For confirmed deficiency, not for tiredness alone — and it shuts down your own sperm production while you take it.
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Testosterone gel replaces testosterone through the skin, absorbed daily to maintain a steady level.
It is one of several routes — gels, injections and patches — and gels have the advantage of steady levels and of being stoppable quickly if something goes wrong, unlike a long-acting injection.
Testosterone is a controlled drug in the UK, reflecting its misuse for bodybuilding.
The central thing to understand is that replacement switches off your own production. The brain detects adequate testosterone and stops signalling the testes. That has consequences for fertility and for stopping, and it is why this is a long-term commitment rather than a trial.
It is not a treatment for normal ageing. Testosterone falls modestly with age, and most men with age-related symptoms and low-normal levels do better from addressing sleep, weight, alcohol, activity and mood.
Testosterone gel transfers to other people through skin contact, and has caused early puberty in children and virilisation in female partners.
This is not a theoretical precaution — it has caused real harm, and it is the reason the instructions are so specific.
Caution applies over 65, where the balance of benefit and risk is less clear.
Before starting: testosterone on two morning samples, LH, FSH, prolactin, SHBG, full blood count, PSA, liver function, lipids, and a prostate examination.
Then: at 3, 6 and 12 months, and annually thereafter — testosterone level, haematocrit, PSA, blood pressure and symptoms.
Haematocrit is the one that most often requires action. If it rises too high, the dose is reduced or treatment paused, because thickened blood raises clot and stroke risk.
Anyone offered testosterone without this monitoring schedule is not being treated properly.
Only for genuinely confirmed testosterone deficiency, and only with proper monitoring. Not for tiredness, low mood or low libido on their own.
What confirmation requires:
We will say no where the tests do not support it, and the fee still applies — because you are paying for the assessment. Private testosterone clinics that treat on symptoms and one borderline result are selling, not assessing.
We will also not prescribe it for muscle building or athletic performance under any circumstances.
Testosterone gel is moderately priced as a generic, and is a lifelong cost. Injections work out cheaper per month but require administration and give less steady levels.
The real cost is monitoring, and it is not optional — blood tests several times in the first year and annually thereafter. Any quoted price that excludes monitoring is not the real price.
Testosterone bought online or from gyms is frequently counterfeit, of unknown dose and purity, and used without any of the monitoring above. That is how people end up with dangerously high red cell counts and no one watching.
Your own production has been suppressed, and it takes months to recover — sometimes longer, and occasionally not fully. During that period symptoms are typically worse than before treatment started.
This is why starting deserves proper thought. It is generally a long-term commitment rather than something to try for a few months.
Testosterone replacement suppresses sperm production and functions as a male contraceptive — though not a reliable one. If you may want children, say so before starting. Alternatives exist that raise testosterone without suppressing fertility, and sperm storage can be arranged.
Obesity lowers testosterone substantially, and weight loss raises it measurably — in some men enough to remove the need for treatment altogether. Sleep apnoea, alcohol, opioids and poor sleep all lower it too, and all are treatable in their own right.
Because testosterone varies through the day and between days, and a single low reading is frequently normal on repeat. Both samples must be taken before 11am.
Only if low testosterone is genuinely the cause. Those symptoms have many causes, and treating a normal testosterone level does not help them. That is why the assessment comes before the prescription.
Yes — it suppresses sperm production, often to zero. Tell us before starting if you may want children; there are alternatives that avoid this.
Yes, and this has caused real harm to children and partners. Wash your hands, let it dry, cover the site with clothing, and wash the area before close contact.
Yes. Haematocrit and PSA in particular need watching, and a rising haematocrit needs acting on. Treatment without monitoring is not safe treatment.
You can, but recovery of your own production takes months and you may feel worse during that time. Start on the basis that it is long term.
We do not prescribe it for that, at any level, in any circumstances.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026
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