As celebrity endorsements go, it’s perhaps slightly unexpected. In a one-minute video clip, former boyband star Duncan James speaks earnestly to the camera. ‘It all started about four years ago,’ he says. ‘I had low energy, low sex drive, low mood, bad sleep – and I didn’t know why for the longest time.’
A trip to a private doctor, explains the ex-Blue singer, revealed the source of his struggles: low levels of the male sex hormone testosterone. ‘Since then I’ve been taking testosterone replacement therapy,’ he continues. ‘And it’s completely transformed how I feel. I know this is something us men don’t like to talk about, but if you can get help, you should.’
James, 46, shared the post with his nearly half a million Instagram followers in October. Fans congratulated him for ‘opening up’ about his health and raising awareness ‘to help others’ – while the caption makes it clear that it’s an advertisement for Prime Life Clinic.
It’s one of a number of firms that have sprung up in recent years specialising in testosterone replacement therapy (TRT). They often use young, seemingly healthy men to promote their products. And many of them insist on an initial blood test which can cost as much as £200.
The treatment was once reserved for a small number of men who suffered from low levels of the sex hormone. Now TRT is being pitched as a drug which can help men as young as 30 with a variety of minor symptoms, from fatigue to muscle-growth and stronger erections.
But experts warn that those who take testosterone they don’t need could seriously damage their health.
An investigation by The Mail on Sunday has discovered that the number of adverts promoting TRT in the UK has soared in the past two years on Facebook alone. Between 2018 and 2022 there were 32. Last year there were 6,000. And in 2024, so far, there have been nearly 50,000.
Former boyband star Duncan James, 46, in a video for Prime Life Clinic on Instagram
But experts say muscular men in their 40s, such as Duncan James, do not typically suffer from clinically low testosterone.
‘It would be a very unusual case for men this age to be suffering from low testosterone, particularly with that physique – men with the condition are more likely to be overweight than toned,’ says Professor Mike Kirby, president of the British Society for Sexual Medicine.
‘It appears to me these companies are preying on a vulnerable group of men, who are easily led, to make money from the initial tests.’
A representative for Mr James would not comment on his medical history but said there are ‘a number of reasons a person may choose this treatment’.
Others claim the explosion in private testosterone clinics is a result of NHS failures. They argue that its refusal to test men for low testosterone means thousands are going undiagnosed and needlessly suffering debilitating side-effects.
Some even liken the lack of TRT on the NHS to the once-poor provision of hormone replacement therapy (HRT) for women, which has become widely available only in the past five years.
‘For men in their 40s, 50s and 60s, low testosterone is a much bigger problem than many realise,’ says Dr Paul Jenkins, a hormone expert at The London Endocrine Centre. ‘And TRT can massively improve their symptoms.
‘The NHS is behind the times on this issue, it really should be offering more men testosterone.’
So what’s the truth about testosterone replacement therapy – and is it right for you?
Testosterone is produced by both men and women. While women produce less, it still plays a crucial role in certain bodily functions. For men, it is vital for muscle and bone growth, as well as triggering the bodily changes connected with puberty – the appearance of body hair, the deepening of the voice and the arrival of a sex drive.
Research suggests that, after the age of 40, men’s testosterone levels fall about 1 per cent every year. For the majority of men, this will not mean any noticeable changes.
However, some men experience an extreme drop, leading to a condition called hypogonadism – also known as the male menopause or the ‘manopause’.
These men often report depression, loss of sex drive or erectile dysfunction. Other symptoms include poor sleep, brain fog and increased fat around the belly or pectoral muscles, leading to ‘manboobs’. Studies show the problem is more common in overweight men. Injuries to the testicles and cancer treatment can also impact testosterone production.
According to research TRT – which involves regular doses of artificial testosterone – can drastically improve the lives of those suffering with hypogonadism. On the NHS, men are usually offered an injection, given every three months, or a daily gel usually applied to the shoulders.
However, the number of men living with the male menopause is debated. Some studies suggest just two per cent of men have medically low levels of testosterone – others estimate it could be ten times that, affecting as many as one in five.
Many experts argue that this uncertainty is due to the fact that the doctors rarely test for hypogonadism.
One study of GP records found just 66,000 men – 0.2 per cent of the adult male UK population – had their testosterone levels checked in the ten-year period to 2011.
Unsurprisingly, the number of TRT prescriptions handed out by the NHS is very low – just 40,000 in England and Wales – but this figure also includes women, who research suggests are more likely to be offered the treatment.
Experts say this lack of NHS care for hypogonadism has allowed private TRT clinics to flourish.
These firms usually first send patients a fingerprick blood test, which they do at home and return via mail. If a low testosterone level is detected, they are invited to a clinic for a more detailed blood test, before a prescription for testosterone is given.
Most clinics offer the hormone for a monthly fee of about £50, plus initial set-up costs of between £40 and £200.
Some experts question the reliability of these blood tests.
‘Testosterone levels fluctuate throughout the day,’ says Dr Jenkins. ‘Most men would have clinically low levels in the afternoon, but by the next morning these would be back to normal.
‘So a positive test result doesn’t mean you have a medical condition. Doctors should prescribe TRT only to those who have low levels and severe symptoms such as reduced libido, energy and muscle strength.’
Some private clinics also have a wider definition of what is classed as ‘medically low levels’ of testosterone compared with the NHS.
According to guidelines set out by the British Association for Sexual Medicine, hypogonadism can occur when testosterone levels are below 12nmol/l – which means there is less than 12 nanomoles of the hormone for every litre of blood. A normal level can be up to about 30nmol/l.
Paul Milana, 59, from Brighton, sought out testosterone injections after noticing a drop in his sex drive around his 49th birthday, but his blood pressure became dangerously high
The NHS typically will not offer the treatment to men unless they have levels lower than 8.6nmol/l. Even then, most Health Service clinicians will require them to attempt lifestyle changes first – such as exercise and improved sleep – before offering the medicine.
But some experts say the NHS makes it too difficult for men to access TRT, meaning many affected by the problem are forced to get the treatment privately.
When taken in larger doses, TRT acts as a steroid, allowing users to lift heavy weights and exercise for longer. But studies show that greatly increasing testosterone levels can raise the risk of heart attacks and strokes.
Experts say that some, less reputable, online pharmacies do not ask patients to do a blood test before getting a TRT prescription, meaning men can lie to access it.
One patient who suffered as a result of taking too much testosterone is Paul Milana, 59, from Brighton. He sought out the hormone after noticing a drop in his sex drive, as well as suffering fatigue and having difficulty gaining muscle despite regular trips to the gym.
‘This all happened around my 49th birthday,’ says the entrepreneur, now 59. ‘I asked my GP whether I could get TRT on the NHS, but I was told my levels weren’t low enough.’
Desperate to combat the symptoms, Paul found an online pharmacy that allowed him to buy the injections without taking a blood test. The firm also did not offer any follow-up consultation or a limit on how long he could take the drugs.
‘My life dramatically improved after I started the injections,’ says Paul. ‘I had the sex drive of a 25-year-old, it was crazy, and I noticed a big difference at the gym.’
However, last year, a check-up at his GP revealed his blood pressure was dangerously high.
He now takes medication to bring it down, but has been told he has a much higher risk of having a heart attack or stroke. ‘I had no idea of the danger when I started taking it,’ he says.
Other experts argue the NHS places limits on who can get TRT for good reason. Many point out that – even if the risk of heart attack or stroke is low for those with hypogonadism – there are other health risks.
Prolonged testosterone treatment can raise the risk of an enlarged prostate – which triggers a number of uncomfortable symptoms, such as difficulty peeing.
It can also disrupt the body’s production of sperm, and the NHS advises that anyone looking to have children discusses the possibility of infertility with their doctor before starting TRT. Other TRT side-effects include weight gain, hot flushes, acne, depression, aggression and sweating.
Instead, experts argue that many men with low testosterone can reverse their symptoms by eating foods rich in healthy fats, such as fish, avocado, seeds, nuts, eggs and beans.
Getting a good night’s sleep and regular high-intensity exercise can also boost levels.
‘In a lot of cases these low testosterone levels are a symptoms of another condition,’ says Dr Channa Jayasena, a hormone specialist at Imperial College London.
‘This might be down to having type 2 diabetes or being obese. Excessive smoking or drinking alcohol can bring down your testosterone.
‘Testosterone can be a useful therapy for some, but that group is a minority.’
Prime Life Clinic said it follows the British Society for Sexual Medicine guidelines and requires two sets of confirmed low testosterone levels, alongside symptoms, before initiating treatment.
Women’s libido lifted by Davina’s gel
Despite the tight restrictions placed on men trying to get testosterone on the NHS, some women are handed it just to boost their sex drive.
Women who have been through the menopause can be prescribed testosterone gel or cream if they have a reduced libido, but only after hormone replacement therapy (HRT) has not proved to be effective.
Davina McCall holding a tube of testosterone in October 2021 for Menopause Awareness Month
In 2022, TV presenter Davina McCall championed the treatment in a menopause documentary she hosted. After the show was broadcast, thousands of women across the UK requested and received a testosterone prescription, which was later dubbed the ‘Davina effect’.
In women, testosterone is produced by the ovaries and levels usually get lower with age.
They can fall dramatically during the menopause, by up to a quarter of the amount women had during their 20s. Drop-off can be particularly severe for women with a medically induced menopause, which can cause a 50 per cent reduction.
Testosterone gels are not currently licensed for use for women, although they can be prescribed after the menopause by a specialist doctor if they think it might help restore a patient’s sex drive.
The risk of suffering side effects is considered low for women because the testosterone is simply replacing lost hormones.
