
Testosterone replacement therapy
Testosterone deficiency is a medical condition that can lead to regular fatigue, rapid weight gain, diminished sex drive, erectile dysfunction, and low mood. With specialist care at Numan, it can be addressed and optimised.
We provide personalised care to ensure each patient receives the most effective treatment for their needs. Discover our range of treatment options, including testosterone replacement therapy, testosterone optimisation, and the Numan weight loss programme.
Testosterone replacement therapy (TRT) works by supplementing or replacing the body's natural testosterone levels when they’re insufficient. TRT can be administered in various ways including: pills, gels, and injections. Once administered, the exogenous testosterone enters the bloodstream and mimics the natural hormone's actions, restoring testosterone levels to a normal range and addressing the symptoms associated with testosterone deficiency.
Kyzatrex is an immediate-release oral pill containing the active ingredient testosterone undecanoate. It’s absorbed through the lymphatic system, bypassing the liver, and is then broken down by enzymes into testosterone, which the body can use.
An oral pill taken twice daily with food
In a six-month study involving 127 men diagnosed with testosterone deficiency, several significant health improvements were observed:
96% of the participants achieved normal testosterone levels within three months.
There was a twofold increase in mean free testosterone levels.
Notable improvements were recorded on the Aging Males’ Symptoms (AMS) scale
Benefits:
Convenient to take
Flexible dosing
Achieves stable testosterone levels (limits peaks & troughs)
Limitations:
Can increase blood pressure
Prior to treatment: Two blood tests and one blood pressure reading
1 month after treatment: One blood test and one blood pressure reading
3 months after treatment: One blood test and one blood pressure reading
6 months after treatment, and every 6 months thereafter: One blood test and one blood pressure reading
Testogel is a topical gel that delivers testosterone through the skin via transdermal absorption, allowing it to enter the bloodstream and increase overall levels. Applied daily, Testogel helps maintain stable testosterone levels throughout the day.
Applied once a day in the morning, to the upper arms and shoulders
Comes in a pump form, delivered monthly
In a placebo-controlled trial with 274 patients, 82% (139 out of 169) of the men with hypogonadism who were treated with an optimised dose of testosterone gel attained normal testosterone levels within six months.
Benefits:
Convenient to apply
Flexible dosing
Achieves stable testosterone levels
Limitations:
Risk of transfer through skin-to-skin contact, requiring extra care during and after application
Can cause localised skin reactions
Factors such as sweating and showering can affect absorption, and consequently the effectiveness of the dose taken
Prior to treatment: Two blood tests and one blood pressure reading
1 month after treatment: One blood test and one blood pressure reading
3 months after treatment: One blood test and one blood pressure reading
6 months after treatment, and every 6 months thereafter: One blood test and one blood pressure reading
Testosterone cypionate is a short-acting injection that works by steadily releasing testosterone into the bloodstream, replacing the testosterone your body is unable to make.
A small injection self-administered on alternate days into subcutaneous fat (usually found around the abdomen)
Injectable TRT is effective at restoring testosterone levels to normal, with most effects starting to take place within 6 months after initiating treatment. The alternate-day dosing of testosterone cypionate allows for better testosterone level stability.
Benefits:
Flexible dosing
Achieves stable testosterone levels
Limitations:
You have to self-inject every other day
Absorption varies from person to person
Requires extra care when handling and storing equipment
Prior to treatment: Two blood tests and one blood pressure reading
1 month after treatment: One blood test and one blood pressure reading
3 months after treatment: One blood test and one blood pressure reading
6 months after treatment, and every 6 months thereafter: One blood test and one blood pressure reading
Nebido is a long-acting TRT containing testosterone undecanoate as the active ingredient. It’s suspended in an oily solution and injected into a muscle, where it’s gradually released over time. This slow-release formula ensures that your testosterone levels remain stable without causing a buildup in your blood.
Nebido is administered by a clinician every 10 to 14 weeks into the buttocks.
In a study of 133 patients with erectile dysfunction and low testosterone levels, 1,000 mg of TU was administered initially, then again at 6 and 18 weeks. Over a period of 6 months, the study observed several significant health improvements in patients:
Total testosterone levels increased by 183%
Free testosterone levels increased by 181%
Cholesterol levels decreased
Erectile function improved in 77% of the patients
Significant improvements were noted on the Ageing Males’ Symptoms (AMS) scale
Safety tests showed increases in haemoglobin, hematocrit, and PSA, but all remained within normal ranges, with no serious side effects observed.
Benefits:
Injections only once every 3 months
Injected by a clinician
Limitations:
Requires post-injection monitoring
Intramuscular injections can be painful
It can be harder to achieve stable testosterone levels with injections since you're committed to the dose for three months.
Prior to treatment: Two blood tests and one blood pressure reading
3 months after treatment: One blood test and one blood pressure reading
6 months after treatment: One blood test and one blood pressure reading
9 months after treatment: One blood test and one blood pressure reading
12 months after treatment, and every 6 months thereafter: One blood test and one blood pressure reading
Testosterone optimisation treatments work by stimulating the body's natural hormone production pathways to increase testosterone production, rather than directly supplying testosterone. They’re particularly useful for men who want to maintain fertility and testicular function while addressing symptoms of low testosterone, though they may be less effective in restoring testosterone levels to the same degree as direct testosterone replacement therapies.
Clomid, traditionally a fertility treatment for women, is used off-label to treat men with low testosterone and low sperm counts by correcting hormonal imbalances and boosting hormone production. As a selective oestrogen receptor modulator, Clomid blocks oestrogen's effects, increasing the production of follicle-stimulating hormone (FSH) and luteinising hormone (LH), which promote the production of sperm and testosterone.
It’s important to note that Clomid is not a testosterone replacement product, but a testosterone optimisation medication.
Clomid is taken orally, every day.
Seventeen studies looked at the effectiveness of clomiphene citrate on hypogonadal men, with 1279 patients. The review showed that clomiphene citrate treatment significantly increased total testosterone levels and other related hormones, improving symptoms, with side effects reported in less than 10% of patients.
However, studies show that it takes longer for testosterone levels to rise and symptoms to improve for men taking clomiphene than it does for those using TRT.
Benefits:
Preserves fertility
Stimulates natural testosterone production
Convenient and flexible dosing
Limitations:
Variable response
Off-label use, therefore less researched
Prior to treatment: Two blood tests and one blood pressure reading
1 month after treatment: One blood test and one blood pressure reading
3 months after treatment: One blood test and one blood pressure reading
6 months after treatment, and every 6 months thereafter: One blood test and one blood pressure reading
Zivafert is a treatment that mimics the effect of luteinising hormone and stimulates your testicles to naturally produce more testosterone, unlike TRT which adds testosterone to your body. This helps maintain testosterone levels and maintain fertility by maintaining sperm production. It can be used as a treatment on its own but it can also be used off-label alongside TRT to support fertility maintenance.
A small injection self-administered every Monday, Wednesday, and Friday into subcutaneous fat (fat around the abdomen).
A review of 42 men with low testosterone at Men’s Health Boston found that HCG monotherapy, starting with a dose of 1500IU three times a week, significantly improved testosterone levels in 95% of the men over an average follow-up of 13 months.
Another study of 20 men treated with HCG for hypogonadism showed similar results, with significant increases in testosterone levels and 50% of patients reporting symptom improvement with no side effects over 6 months.
Benefits:
Preserves fertility
Stimulates natural testosterone production
Limitations:
Variable response
Off-label use, therefore less researched
Have to inject three times per week
Prior to treatment: Two blood tests and one blood pressure reading
1 month after treatment: One blood test and one blood pressure reading
3 months after treatment: One blood test and one blood pressure reading
6 months after treatment, and every 6 months thereafter: One blood test and one blood pressure reading
Testosterone supplements can help support the body's natural testosterone production by providing essential vitamins, nutrients, and compounds that support hormone health.
Numan's high-strength testosterone supplement is a daily powdered blend of vitamins and minerals. Taken once daily, it supports balanced testosterone levels, boosts energy, aids muscle growth, and improves mood.
Key ingredients include zinc for testosterone, vitamin D3 for muscle function, and magnesium to reduce fatigue. It offers 12 times more fenugreek extract, 50% more zinc, and three times the vitamin D than standard supplements.
Supplements are not clinically proven treatments. Instead, they’re products taken to indirectly support testosterone production and maintenance, while bridging certain nutritional gaps.
D-aspartic acid: A natural amino acid that may increase hormones stimulating testosterone release.
Zinc: Essential for health, and a deficiency is linked to low testosterone; zinc supplementation can promote testosterone production in the testes and potentially increase levels long-term.
Magnesium: This mineral can boost free and total testosterone levels, with greater benefit observed in those who exercise.
Vitamin D: This vitamin supports normal muscle function and strengthens bones.
Fenugreek: A 12-week study showed that a daily 500-mg fenugreek supplement can significantly boost testosterone levels, with 90% of participants experiencing up to a 46% increase.
Benefits:
Supports energy, muscle function, mood and testosterone levels
Natural ingredients
Limitations:
Not a proven clinical treatment for low testosterone
The high-strength testosterone supplement does not require routine monitoring, but we recommend scheduling blood tests every 6 months to keep track of your testosterone levels and wider blood count.
Excess body fat, particularly visceral fat, can contribute to lower testosterone levels. Fat tissue contains aromatase, an enzyme that converts testosterone into oestrogen.¹ By reducing fat mass, the conversion of testosterone to oestrogen decreases, potentially leading to higher testosterone levels.² Obesity is often linked to insulin resistance, which can negatively impact testosterone levels.³ The use of GLP-1 medications in men may therefore help restore normal testosterone levels through weight loss mechanisms.³
Wegovy (semaglutide) and Mounjaro (tirzepatide) are once-weekly injectable medications that help manage weight, indirectly boosting testosterone by reducing body fat. Wegovy targets the GLP-1 receptor, slowing stomach emptying, increasing fullness, and reducing cravings. Mounjaro targets both the GLP-1 and GIP receptors, offering similar benefits while also enhancing the body's ability to use stored fat as energy, potentially providing broader weight management effects.
Taken as a once-weekly pen injection.
In a double-blind trial with 1961 adults, semaglutide (2.4 mg) over 68 weeks resulted in a 15% weight reduction compared to 2% with placebo, with 86% achieving significant weight loss versus 32% on placebo.
Similarly, a phase 3 trial with 2539 adults found that weekly tirzepatide (5 mg, 10 mg, or 15 mg) over 72 weeks led to weight losses of 15%, 20%, and 21%, respectively, compared to 3% with placebo, with over 85% losing at least 5% of their weight and up to 57% losing 20% or more.
Benefits:
Promotes significant weight loss
Can be used alongside TRT
Limitations:
Doesn’t directly increase testosterone levels
Weekly injection
Treatment with GLP-1 medications doesn’t require routine monitoring, but we recommend scheduling blood tests every 6 months to keep track of your testosterone levels and wider blood count.
Erectile dysfunction (ED) is a prevalent symptom among men with low testosterone and can be treated with medication. However, ED medications do not address the underlying hormonal imbalance. Treating the testosterone deficiency with TRT is the optimal approach if low testosterone is contributing to ED.
Tadalafil Daily provides a steady, low dose of tadalafil, helping to produce an erection whenever you need one after 3-5 days of consistent use.
While it doesn't address the underlying cause of erectile dysfunction or increase sexual desire, it allows for spontaneous sex as it remains active in your system. It works by increasing blood flow to the penis, which results in longer, firmer erections.
Tadalafil Daily is a medication that is very effective at alleviating erectile dysfunction, a common symptom of low testosterone. It does not, however, impact testosterone levels.
Benefits:
Daily dosing to remove the “planning phase” out of romance
Convenient to take
Limitations:
Does not affect testosterone levels
Tadalafil Daily does not require routine monitoring, but we recommend scheduling blood tests every 6 months to keep track of your testosterone levels and wider blood count.
¹ Cohen PG. Aromatase, adiposity, aging and disease. The hypogonadal-metabolic-atherogenic-disease and aging connection. Med Hypotheses [Internet]. 2001;56(6):702–8. Available from: http://dx.doi.org/10.1054/mehy.2000.1169
² Okobi OE, Khoury P, De la Vega RJ, Figueroa RS, Desai D, Mangiliman BDA, et al. Impact of weight loss on testosterone levels: A review of BMI and testosterone. Cureus [Internet]. 2024; Available from: http://dx.doi.org/10.7759/cureus.76139
³ Grossmann M, Tang Fui M, Dupuis P. Lowered testosterone in male obesity: Mechanisms, morbidity and management. Asian J Androl [Internet]. 2014;16(2):223. Available from: http://dx.doi.org/10.4103/1008-682x.122365