At which point you’ll need to ‘wash out’ for 16 weeks: They’ll have you wait 16 weeks to make sure you’ve really got it out of your system so they can get some baseline figures that will show you’ve got low testosterone.

The stupid thing is that once you have started treatment with exogenous testosterone, there’s two hormones they’re looking at. One is called luteinizing hormone, and one is follicle stimulating hormone. The ratio of the two will help them ascertain whether your deficiency is primary (testicular cause) or secondary (pituitary cause — the signal).

But once you’ve started exogenous testosterone, those two fall to zero, and they don’t come back unless you run post-cycle therapy. So actually the test will NOT reveal whether it is primary or secondary at that stage. It should have been done beforehand. So if you go down the private testing route, make sure you’re getting LH and FSH checked, because you’ll never get those values back again. The NHS, in particular, will want to know what’s the cause. They’re looking for this value to rule out a prolactinoma, a benign, hormone producing tumour in the brain that could need an MRI or surgery.

But during the wait, you’re feeling like an old man again. So stopping treatment for 4+ months simply to prove to the NHS that you need treatment wasn’t worth it for me. I decided it was worthwhile continuing privately for £600/year.

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