The Times Magazine - UK (2021-11-13)

from 40 countries. He see patients of all ages,

although most are between 35 and 55.

I ask Stevens if there is a typical patient.

“No, because low testosterone can affect

18-year-olds. You can just be unlucky.”

Previously an NHS surgeon, Stevens says

he became “disillusioned” with the NHS

“firefighting model” and wanted to be more

involved in “prevention”.

“This was an area of medicine I’d identified

that needed somebody to take the bull by the

horns and run with it, because TRT is not

done very well here [in the UK].”

I was finding that out for myself. I’d been

taking Clomid for several weeks now. I took

50mg every other day, but the drug hadn’t

had the desired effect. I was extremely moody.

A wave of negative thoughts took hold of me

each morning not long after I woke up. I felt

as if I were riding an emotional rollercoaster.

I kept starting pointless arguments with my

girlfriend. She was definitely going to dump

me if I didn’t snap out of it.

I needed a second opinion, so I emailed the

results of my bloods (I’d done four tests by

now) to Stevens. A few hours later he emailed

back. “Your hormone profile in June [the date

of the first test] was entirely normal, so I don’t

know why further bloods were suggested.”

The Times Magazine 31

that’s left over. The body draws on this to
perform its functions.
I received the results of the blood test
a few days later. My testosterone and my free
testosterone were at the higher end of the
normal range. Nevertheless, the company that
had conducted the test wanted to schedule a
follow-up call.
It might not be as clear-cut as I thought,
they informed me over the phone. Big words
and medical jargon were used. There were
some worrying patterns in my medical history,
the man said. I was advised to take a further
blood test. This one was to be more
comprehensive (and more expensive) than the
first. I gave my assent. I reasoned that they
were the experts and probably knew more
about all this than I did.

Deciding to inject synthetic testosterone is
a life-altering decision, especially if you plan
to have children. Injecting TRT shuts off the
natural production of testosterone in the
testicles. It’s difficult – though not impossible

• to restart this process. It certainly isn’t
  something you mess around with for a few
  years before packing it in. Typically, TRT is
  a lifelong commitment.
  I learnt this from my own research rather
  than the company I was using – it seemed
  intent on getting me on TRT injections. The
  company appeared reputable. Its website was
  slick and appeared near the top of the search
  results, but I started to suspect that I might
  have been sucked in by glossy marketing and
  a veneer of medical expertise.
  When my second set of results came back,
  both my testosterone and free testosterone
  were slightly lower than in the previous test.
  Again, though, both were within the normal
  range. During my follow-up call with a
  specialist from the company, much was made
  of the drop. Medical terms were thrown
  around. I was feeling bamboozled. I was also
  booked in for a further Zoom consultation
  with the company’s resident doctor. This took
  place a week later. The call was brief. The
  doctor said I had hypogonadism and wanted
  to put me on TRT. He would send the forms
  for me to sign. Somehow, I was about to start
  injecting myself with testosterone.
  Several weeks later, I still hadn’t signed.
  The more I thought about it, the more
  reckless it seemed to sign up for a lifelong
  regimen of injections when the results of my
  bloods seemed inconclusive at best.
  I emailed the company that was about to
  start prescribing me TRT and said I was
  unsure. I told them I had concerns about
  fertility. I wanted to try something else first.
  An alternative drug called clomiphene (aka
  Clomid) was suggested.
  Usually given to women with polycystic
  ovary syndrome, Clomid has been shown to

boost men’s level of free testosterone. I decided

I would give that a shot instead.

For men suffering from low testosterone, the

risks of using TRT can seem small compared

with the misery caused by the symptoms that

accompany the condition. Because TRT is

sometimes associated with bodybuilding and

the use of anabolic steroids, it can also be hard

for sufferers to be taken seriously and receive

an accurate diagnosis from clinicians.

“We have this wrong association of

testosterone being all about muscles and sex,”

says Dr Robert Stevens, 47. He runs the Men’s

Health Clinic in Dorset, a private medical

practice that specialises in treating men with

testosterone deficiency. The clinic opened in

2015. Today it has more than 1,000 patients

Q Up to 11 per cent of

middle-aged men – nearly

2 million – in the UK

could be affected by low

testosterone. Levels of the

male hormone peak during

a man’s twenties, but then

typically drop by 1 per cent

a year. Age, genetics, diet,

illness and medication can

all affect the decline.

Q Early signs of deficiency

include poor mood, fatigue,

reduced libido, weight gain,

brain fog, gynaecomastia

(swelling of the breasts),

erectile dysfunction and

night sweats.

Q If testosterone deficiency

is a possibility, a blood test

should always be done.

Testosterone levels vary

throughout the day, so it

is important to take blood

at the right time – before

11am, according to guidelines

from the British Society

for Sexual Medicine. The

reading must include “free”

testosterone levels.

Q If the result is around

350ng/dL or higher, then

testosterone deficiency is

unlikely to be the cause of

problems. If the reading is

below 230ng/dL (and the

test should be repeated at

least once to confirm this),

then treatment may be

recommended. One

possibility is a prescription

for Clomid, a common

fertility drug for women,

which tells the pituitary

gland to instruct the gonads

to make more testosterone.

Alternatively, testosterone

replacement therapy is

administered, either with

a gel or a patch.

Q Men with borderline

readings should look at their

general health. Avoid stress,

get more sleep and lose

weight. Lifestyle changes

such as avoiding alcohol,

refined carbohydrates and

sugar and limiting dairy can

help. There is some evidence

that soy-based products may

lower testosterone (some

experts recommend limiting

intake of tofu and soya

milk). Taking supplements

such as vitamin D, zinc and

omega-3 fatty acids can

naturally boost T levels.

Q Boosting testosterone

levels excessively can cause

unwanted and harmful side

effects – shrinking testicles,

breast development and a

drop in sperm count,

potentially infertility and

erectile dysfunction. Boosters

can also lead to acne,

baldness, mood swings and

aggressive behaviour.

Q Taking testosterone when

it isn’t needed could cause

irreversible issues, including

liver damage, high blood

pressure and a higher risk

of stroke or heart attack.

LOW TESTOSTERONE WHAT YOU SHOULD KNOW

‘We have this wrong

association of

testosterone being

all about muscles

and sex’