Correctly diagnosed it is worth treating. Incorrectly diagnosed, treatment causes real harm.
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Testosterone falls gradually with age — around 1% a year from the late thirties — and for most men that decline causes no symptoms and needs no treatment. Genuine testosterone deficiency is a specific medical diagnosis, not simply a number at the lower end of a range.
This is an area where we should be direct about the commercial landscape. A growing number of clinics diagnose low testosterone on a single blood test, sometimes taken in the afternoon, and start lifelong treatment on that basis. That is not adequate. Testosterone follows a daily rhythm and falls substantially through the day, so an afternoon sample is not interpretable.
The opposite error also exists. Testosterone deficiency is genuinely under-diagnosed in specific groups — men with obesity, type 2 diabetes, on long-term opioids, or with a history of anabolic steroid use — where it is common, real, and worth treating.
So the aim here is neither to dismiss nor to sell. It is to establish properly whether you have it, find out why, and — crucially — consider whether the cause can be reversed before committing to treatment that is usually lifelong and that suppresses fertility.
These correlate best with genuinely low testosterone:
Real, but caused by a great many other things too — which is exactly why testing on symptoms alone leads to over-diagnosis:
Fatigue and low mood on their own are a poor basis for testing, because thyroid disease, iron deficiency, sleep apnoea, depression and alcohol all produce exactly that picture and are far more common.
This group matters because several causes are reversible:
Getting this right matters more than in almost any other area, because the treatment is usually lifelong and has significant consequences.
Our Well Man panel and testosterone testing cover this properly.
Broadly, a total testosterone below 8 nmol/L with symptoms supports the diagnosis; above 12 nmol/L makes it unlikely. Between 8 and 12 is a grey zone requiring free testosterone, repeat testing and clinical judgement rather than an automatic prescription — and it is where most over-treatment happens.
This is assessed remotely through history and blood tests. What we will not do is diagnose on one sample or treat a number without symptoms.
This step is skipped by services whose business model is the prescription:
Where deficiency is confirmed on two morning samples with consistent symptoms, replacement works well: gels applied daily, or injections every few weeks to twelve weeks. Benefits to libido, energy, mood, muscle mass and bone density are genuine.
Testosterone replacement suppresses sperm production and causes infertility, sometimes irreversibly. The body detects the external testosterone and shuts down its own signals, which also stops sperm production.
If you may want children — now or in future — this must be discussed before you start. Alternatives that raise your own testosterone while preserving fertility exist and are managed by specialists. This conversation is the one most often missing from a fast online prescription, and it is not reversible after the fact.
Anyone on treatment needs regular blood tests:
Treatment without monitoring is not acceptable care, and any service offering the first without the second should be treated with caution.
We do not prescribe testosterone for performance, bodybuilding or general vitality in men with normal levels. We will not diagnose on a single afternoon sample, and we will not take over a regime we consider unsafe without proper reassessment.
Go to A&E immediately for:
Seek prompt assessment for:
Book a routine consultation for:
Testosterone-boosting supplements do not raise testosterone. Tribulus, D-aspartic acid, and the various proprietary blends have been studied and do not work. Some contain undeclared ingredients. The money is better spent on a gym membership, which does.
Past or present, including SARMs and anything obtained without prescription. It changes the interpretation of every result and the whole treatment approach. It is far commoner than people assume, and it will be met with a clinical response rather than a moral one.
This is the area of private men's health with the worst practices, and it is worth being blunt about it.
Testosterone replacement is a lifelong treatment with real consequences — including infertility, since it suppresses sperm production, often irreversibly. It should not be started on a single borderline blood test taken in the afternoon, and it should not be started without excluding the reversible causes.
The diagnostic standard is specific and frequently ignored by private clinics: at least two separate morning samples, taken fasting before 11am, with LH, FSH, prolactin and SHBG alongside — because those distinguish a testicular problem from a pituitary one, and a pituitary tumour is a diagnosis you do not want missed.
The reversible causes matter more than the prescription. Obesity, sleep apnoea, alcohol, opioids, poorly controlled diabetes and anabolic steroid use all suppress testosterone — and treating those raises it without any replacement at all.
NHS endocrinology assessment is free, and NHS testosterone is free once genuine hypogonadism is confirmed. That is the right route.
Where a private consultation is genuinely useful is doing the testing properly and having an honest conversation — including saying that a borderline result in a tired man is usually not the answer.
We will not prescribe testosterone on inadequate testing, and we will always discuss fertility before anyone starts it.
British Society for Sexual Medicine (BSSM) guidelines on adult testosterone deficiency are the principal UK reference. They require two separate fasting morning total testosterone measurements for diagnosis, with LH, FSH, prolactin and SHBG to determine the cause.
BSSM recommends excluding and treating reversible causes — obesity, obstructive sleep apnoea, excess alcohol, opioids, and metabolic syndrome — before considering replacement.
BSSM and Society for Endocrinology guidance require assessment of haematocrit, PSA and prostate examination before starting, with monitoring thereafter, given the risk of polycythaemia.
BSSM is explicit that testosterone replacement suppresses spermatogenesis and that fertility should be discussed before initiation — the basis for the point above.
NICE CKS, Hypogonadism, aligns with this and recommends specialist input where the diagnosis or cause is uncertain.
No. Testosterone varies by time of day, by day, and with illness — which is why two separate morning samples before 11am are required, along with LH, FSH, prolactin and SHBG. Any service diagnosing on a single afternoon reading is not following recognised practice, and it is worth asking why.
Almost certainly yes, while you take it — and occasionally permanently. External testosterone shuts down the signals that drive sperm production. If you might want children at any point, this must be discussed before starting, and alternatives that preserve fertility exist. It is the most important question in this whole area and the one most often skipped.
Possibly not. Between 8 and 12 nmol/L is a genuine grey zone requiring free testosterone, a repeat sample and clinical judgement. If you are carrying excess weight, have untreated sleep apnoea, or take opioids, treating those may restore the level without any prescription. Rushing into lifelong treatment from that range is where most over-treatment happens.
No. They have been studied and do not raise testosterone meaningfully. Some contain undeclared substances. Resistance training, weight loss and adequate sleep genuinely do work, and cost less.
Not when properly monitored. The risks that need watching are thickened blood — which raises clot risk and is checked with haematocrit — prostate effects, worsening sleep apnoea, and infertility. Treatment without regular monitoring is where the danger lies, rather than in the treatment itself.
Very. Anabolic steroids suppress natural production, sometimes long after stopping and occasionally permanently. It changes both the interpretation of your results and the right treatment — there are approaches specifically for restarting your own production. Please say so; it is common and it will be dealt with clinically.
Quite possibly, if you are carrying significant excess weight. Obesity is the commonest cause of low testosterone in younger men, the mechanism is well understood, and weight loss reverses it in many cases. It is worth attempting before committing to lifelong treatment.
Not really. The term is misleading — there is no abrupt hormonal event equivalent to the menopause in men, just a gradual decline that most men tolerate without symptoms. Where a genuine deficiency exists it usually has a specific cause worth identifying, rather than being an inevitable consequence of ageing.
August 23, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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