About TRT
Understanding Testosterone Replacement Therapy, causes of hormone deficiency, and our evidence-based clinical protocols.
What is testosterone?
Testosterone is one of the Androgens, the group of sex hormones that give men their ‘male’ characteristics (collectively called virilisation).
The major sex hormone in men is testosterone, produced mainly in the testes. It is essential for the development of male growth, physical stamina, and masculine characteristics.
Brain signals sent to the pituitary gland at the base of the brain control testosterone production. The pituitary gland then relays signals to the testes to produce testosterone. A delicate “feedback loop” closely regulates hormone levels in the blood. When testosterone levels rise too high, the brain signals the pituitary gland to scale back production.
Primary Functions in the Body
- Regulates bone density, muscle distribution and strength
- Drives sexual desire (libido) and reproductive fertility
- Influencing mood, focus, energy levels, and cognitive sharpness
- Stimulates red blood cell production and metabolic efficiency
What does testosterone do?
Testosterone plays multiple vital roles throughout a man's entire life cycle:
Penis & Testes Development
Essential for primary male organ growth during early development and puberty.
Vocal Deepening & Hair Growth
Drives voice deepening during puberty and facial/body hair growth (and balding later in life).
Muscle Size & Physical Strength
Promotes protein synthesis, muscle hypertrophy, and physical endurance.
Bone Growth & Mineral Density
Stimulates bone mineralisation, reducing fracture and osteoporosis risks.
Sex Drive & Libido
Crucial for maintaining healthy sexual desire, stamina, and erectile function.
Sperm Production & Fertility
Directly regulates spermatogenesis within the testes for reproductive health.
Cognitive Sharpness & Mood
Supports emotional stability, motivation, concentration, and mental stamina.
Sleep Quality & Recovery
Helps maintain restful sleep architecture and overnight tissue recovery.
Can you have too little testosterone?
As men age, testosterone levels drop gradually by approximately 1% to 2% each year. The testes produce less testosterone, while the liver produces higher levels of Sex Hormone-Binding Globulin (SHBG), which binds circulating testosterone — reducing the active "free" testosterone available for body tissues to use.
1 in 4
men over age 40 experience lower testosterone levels than clinically recommended for optimal health.
Symptoms of Testosterone Deficiency in Adult Men
Low testosterone can significantly impact fit, healthy men in various ways:
If you experience any of these symptoms, you are not alone. Millions of men over age 30 face similar challenges every day.
How Testosterone Replacement Therapy (TRT) Can Help You
Men diagnosed with testosterone deficiency often experience meaningful improvements when their hormones are restored to healthy physiological levels — from strengthening bone density and lowering fracture risk, to improving energy, mood and body composition.
Testosterone levels are measured through a simple morning blood test, while symptoms are formally evaluated using validated clinical questionnaires such as the ADAM questionnaire (Androgen Deficiency in the Ageing Male). The most crucial step is interpreting these results correctly. Initiating TRT requires a detailed consultation with Matthew Smith, Advanced Nurse Practitioner, who considers your full medical background and concurrent medications.
The ADAM Questionnaire
The Androgen Deficiency in the Ageing Male (ADAM) questionnaire is a validated clinical screening tool used to identify symptoms consistent with testosterone deficiency. Answer all ten questions honestly to receive an indicative result — it takes under two minutes.
Do you have a decrease in libido (sex drive)?
Who You'll See at Smiths Medical Group
Your TRT journey is led personally by our Advanced Nurse Practitioner, with specialist medical input available when needed. Here's how your consultation pathway works:
Matthew Smith
Advanced Nurse Practitioner
You will be seen by Matthew Smith, Advanced Nurse Practitioner, for your consultation, blood tests, and the discussion of your results and treatment. Matthew leads every stage of your TRT journey — from initial assessment through to ongoing care.
- Initial consultation & clinical assessment
- Blood test administration
- Discussion of results and treatment options
- Ongoing monitoring and care
Dr Mushaud Iqbal
Clinical & Medical Oversight
In the event that your blood results do not indicate a clinical need for TRT, a review can be arranged with Dr Mushaud Iqbal, our clinical oversight partner, to review your results in detail and discuss appropriate onward referral pathways. This review is conducted as a telephone consultation, with clinics typically scheduled on a Thursday afternoon.
Please be advised that Dr Iqbal does not provide treatment or issue prescriptions in respect of blood test results outside the scope of TRT.
A telephone consultation with Dr Mushaud Iqbal is subject to an additional fee of £35, should you wish to proceed. If TRT is not indicated, an appointment with Dr Iqbal can be arranged on request.
How consultations and blood tests fit together
Blood tests and consultations happen at set points, so treatment is only started — and only continued — when it is safe.
Initial Consultation + Blood Test
A consultation with Matthew Smith and a focused testosterone blood test, done together.
Full Health Screen
A repeat morning test and broader screen give the full picture before any treatment.
Treatment Begins
If TRT is right for you, a personalised plan starts — with medication delivered to your door.
Quarterly Monitoring
A consultation and blood test confirm your treatment stays safe and effective.
Compulsory Safety Check
Miss a quarterly review and treatment pauses until monitoring is up to date — a safety requirement, not an option.
Initial Consultation + Blood Test
A consultation with Matthew Smith and a focused testosterone blood test, done together.
Full Health Screen
A repeat morning test and broader screen give the full picture before any treatment.
Treatment Begins
If TRT is right for you, a personalised plan starts — with medication delivered to your door.
Quarterly Monitoring
A consultation and blood test confirm your treatment stays safe and effective.
Compulsory Safety Check
Miss a quarterly review and treatment pauses until monitoring is up to date — a safety requirement, not an option.
Clinically led throughout by Matthew Smith, Advanced Nurse Practitioner, with medical oversight from the Harley Street TRT Network when required. If TRT isn't right for you, we'll explain why.
TRT Options
Every man is unique, which is why an individual consultation with Matthew Smith, Advanced Nurse Practitioner, is essential. At Smiths Medical Group, we do not use rigid one-size-fits-all protocols. We assess your unique medical background and preferences to select the optimal treatment method together.
| Method | Capsules | Injections | Gels |
|---|---|---|---|
| Ease of use | Easy | Moderate | Difficult |
| Frequency of dosing | 1–2 tablets, once or twice daily | Self-inject 2–3 times a week | Apply gel to shoulders daily |
| Efficacy & Speed | Noticeable impact within 1–2 weeks | Rapid onset of effect | Varied individual absorption |
| Key Advantages | Simple oral intake & steady physiological levels | Direct absorption & high efficacy | Non-invasive daily application |
| Considerations | Requires consistent daily schedule | Requires basic self-injection technique | Avoid skin contact with others for 1 hr after applying |
Ready to Take Control of Your Hormone Health?
Book a confidential consultation with Matthew Smith at Smiths Medical Group today.