Men’s health
Energy, strength and honest answers
A proper medical assessment, not a prescription on request. Testosterone deficiency has a clinical definition, several common causes that are reversible, and a diagnosis that needs two blood samples — not one.
Fully online. Video consultation with Dr Qurbain, medication dispensed to your door, and no need to travel anywhere.
Flat, foggy, and tired of being told it is just age?
If any of these sound familiar, this consultation was built for you.
You want to know where you actually stand, with numbers.
You would rather be told you do not need treatment than be sold it.
You want the fertility conversation had properly, before anything starts.
You want someone who will stop it if it is not helping.
Half of the men who come with low testosterone have a reason for it that treatment would hide.
Obesity, opioid painkillers, steroids, poorly controlled diabetes, an underactive thyroid, sleep apnoea, recent illness or significant stress all lower testosterone. So does using anabolic steroids. Each of those is worth finding, because addressing the cause can normalise the level and leave you better off than replacement would.
That is why the sequence here is diagnosis first: symptoms scored with a validated questionnaire, two blood samples taken before 11am on separate occasions, the pituitary hormones measured to work out where the problem actually is, and reversible causes looked for before replacement is discussed at all.
How it works
Four steps, all from home
Symptoms, scored properly
A validated 17-item symptom questionnaire covering the psychological, physical and sexual domains, scored and recorded at baseline. Full history: onset and duration, medical conditions, medicines, alcohol, any anabolic steroid use, and whether you want children in future.
Two morning blood samples
Testosterone varies through the day, so samples are taken between 8 and 11am, on two separate occasions. Alongside: binding globulin so free testosterone can be calculated, the pituitary hormones, prostate-specific antigen, a full blood count, liver and kidney function, HbA1c and lipids.
Causes before treatment
Results are read by the doctor and reversible causes addressed first. Where the picture points to the pituitary rather than the testicles, you are referred for imaging and endocrine assessment.
Treatment and monitoring, if it is right
Where replacement is appropriate it is prescribed in a form suitable for use at home, with a minimum six-month trial before continuation is decided, and bloods at three months, six months, twelve months and annually. Your GP is told.
Diagnosis before treatment
Testosterone deficiency has a clinical definition and a diagnostic process. Both samples have to be taken in the morning, because levels fall through the day.
Step 1
Symptoms scored
A validated 17-item questionnaire across the psychological, physical and sexual domains, recorded at baseline.
Step 2
Two morning samples
Taken between 8 and 11am on two separate occasions, with binding globulin, the pituitary hormones, PSA and a full metabolic panel.
Step 3
Reversible causes first
Weight, opioids, steroids, thyroid, diabetes, sleep apnoea and recent illness all lower testosterone. Addressing the cause can normalise the level.
Step 4
A six-month trial
If replacement is right, a minimum six-month trial before anyone decides it is working. No response at an optimised dose means stopping.
What the assessment covers
Testosterone deficiency
- Diagnosed on two morning samples, not one
- Total testosterone below 12 nmol/L, or calculated free testosterone below 225 pmol/L, with symptoms
- Primary and secondary causes distinguished, because they lead to different places
- A six-month minimum trial before anyone decides it is working
Fatigue investigated properly
- Thyroid function, anaemia, ferritin, vitamin D and B12
- HbA1c and lipids — metabolic causes are common and treatable
- Liver and kidney function
- Sleep apnoea screened for, because it causes both fatigue and low testosterone
Delivered remotely, honestly
- Forms suitable for self-application at home are what this service prescribes
- The long-acting injection needs in-person administration and is referred, not prescribed here alone
- Physical examination is not possible remotely — that limitation is recorded, and anything needing examination is referred
- No upper age limit where there is benefit and no new contraindication
What replacement does, and what it costs you
Where there is genuine deficiency, replacement commonly improves energy, mood, libido, muscle mass and bone density. It is also long-term treatment: the benefit lasts while you take it. The trade-off that matters most is fertility — replacement suppresses sperm production, usually within three months, often to the point of infertility. If you may want children, say so before you start: sperm banking is offered to every man under 50 who wants future fertility, and there are alternatives that work differently.
What you need to know before starting
Side effects, and what to do about them
Read
This is effective treatment with a small number of specific risks, each of which is monitored on a fixed schedule.
- Transfer to other people by skin contact. The MHRA requires that you be told: transfer raises another person’s testosterone, and in women causes facial and body hair growth, voice deepening and menstrual changes, and in children genital enlargement and early puberty. Wash your hands after applying, wash the application area with soap and water before skin contact with anyone, and cover the site with clothing once dry.
- Thickening of the blood. Treatment raises your red cell concentration, which raises clot risk. Measured at baseline, three months, six months, twelve months and annually. At 54% or above the dose is reduced or treatment stopped.
- Prostate monitoring. PSA at baseline and annually. A rise of more than 1 ng/mL in a year, or a level above 4, means treatment stops and you are referred urgently to urology.
- Sleep apnoea can worsen. If it is untreated, it is treated first.
- Acne, mood change and fluid retention can occur and are asked about at every review.
- Not applied to the genitals, and not to broken or irritated skin.
When we will not prescribe
Who this service cannot treat, and why
Read
These are not negotiable, and several of them are the reason the baseline bloods are mandatory.
- Active or suspected prostate cancer, or a PSA of 3 or above without urological clearance first
- Male breast cancer
- A red cell concentration of 54% or above. Between 48 and 50% at baseline is a caution zone needing a recorded reason and earlier retesting
- Untreated severe sleep apnoea — treated and controlled first
- Significant urinary obstruction from prostate enlargement, assessed objectively — urological review and symptom control first
- Severe or decompensated heart failure
- Wanting children in the near future — treatment suppresses fertility; you are referred instead
- A single low reading without a second confirmatory sample
- Anyone under 18
This is not a prescription service for testosterone. Where the assessment shows your level is normal, or that something else explains your symptoms, you are told that plainly and helped with the actual problem.
Monitored on a fixed schedule
The full review and monitoring schedule
Read
At three months: testosterone level timed to your application, red cell concentration, liver function and PSA, with symptoms rescored and the dose adjusted. At six months: the full panel, a complete symptom review, cardiovascular risk, and the decision on whether it is working — no response at an optimised dose after six months means stopping. At twelve months and annually after that: the full panel again, annual review letter, and your GP updated with the clinical justification for continuing.
The blood test that governs your treatment
Replacement raises the concentration of red cells in your blood, which raises clot risk. It is measured at baseline, three months, six months, twelve months and annually, and these are the thresholds that trigger action.
Our approach follows current national guidance. See the guidelines we work to.
Initial consultation
Your initial consultation is paid when you book, before the consultation, and is charged whether or not treatment is prescribed. A follow-up review is paid when it happens, and only if you or your doctor decide you need one.
Joining the waiting list is free. Medicine, if prescribed, is bought separately from the dispensing pharmacy and its cost is confirmed with you before you pay for each supply.
Video consultation, validated symptom scoring, the full baseline blood panel including both morning testosterone samples reviewed by the doctor, and a written plan. Medication, where prescribed, is dispensed separately by a registered pharmacy and priced before you pay.