Men's hormones & TRT, Johannesburg
Low testosterone and TRT assessment in Johannesburg.
Evidence-based assessment of possible testosterone deficiency, with treatment considered only when symptoms and appropriately measured testosterone levels support the diagnosis.
In short
Testosterone deficiency should be diagnosed only when compatible symptoms are accompanied by consistently low, accurately measured testosterone levels. Evaluation should include repeat early-morning testing and assessment for reversible or underlying causes. TRT is considered only when the diagnosis is established and the expected benefits, risks and fertility implications have been discussed.
Medically reviewed by Dr Arnav Kapur, MBBCh Cum Laude
The approach
Understand first. Then treat.
Low energy, reduced libido, erectile changes, reduced strength and changes in body composition can occur with testosterone deficiency, but they are not specific to it. Obesity, sleep apnoea, medication, thyroid disease, depression and other conditions can produce the same symptoms.
The aim is to establish whether genuine hypogonadism is present, identify the cause and address reversible contributors before deciding whether testosterone replacement therapy is appropriate.
What the assessment covers
- At least two early-morning testosterone measurements where diagnosis is uncertain or not already established
- SHBG and free testosterone assessment where indicated
- LH and FSH to distinguish primary from secondary hypogonadism
- Prolactin and additional pituitary evaluation where appropriate
- Full blood count and haematocrit
- Prostate risk assessment where age and clinical context make it relevant
- Sleep apnoea, obesity, alcohol, medication and other reversible contributors
- Fertility goals before treatment
- Cardiometabolic health and body composition
- Treatment options and structured monitoring if TRT is started
Diagnosis requires symptoms and low testosterone
A single borderline or random testosterone result is not enough. Current endocrine guidance recommends compatible symptoms together with consistently low testosterone concentrations, confirmed with repeat early-morning testing.
Look for the cause before replacing the hormone
Obesity, untreated sleep apnoea, certain medicines, acute illness and pituitary or testicular disease can all affect testosterone. The cause influences treatment and sometimes allows testosterone to improve without replacement.
TRT is a medical treatment, not an optimisation shortcut
When genuine hypogonadism is diagnosed, TRT may improve relevant symptoms and maintain normal androgen-dependent functions. It also has contraindications, fertility implications and monitoring requirements that should be discussed before treatment begins.
Monitoring continues after treatment starts
Follow-up assesses symptoms, testosterone level, haematocrit and treatment-related adverse effects. Prostate monitoring is individualised according to age and risk, and therapy is adjusted according to clinical response and safety.
Common questions
Answers before you book.
Do I need TRT for life?
TRT is often a long-term treatment because it replaces testosterone rather than curing every underlying cause. Duration depends on why treatment was started, your response and your ongoing clinical circumstances, which is why the decision to begin should be made carefully.
Will TRT affect fertility?
Yes. Exogenous testosterone can suppress sperm production. If fertility matters now or in future, this must be discussed before treatment because other approaches may be more appropriate.
Can testosterone improve without TRT?
Yes in some cases. Weight loss, treatment of sleep apnoea, medication review and management of reversible contributors can improve testosterone, particularly where no permanent testicular or pituitary disorder is present.
Is TRT safe for the heart?
Recent evidence has reduced some cardiovascular concerns, but long-term safety questions remain and individual risks still matter. TRT should be prescribed only after appropriate diagnosis and monitored over time.
This page is general health information and is not medical advice. Testosterone is a prescription medicine, provided only after clinical assessment and with monitoring.
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Centre of Advanced Medicine · 13 Scott Street, Waverley, Johannesburg
Monday to Friday, 07:40 to 17:00
011 440 8721