Patients typically come to us with one or more of the following symptoms that may indicate low testosterone:
- Low mood or depression
- Fatigue or low energy
- Poor sleep
- Low libido or erectile dysfunction
- Difficulty concentrating or “brain fog”
- Mood swings or irritability
- Decrease in muscle mass or strength
- Hot flushes
These symptoms alone do not confirm low testosterone, but they are strong indicators that testing may be appropriate.
Two Confirmatory Blood Tests
The BSSM clinical guidelines require two separate blood tests confirming low testosterone before starting TRT. This is because testosterone levels naturally fluctuate throughout the day, and readings can be temporarily affected by things like illness, poor sleep, alcohol intake, or even the time of day. Having two tests ensures there really is a consistent testosterone deficiency.
At least one of your two required tests needs to be an enhanced blood test. This is a much more comprehensive assessment than the finger-prick test, because it doesn’t just confirm your testosterone levels. It also looks at 39 key biomarkers. These include your full hormone profile, blood count, liver and kidney function, and other important health indicators. Since TRT can cause changes in these areas, it’s important for our clinicians to have this full picture. That way, they can make sure treatment is both appropriate for you and completely safe.
Treatment Thresholds
- Total testosterone: must be 15 nmol/L or below
- Free testosterone: must be 0.35 nmol/L or below
Final Clinical Review
During the doctor consultation, your blood test results will be reviewed in detail, your symptoms and medical history discussed, all treatment options and associated costs explained, and any clinical questions addressed so you feel fully informed and confident about the next steps.