The choice between testosterone gel vs injections is a big decision for men dealing with age-related hormone changes. A man's testosterone levels naturally fall about 1% each year after 30. By age 75, these levels drop roughly 30% compared to what they were at 25. The numbers paint a clear picture - more than 33% of men over 45 have low testosterone. About 16-18% of men above 65 get diagnosed with hypogonadism, which means their morning testosterone stays below 280 ng/dl.
Men might notice several signs that point to low testosterone. These include losing muscle, feeling more irritable, brain fog, hot flashes, reduced sex drive, or trouble with erections. The quickest way to boost testosterone levels varies between patients. Injections give steady and predictable hormone levels in the blood. Gel options available in the UK work differently. Each method has its own pros and cons when it comes to how well the body absorbs it and how easy it is to use. Many patients also want to know the difference between natural and synthetic testosterone options.
This piece has sections about everything you need to know if you're a man over 60 in the UK who's thinking about testosterone replacement. You'll learn about how fast each type works, how often you need it, what the NHS covers, and what side effects to watch for. This information will help you pick the right testosterone replacement that fits your daily routine and needs.
Understanding Testosterone Decline After 60
Men face tough challenges as their male hormone production slowly decreases in their sixties and beyond. Men's testosterone levels decline subtly over time, unlike women who experience sudden hormonal changes during menopause.
Why testosterone levels drop with age
Men's testosterone production starts to decrease between ages 30-40. Studies show levels drop about 1% per year after age 40 [1]. Each person is different, and some men keep higher levels than others their age [2].
The whole reproductive system changes with age, which leads to this hormone reduction. We focused on the hypothalamic-pituitary-testicular axis—the body's hormone production center [3]. The hypothalamus makes less gonadotropin-releasing hormone (GnRH) as men age, so the pituitary gland produces less luteinizing hormone [3].
On top of that, it affects how the testicles work. Leydig cells make testosterone but become less responsive to luteinizing hormone as time goes on [3]. These cells struggle with mitochondrial problems, poor autophagy, and oxidative stress—all of which reduce their ability to make testosterone [3].
Here are other factors that speed up testosterone decline:
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Long-term inflammation (common in aging)
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Fewer working Sertoli cells
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Changes in cholesterol metabolism
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More oxidative damage in reproductive tissues
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Health issues like obesity and diabetes
In fact, research shows that 30% of overweight men had low testosterone, compared to just 6.4% of men at normal weight [2]. The numbers tell a similar story with diabetes - 24.5% of diabetic men had low testosterone, while only 12.6% of non-diabetic men showed low levels [2].
Common symptoms of low testosterone in older men
Low testosterone shows up in physical, sexual, and psychological ways. Research points to sexual symptoms as the most reliable signs of low testosterone in aging men [1]. Men notice less sexual desire, fewer morning erections, and trouble with erectile function [2].
Men with testosterone deficiency often report these issues:
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Physical changes: Less muscle, more belly fat, lower energy, joint pain, too much sweating, night sweats, and hot flushes [2][1]
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Mental/emotional symptoms: Quick temper, depression, mood changes, anxiety, lack of drive, brain fog, and poor focus [2][4]
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Other indicators: Less facial and body hair growth, sleep problems, weaker bones, and sometimes enlarged breast tissue (gynaecomastia) [2][1]
These symptoms often look like other age-related issues or medication side effects, which makes diagnosis tricky [4]. But certain combinations of these symptoms point to hormone problems rather than normal aging.
When to consider treatment options
Doctors suggest looking at testosterone replacement options like gels or injections only in specific cases. You need both consistently low testosterone levels and clear symptoms to be diagnosed with hypogonadism [1].
Doctors generally agree that testosterone below 8 nmol/L (250 ng/dL) signals a deficiency [1]. A single blood test isn't enough to know for sure. You'll need two morning testosterone tests (before 11 am when levels peak naturally) [1].
The full checkup usually includes:
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LH and FSH tests to find the type of hypogonadism
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SHBG measurement for unclear results
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Prolactin testing when secondary hypogonadism might be the cause
Treatment makes sense when tests confirm hypogonadism and symptoms affect your quality of life [1]. Doctors need to check for any health issues that might make treatment unsafe and rule out other possible causes [1].
Men interested in alternatives might want to learn about natural vs synthetic testosterone approaches, especially with borderline deficiency or mild symptoms.
Testosterone Gel Vs Injections: TRT Delivery Methods Explained
Men who want to try hormone therapy need to know about different TRT delivery methods to make smart treatment choices. Each method works differently when it comes to how well the body absorbs it, how easy it is to use, and how stable the hormone levels stay.
Testosterone injections: how they work
The body quickly absorbs intramuscular testosterone injections through muscle tissue straight into the bloodstream [5]. Doctors usually prescribe testosterone cypionate or enanthate formulations, with doses ranging from 100–200 mg weekly [6].
The injection process involves:
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Cleaning the injection site with alcohol
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Inserting a 21-23 gage needle at a 90-degree angle
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Putting the medication slowly into either the gluteus maximus (buttock) or vastus lateralis (thigh) muscle [5]
Injections create distinct peaks in testosterone levels that slowly drop until the next dose [4]. This up-and-down pattern means people who use injectable testosterone spend less time with normal hormone levels compared to other methods. The risk of erythrocytosis (hematocrit >50%) happens more often with injectable testosterone (66.7%) than with gels (12.8%) or pellets (35.1%) [6].
Testosterone gel UK options: Testogel, Tostran
UK patients can choose topical applications instead of injections. There are two main gel options:
Testogel uses testosterone as its active ingredient and helps restore natural testosterone levels. You should apply 5g once daily, usually in the morning. Never use more than 10g per day [7]. Many men say they feel more energetic and notice better erections and sex drive with this treatment [7].
Tostran Gel also enters the bloodstream through the skin. Most people start with 3g (60mg testosterone) daily, which can go up to 4g (80mg testosterone) [8]. Tostran comes in a canister with a pump—each pump gives you 10mg of testosterone gel [9].
Both gels slowly raise testosterone levels, and most men notice changes within the first few weeks [8].
Natural supplements and herbal boosters
Some people prefer non-prescription options, and several nutritional supplements claim they can help boost testosterone:
Zinc plays a vital role in making testosterone and helping fertility [10]. Vitamin D supplements might help maintain healthy testosterone levels by affecting blood sugar control [10]. Ashwagandha shows real promise, with clinical trials suggesting it can boost testosterone levels by 10–22% [11].
Popular supplements include:
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Fenugreek, which some studies show can raise testosterone levels by up to 12% [11]
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Panax ginseng, an adaptogenic herb that's traditionally good for male health [10]
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Tribulus terrestris, which many use to boost libido and sexual function [10]
These supplements aren't FDA-regulated, so there's no guarantee about their strength or ingredients [12]. This makes them quite different from medical testosterone therapy [12].
Transdermal vs injection testosterone: key differences
These delivery methods affect the body differently. Injections cause big spikes in testosterone levels, while transdermal systems create gentler but steady increases [4]. This affects both how well they work and how safe they are.
Gels keep hormone levels steady longer than patches when you apply them daily [4]. Studies show that compared to gel users, people who use injections face higher risks of cardiovascular problems (1.26), hospital stays (1.16), and death (1.34) [4].
Other differences include:
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How often you use them: Weekly to monthly for injections, daily for gels [13]
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How steady the hormones stay: Gels keep levels more stable without big ups and downs [13]
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Ease of use: Many people find gels easier to use than patches or injections [7]
Your choice between testosterone gel and injections depends on what works best for your lifestyle, what you prefer, and what your doctor recommends.
Pros and Cons of Each Method
The best testosterone therapy depends on how well each delivery method matches your needs, lifestyle, and health situation. Each option comes with its own set of pros and cons that need a closer look.
Injections: benefits and drawbacks
Testosterone injections are a popular choice because they work reliably and are budget-friendly. These intramuscular treatments get absorbed quickly and dependably into your bloodstream [1]. Many patients like that they're available at most UK clinics at a lower cost than other TRT methods [1].
The downsides need attention too. Many men struggle with needle discomfort, especially when they need regular shots [1]. You'll need to stick to a strict schedule - weekly or biweekly appointments - which can throw off your routine [1]. The treatment creates distinct hormone peaks that slowly drop until your next dose [14].
These ups and downs might affect your mood and energy levels throughout treatment. On top of that, injectable testosterone might raise your red blood cell count more than other methods [15], which could increase your risk of blood clots. Research shows injection users faced higher risks of cardiovascular events (1.26) and hospital stays (1.16) compared to those using gels [1].
Gels and creams: what to expect
People who don't want needles often choose testosterone gels that you apply to your skin daily. These gels are painless and keep hormone levels steady without big swings [3]. Most users find it easy to work the daily application into their morning routine [1].
Your testosterone levels stay more consistent with gels than with injections, which helps avoid mood swings from hormone fluctuations [3]. But these conveniences come with important warnings. The biggest problem is accidentally transferring testosterone to others through skin contact—especially dangerous for pregnant women or children [3]. You must let the gel dry completely and cover the area with clothing to prevent transfer [16].
The treatment requires daily attention and costs more than injections [1]. Some people's skin gets irritated where they apply the gel [17]. While not common, testosterone gels might cause side effects like acne, headaches, or changes in sex drive [17].
Natural supplements: effectiveness and safety
"T booster" supplements attract many men looking for alternatives to prescription testosterone. These supplements claim to boost your body's natural testosterone production instead of replacing the hormone directly [2].
The evidence about how well they work isn't clear cut. A study of 109 supplements found only 24.8% had any proof they increased testosterone levels [2]. Among these, more than half (55.5%) showed conflicting results - either no change or decreased testosterone [2]. Popular ingredients like fenugreek and ashwagandha show mixed results in clinical trials [18].
Safety deserves careful thought. Supplements don't face the same FDA regulations as prescription medicines when it comes to proving they work [2]. The FDA states clearly that "supplements are not intended to treat, diagnose, prevent, or cure diseases," [2] yet many products hint at health benefits anyway [2].
Some supplements pack excessive nutrients—including 1,291% of daily B12 needs and 807.6% for B6 [2]. High zinc levels raise particular concerns, as too much can mess with how your body uses copper, affect cholesterol, or even cause anemia [2].
Men over 60 who are weighing natural vs synthetic testosterone options should talk to healthcare professionals about both prescription and non-prescription choices to make smart decisions about managing their hormones.
Absorption, Dosing, and Hormonal Stability
The way testosterone delivery systems work in your body plays a key role in treatment success for men who need hormone balance. Learning about how each method works helps you make better choices about what might work best for you.
How your body absorbs each method
Injectable testosterone goes straight into your bloodstream through muscle or under the skin. When you get intramuscular shots, testosterone cypionate and enanthate slowly dissolve in their carrier oils—cypionate in olive oil and enanthate in sesame seed oil [19]. These oil-based carriers create a depot effect that releases testosterone as the ester bonds break down through hydrolysis [5]. Your plasma binds about 98% of testosterone to globulin, and free testosterone determines the actual half-life [19].
Transdermal applications work by going through your skin. Gels and creams let testosterone enter your bloodstream without first going through your liver [20]. The amount that gets absorbed changes based on where you put it—research shows that testosterone gel on your abdomen is 30% less effective than when you put it on your arms and shoulders [21]. Most of the dose gets absorbed within 4 hours [22], though it takes longer to absorb completely.
Natural supplements mostly work through your digestive system. Unlike pharmaceutical testosterone that gives you the hormone directly, these supplements want to boost your body's natural production through different nutrient pathways [23]. The compounds in supplements absorb well, but their effect on your actual testosterone levels isn't as predictable.
How often you take each type
Injectable testosterone lets you choose different schedules. Old protocols suggested shots every two weeks or monthly, but newer approaches work better with more frequent doses. Testosterone cypionate and enanthate, with half-lives of about 8 and 7 days respectively [19], work best with weekly shots to avoid big peaks [19]. Some doctors now suggest twice-weekly or daily tiny doses to keep levels steady [5].
Transdermal options need daily use to keep hormone levels stable. You should put testosterone gels like Testogel and Tostran on each morning at the same time [24]. Missing a gel dose makes your hormone levels drop faster within 24 hours [20], so sticking to the schedule matters a lot.
Natural supplement schedules usually need two doses per day. Standard protocols suggest 400-800 mg daily, split into two doses with food to help absorption [23]. The exact timing matters less than being consistent—though taking them with fatty foods helps them work better [23].
The most stable hormone levels
Topical testosterone gives you the most natural hormone pattern. Using gel each day creates steady-state testosterone levels that match your body's natural rhythm without big ups and downs [7]. This stability means fewer mood swings and more consistent energy throughout treatment [8].
Regular injection schedules create clear peaks and valleys. Your testosterone levels usually peak within 0.5-5 days after the shot before slowly dropping [5]. These changes can affect your energy, mood, and sex drive—many men feel their best right after the shot but notice fewer benefits as they get closer to their next dose [25].
More frequent shots substantially improve stability among injectable options. Splitting your weekly dose into two shots (like Monday/Thursday) helps keep levels more even [9]. Daily tiny shots under the skin with testosterone cypionate are becoming popular because they keep levels remarkably stable and copy your body's natural patterns [5].
Men over 60 who look at these options might find daily gels or more frequent, smaller shots work best for steady hormone levels. Each method has its advantages based on what you prefer about application method, stability needs, and lifestyle.
Access, Cost, and Prescription Options in the UK
Men seeking testosterone treatment in the UK have several paths to choose from. A clear understanding of access options, who qualifies, and what it costs helps make smart choices about treatment.
NHS eligibility and limitations
Men must meet strict criteria to get NHS-funded testosterone replacement therapy. Total testosterone levels must fall below 8 nmol/L [26]. Some trusts set the bar even lower. Many men with symptoms and levels between 8-12 nmol/L don't qualify for treatment [27].
Your NHS trip starts with a GP visit to talk about symptoms and get blood tests. Low testosterone results lead to an endocrinologist referral. This whole process takes months, maybe even a year [26]. NHS treatment choices are limited to testosterone gels and sometimes injections [28].
NHS treatment saves money upfront. The biggest problems are long wait times, limited access to specialists, and few medication options [12].
Private TRT clinics: what they offer
Private clinics take a different approach with specialized testosterone care. These clinics run complete hormone checks that look at total testosterone, free testosterone, SHBG, estradiol, and other key markers [29].
You can see a doctor within days instead of months [26]. Many clinics now offer online appointments. Private doctors often work with more flexible criteria. They might treat men who have testosterone levels between 8-15 nmol/L if they show symptoms [30].
Private providers give you more treatment choices. Options include fast-acting injections like cypionate, long-lasting Nebido, daily gels, and sometimes compounded creams [29]. The UK has several 10+ years old clinics like Optimale [31], The Men's Health Clinic [32], and Balance My Hormones [30].
Cost comparison: injections vs gels vs supplements
Treatment costs vary based on your chosen path. NHS patients pay only standard prescription charges—currently £9.90 per item [29], whatever medication they choose [28].
Private treatment costs reflect both medications and service quality. Monthly costs range from £59.99 [33] to £150-£300 [29]. Your provider, medication type, and monitoring needs affect the price. The first year costs more because of initial consultations and blood work. Costs usually drop in following years [6].
Nebido, a long-lasting injection, costs more upfront at £87.11 per dose but needs fewer shots [4]. Daily gels cost less - Testogel at £31.11 and Tostran at £28.63 [4].
Natural supplements cost less to start but are nowhere near as effective as prescribed testosterone therapy.
Side Effects and Lifestyle Considerations
Men over 60 should take time to assess the side effects and lifestyle changes that come with different testosterone delivery methods before they start treatment.
Common side effects of TRT delivery methods
Safety matters with every delivery method. Injectable testosterone leads to erythrocytosis (elevated red blood cell count) in 66.7% of users, while only 12.8% experience it with gels and 35.1% with pellets [13]. These elevated levels might increase the risk of blood clots and cardiovascular events [34].
People who use topical applications often deal with skin reactions. About 18.8% of patch users experience irritation at the application site [13]. Gels come with their own risk - testosterone can transfer to partners or children through skin contact [13].
Users of any method might experience acne, breast enlargement, decreased sperm count, and ankle swelling [35]. TRT isn't right for everyone. Men with metastatic prostate cancer, hematocrit above 50%, or heart failure should avoid it [13].
Impact on daily routine and convenience
Gels need daily application, which takes time, but many men prefer this to getting injections at a clinic or learning to self-inject. The frequency of injections depends on what works best - some guys do fine with weekly shots while others need them twice a week [10].
Nebido (administered every 10-14 weeks) offers a convenient option but doesn't let you adjust the dose easily [10]. Gel users must be careful. They need to wash their hands well and cover the spots where they put the gel with clothing [24].
When natural vs synthetic testosterone makes sense
Natural approaches work well for men with borderline low testosterone or those who want to support their overall hormone health. Synthetic TRT becomes the right choice when someone has diagnosed hypogonadism that really affects their quality of life [36].
Bioidentical hormones (like Testogel and Tostran) sit right in the middle. They're similar to natural testosterone but made in a lab for treatment [11]. Many men like these options because they work just like the body's own hormones.
You can find more details about [natural remedies for male andropause and low testosterone](https://goldmanlaboratories.com/blogs/blog/natural-remedies-male-for-male-andropause-low-testosterone) if you want to explore non-pharmaceutical ways to balance your hormones.
Conclusion
Men over 60 need to think over several factors when choosing testosterone replacement options. Each method comes with its own benefits and drawbacks. Testosterone shots give you stable hormone levels and you need them less often. But they create bigger ups and downs that can affect your mood and energy. Gels match your body's natural rhythms better and don't need needles. You just need to apply them daily, but they might rub off on other people.
Money plays a big role in picking the right treatment. NHS offers budget-friendly choices but has strict rules and long wait times. Private clinics give you faster service and more options at a higher cost. These clinics are great for men who want tailored treatment plans.
Men with borderline testosterone or those unsure about medical treatments can start with natural methods through lifestyle changes and supplements. These natural remedies for male andropause and low testosterone can boost hormone health through diet, exercise, stress control, and key nutrients. Learning about TRT versus natural testosterone support helps men make smarter choices about their hormone health.
Your best treatment option depends on your symptoms, testosterone levels, health, priorities, and budget. Clinical hypogonadism with strong symptoms usually needs medical help. Milder cases often improve with balanced nutrition for male hormones and lifestyle changes.
Whatever path you choose, keeping track of your progress is crucial to work safely. Blood tests should check testosterone, hematocrit, PSA, and liver function, especially when starting treatment. Regular doctor visits help adjust doses based on how you feel and any side effects.
Men dealing with low testosterone should talk to qualified healthcare experts before starting hormone replacement. The right treatment can improve your life by a lot. It brings back your energy, mental focus, sexual function, and overall health as you age.
Key Takeaways
Understanding your testosterone treatment options can significantly impact your quality of life and treatment success as you navigate hormonal changes after 60.
• Testosterone naturally declines 1% yearly after age 30, with over 33% of men above 45 having below-normal levels, making treatment consideration important for symptomatic men.
• Gels provide steadier hormone levels than injections, mimicking natural rhythms without dramatic peaks and valleys that can affect mood and energy throughout treatment cycles.
• NHS eligibility requires testosterone below 8 nmol/L, while private clinics offer faster access (days vs months) and treat borderline cases between 8-15 nmol/L.
• Injectable testosterone carries higher cardiovascular risks (26% increased hazard) and erythrocytosis rates (66.7%) compared to gels (12.8%), requiring careful monitoring.
• Natural supplements lack FDA regulation and show mixed results, with only 24.8% of 109 analyzed products showing any testosterone-supporting data in clinical studies.
The choice between testosterone gel vs injections ultimately depends on your individual symptoms, lifestyle preferences, budget, and tolerance for side effects. Consulting with qualified healthcare professionals ensures you select the safest, most effective approach for your specific situation.
FAQs
Q1. Is testosterone therapy recommended for all men over 60? Testosterone therapy is not recommended for normal aging. It's only advisable for men diagnosed with hypogonadism and experiencing significant symptoms. Natural methods like exercise and weight loss are often suggested first to boost testosterone levels.
Q2. How do testosterone gels compare to injections? Testosterone gels provide steadier hormone levels without dramatic fluctuations, mimicking natural rhythms. Injections offer faster, high-peak exposures but can cause more noticeable ups and downs in mood and energy. The choice depends on individual preferences and lifestyle factors.
Q3. What are some natural ways for men over 60 to increase testosterone? Men over 60 can naturally boost testosterone through regular exercise, particularly a combination of aerobic and resistance training. Maintaining a healthy weight, getting adequate sleep, managing stress, and ensuring proper nutrition can also support healthy testosterone levels.
Q4. Can testosterone gel be obtained through the NHS in the UK? Yes, testosterone gel is available on NHS prescriptions in the UK for off-license prescribing. However, eligibility criteria are strict, typically requiring total testosterone levels below 8 nmol/L and the presence of significant symptoms.
Q5. What are the main risks associated with different testosterone delivery methods? Injectable testosterone carries a higher risk of cardiovascular events and erythrocytosis (elevated red blood cell count) compared to gels. Gels, while generally safer, pose a risk of accidental transfer to others through skin contact. All forms of TRT require careful monitoring for potential side effects.
References
[1] - https://www.rrwellnessclinic.com/post/trt-therapy-delivery-methods-injections-vs-gels-vs-pellets
[2] - https://pmc.ncbi.nlm.nih.gov/articles/PMC6920068/
[3] - https://legerclinic.co.uk/blogs/testosterone-health-hub/which-trt-is-right-for-me
[4] - https://www.nottsapc.nhs.uk/media/3xca50qg/testosterone-info-sheet.pdf
[5] - https://themenshealthclinic.co.uk/gold-standard-trt/
[6] - https://legerclinic.co.uk/pages/pricing
[7] - https://medicine.yale.edu/lab/urology-mens-health-blog/2025/september/
[8] - https://lowtcenter.com/news-article/testosterone-replacement-therapy-gels-injections/
[9] - https://www.vitalityhrt.com/blog/trt-twice-a-week-vs-once-weekly/
[10] - https://omniya.co.uk/which-trt-is-right-for-me/
[11] - https://www.drlouisenewson.co.uk/knowledge/synthetic-and-natural-hormones-whats-the-difference
[12] - https://themenshealthclinic.co.uk/testosterone-replacement-therapy-trt-in-the-uk-navigating-the-best-path-for-treatment/
[13] - https://pmc.ncbi.nlm.nih.gov/articles/PMC9925408/
[14] - https://www.serotonincenters.com/blog/trt-pellets-vs-injections-the-pros-cons/
[15] - https://www.numan.com/low-testosterone/treatment/pros-and-cons-of-trt
[16] - https://my.clevelandclinic.org/health/drugs/18661-testosterone-skin-gel
[17] - https://medlineplus.gov/druginfo/meds/a605020.html
[18] - https://www.webmd.com/healthy-aging/the-best-testosterone-boosters-for-men-over-50
[19] - https://www.ncbi.nlm.nih.gov/books/NBK534853/
[20] - https://pmc.ncbi.nlm.nih.gov/articles/PMC5182226/
[21] - https://pubmed.ncbi.nlm.nih.gov/19549089/
[22] - https://fenwayhealth.org/wp-content/uploads/Testosterone-Options-English.pdf
[23] - https://gamedaymenshealth.com/blog/trt-dosage-guide/
[24] - https://www.vivavitalitymn.com/types-of-testosterone-delivery/
[25] - https://www.renewmedandspa.com/trt-injection-frequency
[26] - https://www.centreformenshealth.co.uk/can-i-get-trt-on-the-nhs
[27] - https://www.numan.com/low-testosterone/treatment/can-i-get-trt-on-the-nhs
[28] - https://onlinedoctor.superdrug.com/low-testosterone-nhs.html
[29] - https://omniya.co.uk/what-does-trt-cost-in-the-uk/
[30] - https://balancemyhormones.co.uk/trt-uk/
[31] - https://www.optimale.co.uk/
[32] - https://themenshealthclinic.co.uk/
[33] - https://www.optimale.co.uk/trt-uk/cost-of-trt/
[34] - https://sph.unc.edu/sph-news/study-finds-testosterone-injections-carry-greater-risk-of-adverse-effects-than-gels-patches/
[35] - https://www.webmd.com/men/testosterone-replacement-therapy-is-it-right-for-you
[36] - https://wellbeingnutrition.com/blogs/listing/natural-vs-synthetic-testosterone-supplements-what-you-need-to-know?srsltid=AfmBOopiLd0N4ZBF8EVPBAxfg25A_Qe7Lr4Z6rx58ZxLGb9YQN3c5VTh
