Should I have a PSA test?
It is a decision worth twenty minutes rather than a yes or no. There is no national prostate screening programme in the UK precisely because the evidence is finely balanced.
PSA rises with benign enlargement, infection, recent ejaculation and cycling — and a raised result leads to MRI and sometimes biopsy, which carry their own risks. Some cancers found would never have caused harm.
What shifts the balance: a family history of prostate cancer, and Black African or Caribbean heritage, which carries substantially higher risk. Men over 50 can request a PSA test free from their NHS GP, and men at higher risk should be discussing it earlier.
I am tired, low and losing muscle. Is it my testosterone?
Possibly — but a substantial proportion of men who come asking have normal levels and a different, treatable problem.
Sleep apnoea, depression, thyroid disease, iron deficiency, alcohol and weight all produce exactly this picture. Finding one of those is a good outcome, not a wasted appointment — and starting lifelong hormone treatment for a problem you do not have means the real cause goes untreated.
Why do you need two blood tests?
Because testosterone follows a daily rhythm and is highest in the morning. An afternoon sample can look low in a man with entirely normal levels.
Diagnosis needs two separate early-morning samples alongside genuine symptoms, with other causes excluded. Anyone diagnosing from a single test is not diagnosing properly.
Will TRT affect my fertility?
Yes, substantially — and it is the thing men most often say they were not told. It suppresses sperm production, sometimes to zero, and recovery after stopping is not guaranteed.
If children are a possibility, even years away, say so before starting. Alternatives exist that raise testosterone while preserving fertility.
Is erectile dysfunction a heart warning?
Frequently, yes — and it is worth taking seriously rather than being alarmed by. The arteries supplying the penis are smaller than the coronary arteries and narrow detectably earlier.
ED can precede a cardiac event by three to five years, which makes it an opportunity rather than only a problem.
Why not just buy the tablets online?
Two reasons, and the first can kill you. Nitrates — GTN spray, isosorbide — and nicorandil are an absolute contraindication, and the combination causes a catastrophic drop in blood pressure. A website does not check this properly.
The second is that you lose the warning. Counterfeit rates on unbranded sites are also high.
I found a lump in my testicle.
Get it seen in person, quickly — do not book a video appointment for it.
Testicular cancer is the commonest cancer in men aged 15–49 and is highly curable when caught early. Most lumps turn out to be benign, and the ones that are not do far better for being seen this month rather than next. What costs men here is waiting.
I am getting up several times a night to pass urine.
Worth assessing. Usually benign prostate enlargement, which is common and treatable — but it overlaps with diabetes, urinary infection and, occasionally, prostate cancer.
Also worth mentioning: sleep apnoea causes nocturia, and it is a frequently missed explanation for getting up at night.
Is premature ejaculation treatable?
Yes — it is the commonest male sexual complaint and among the most treatable, and the least discussed.
Start with what is free: stop-start and the squeeze technique genuinely work, and pelvic floor exercises have reasonable evidence. If it developed rather than always being there, there is usually a cause worth finding — often erectile dysfunction, which should be treated first.
Do you sell supplements or subscriptions?
No. We charge for consultations and tests, and nothing else. No medication margin, no supplements, no monthly plan.
Which means there is no financial reason for us to find you deficient — and that is a fair question to ask any private men's health service.