Private clinics in the UK are facing scrutiny from medical experts for allegedly promoting testosterone replacement therapy (TRT) to men who do not require it, potentially medicalizing normal aging symptoms and posing health risks. Adverts appearing on public transport and social media target men over 35, suggesting fatigue, sleep issues, aches, pains, and stubborn belly fat could be signs of low testosterone. For approximately £150 per month, these clinics offer testosterone injections delivered directly to patients' homes.
One clinic reports selling over 200,000 testosterone blood tests and currently treating around 30,000 men. However, leading specialists argue that these clinics are diagnosing vague symptoms that are common to many individuals, leading to unnecessary TRT prescriptions. Experts caution that for otherwise healthy men, TRT can negatively impact fertility by reducing sperm production and may increase the risk of heart disease and stroke due to elevated red blood cell production, potentially leading to blood clots.
Professor Richard Quinton, a consultant endocrinologist and senior author of the Society for Endocrinology's testosterone guidelines, described the trend as "the worst instance of medicalizing normal biology" he has encountered. Investigations have revealed that obtaining TRT from some private clinics can be alarmingly easy, with some offering unlicensed drugs and additional treatments like libido boosters with minimal medical checks.
Under NHS guidelines, TRT is prescribed only for hypogonadism, a condition where sex glands produce insufficient hormones. Treatment typically requires two separate fasting morning blood tests showing total testosterone below approximately 8nmol/L (or 12nmol/L according to BSSM guidelines), alongside specific symptoms like erectile dysfunction and loss of morning erections. Fatigue and poor sleep alone are not sufficient grounds for TRT on the NHS. Even under BSSM guidelines, treatment is considered for normal testosterone levels only if accompanied by severe erectile dysfunction, lack of morning erections, and free testosterone below 0.22, based on two morning blood tests.
However, private clinics often have different prescribing thresholds. One investigation found that a 54-year-old man, who exhibited no symptoms of low testosterone and had high testosterone levels confirmed by his GP on the same day, was still recommended TRT by a private clinic. This recommendation was based on tests conducted outside of recommended fasting and timing protocols, which experts say can inaccurately lower testosterone readings. The clinic offered testosterone injections and tadalafil for approximately £144 per month.
Concerns also extend to the types of testosterone used. Testosterone cypionate, often prescribed by private clinics, is not licensed in the UK and has no fixed price, allowing clinics to set their own rates, which can be significantly higher than licensed formulations. Professor Geoff Hackett, a consultant urologist and author of BSSM guidelines, noted that while commercial clinics may offer faster-acting cypionate to encourage repeat business, there is insufficient evidence of its safety profile compared to licensed products. He warned that men self-administering doses could be tempted to increase them unsafely.
Some clinics have also been found to offer unlicensed drugs, such as enclomiphene, for which regulatory bodies like the US FDA have declined approval due to a lack of demonstrated symptom improvement. Experts suggest that TRT and associated treatments are being used to manage normal biological processes, leading to a cascade of treatments and potential health risks, including elevated estrogen levels that may require further medication.
Leading endocrinologists and urologists emphasize that many symptoms attributed to low testosterone, such as fatigue and erectile dysfunction, can have numerous causes unrelated to hormone deficiency, including poor blood flow or lifestyle factors. Research suggests that lifestyle interventions, such as weight loss, can effectively improve testosterone levels in men with borderline deficiencies. Doctors are increasingly encountering men with fertility issues and thickened blood as a result of unnecessary TRT treatments.