TRT consultation

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– Step 1 of 10

Before you begin. This consultation is for men who have taken testosterone replacement therapy (TRT) before and already have blood test results dated within the last 6 months. A prescriber uses your recent results, with your answers, to review your treatment safely. If you are new to TRT, or your results are older than 6 months, you will need a fresh blood test first.

Have you taken testosterone replacement therapy (TRT) before? *

This form is for existing TRT patients only.

This consultation is for men who have taken testosterone replacement therapy before and already hold blood results dated within the last 6 months. Based on your answers, this route is not right for you yet.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

Please tell us which TRT clinic you have been using *

Do you have blood test results from within the last 6 months that you can upload now? *

This form is for existing TRT patients only.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

Date of your most recent blood test *

Please check the date on your results, it must be within the last 6 months. If it is older than 6 months you will need a repeat test before we can proceed.

Upload your blood test results (the second follow up blood test which could include the following FBC, LFTs, U and Es, HBA1c, PSA, Total testosterone, Free Testosterone , SHBG, Prolactin, TSH (dated within the last 6 months). *

Accepted files: PDF, JPG, PNG, HEIC or Word. You can upload up to 3 files.

I confirm the results I am uploading are mine and are dated within the last 6 months. *

I confirm
I cannot confirm this

This form is for existing TRT patients only.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

Name *

First

Last

Date of birth *

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Are you 18 years of age or over? *

We’re sorry, but there are no suitable treatments for you.

The safety and well-being of our patients is our number one priority, and based on your answers, we can’t recommend any of our treatment options. We know this is both frustrating and disappointing, but we want to make sure that we’re putting your health first and that you find the right care.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

What is your biological sex (sex registered at birth)? *

Male
Female

This particular consultation is for men only.

This TRT review is designed for men. Testosterone can still play an important role in women, particularly for low sexual desire, and we do offer a dedicated service for this.

Please visit our low libido in women page to find the right consultation for you.

Note: if you selected this by mistake, you can go back and change your answer.

Do you believe you have the mental capacity to make decisions about your own healthcare? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Which of these sexual symptoms are you experiencing? *

Lower sex drive
Erection difficulties
Fewer or absent morning erections
Fewer sexual thoughts
Delayed climax
Reduced ejaculate
None of these

Energy and body symptoms *

Tiredness or low energy
Loss of muscle or strength
Reduced body or facial hair
Breast tenderness or swelling
Hot flushes or sweats
Poor sleep
Weight gain around the middle
Bone thinning or a fracture
None of these

Mood and thinking *

Low mood or depression
Irritability or anger
Reduced sense of wellbeing
Poor concentration or memory
None of these

How long have you had these symptoms? *

Under 3 months
3–6 months
6–12 months
Over 1 year

Which single symptom bothers you most? *

A short set of screening questions (the ADAM questionnaire). Please answer yes or no to each.

1. Do you have a decrease in sex drive (libido)? *

2. Do you have a lack of energy? *

3. Do you have a decrease in strength and/or endurance? *

4. Have you lost height? *

5. Have you noticed a decreased enjoyment of life? *

6. Are you sad and/or grumpy? *

7. Are your erections less strong? *

8. Have you noticed a recent deterioration in your ability to play sports? *

9. Are you falling asleep after dinner? *

10. Has there been a recent deterioration in your work performance? *

Do you wish to father children now, or possibly in the future? *

Thanks for letting us know. Standard testosterone therapy can reduce sperm production, so it would not usually be the first choice where fertility matters – but this is not a barrier to treatment. There are fertility-sparing options (such as hCG or clomifene) that your prescriber can discuss with you at your consultation. Please carry on with the form.

Do you currently have active prostate cancer (diagnosed and untreated, or under active treatment)? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you currently have active breast cancer? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Have you been told you have thick blood, a high red-cell count, or polycythaemia (a raised haematocrit)? *

Yes
No
Not sure

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you have severe heart failure (breathless at rest or on the slightest activity)? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you have urinary symptoms, or an abnormal prostate check or PSA blood test awaiting investigation? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Head injury and hormone (pituitary) gland – tick anything that applies *

A significant head injury or concussion
Repeated head knocks from sport (e.g. boxing, rugby)
Previous surgery or radiotherapy to the head or pituitary
A known pituitary or hormone-gland disorder
New or ongoing headaches
Changes to your vision
Milky discharge from the nipples
None of these

We need to look into this before going further.

The symptoms you have ticked can sometimes point to an issue with the pituitary gland, which helps control your hormones. Because of this, we cannot continue with an online review just now, as you may need an extra blood test (prolactin) or a scan first.

This is a precaution, not a cause for alarm. Please contact our prescribing team at info@courierpharmacy.co.uk so we can advise on the right next step for you, and speak to your GP if any symptom is new or getting worse.

Note: if you ticked something by mistake, you can go back and change your answer.

Please tick any medicine you take now or have recently taken. Several of these can lower testosterone or raise a hormone called prolactin, so it is important we know. Brand names are shown to help you recognise them. Please do not stop any prescribed medicine on your own.

Antipsychotic and mood-stabilising medicines

Risperidone (Risperdal)
Paliperidone (Invega, Xeplion)
Amisulpride (Solian)
Sulpiride
Haloperidol (Haldol)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Chlorpromazine (Largactil)
Clozapine (Clozaril)
Flupentixol (Depixol, Fluanxol)
Zuclopenthixol (Clopixol)
Trifluoperazine (Stelazine)
Fluphenazine (Modecate)
Levomepromazine (Nozinan)
Perphenazine
Pimozide (Orap)
Lurasidone (Latuda)
Cariprazine (Reagila)
Asenapine (Sycrest)
None of these

Epilepsy and nerve-pain medicines (anticonvulsants)

Sodium valproate (Epilim, Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Pregabalin (Lyrica)
Gabapentin (Neurontin)
Topiramate (Topamax)
Phenytoin (Epanutin)
Oxcarbazepine (Trileptal)
Phenobarbital
Primidone (Mysoline)
Clonazepam (Rivotril)
Lacosamide (Vimpat)
Zonisamide (Zonegran)
Ethosuximide (Zarontin)
Perampanel (Fycompa)
Brivaracetam (Briviact)
Eslicarbazepine (Zebinix)
Vigabatrin (Sabril)
Tiagabine (Gabitril)
None of these

Strong painkillers (opioids)

Codeine
Dihydrocodeine (DF118)
Tramadol (Zydol)
Morphine (MST, Zomorph, Oramorph)
Oxycodone (OxyContin, OxyNorm)
Fentanyl patch (Durogesic)
Buprenorphine (Butrans, Subutex)
Methadone
Tapentadol (Palexia)
Co-codamol or co-dydramol
None of these

Steroid medicines (corticosteroids)

Prednisolone
Dexamethasone
Hydrocortisone tablets
Inhaled steroid (e.g. Seretide, Symbicort, Fostair)
Regular steroid injections
Long-term steroid nasal spray
None of these

Anti-sickness, stomach and blood-pressure medicines

Metoclopramide (Maxolon)
Domperidone (Motilium)
Prochlorperazine (Stemetil, Buccastem)
Methyldopa (Aldomet)
Verapamil
Cimetidine (Tagamet)
None of these

Any other medicines, inhalers, injections or supplements? Please include the dose if you know it.

Do you have any allergies to medicines? *

Please give details of your allergies *

Heart and circulation – tick anything you have had

High blood pressure
High cholesterol
Heart attack
Angina or coronary heart disease
Irregular heartbeat (atrial fibrillation)
Stroke or mini-stroke (TIA)
Blood clot (DVT or in the lung)
None of these

You have told us you have high blood pressure. Is it currently well controlled (for example, usually below 140/90)? *

Yes, it is well controlled
No, or I am not sure

Upload a recent blood pressure reading *

A clear photo or printout from a home monitor, pharmacy or GP is fine. PDF, JPG, PNG or HEIC.

This form is for existing TRT patients only.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

When did you have your heart attack? *

Within the last 12 months
More than 12 months ago

This form is for existing TRT patients only.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

This form is for existing TRT patients only.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

Other conditions – tick anything you have

Type 2 diabetes
Type 1 diabetes
Pre-diabetes
Under- or over-active thyroid
Liver disease
Kidney disease
None of these

This form is for existing TRT patients only.

If you are new to TRT, or your results are older than 6 months, please start with our blood testing service, which includes a free prescriber consultation: order the TRT home blood-testing kit.

Note: if you made a mistake in your answers, you can go back and change them.

Do you snore, or has anyone noticed you stop breathing during sleep? *

No
Yes – snoring
Yes – breathing pauses noticed
Not sure

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you have any other medical conditions not already mentioned? *

Please give more details *

Do you smoke? *

Never smoked
Ex-smoker
Current smoker

Do you drink alcohol? *

Roughly how many units of alcohol do you drink per week? *

Do you use any recreational drugs? *

Please give brief details (what and how often) *

How would you describe your exercise and training? *

Little or no regular exercise
Light – a few walks or sessions a week
Moderate – regular gym or sport
Intense – heavy training, bodybuilding or endurance

Have you ever used anabolic steroids, SARMs, prohormones or other performance or physique-enhancing products? *

If yes, what did you use and roughly when? (last use, and whether ongoing) *

If you are found suitable, your prescriber will recommend the treatment that best fits you. The options below are prescription-only medicines – you cannot choose or buy them yourself. This section simply records any preference or previous experience to talk through at your consultation. Your prescriber makes the final decision on what is safe and appropriate for you.

What testosterone treatment are you currently using (or most recently used)? *

Testosterone injection (e.g. Sustanon, cypionate, Nebido)
Testosterone gel (e.g. Testogel, Testavan, Tostran)
Clomifene tablets
hCG injection
Other / not currently treating

Please give the name, dose and how often you take it (and who prescribes it). *

Do you have a private prescription for your TRT that you would like to upload?

Upload your private prescription (optional)

PDF, JPG, PNG, HEIC or Word. You can upload up to 3 files.

Which of these would you like to discuss with your prescriber? (Optional – tick any that interest you, or leave blank.)

Testosterone injection – Sustanon 250
Testosterone injection – testosterone cypionate
Testosterone gel – Testogel
Testosterone gel – Testavan
Clomifene tablets (fertility-sparing option)
hCG injection – 5000 iu (Gonasi) (fertility-sparing option)
No preference – happy for my prescriber to advise

If an injection may suit you: injected testosterone can raise your red blood cell count more than gels do, so your prescriber will monitor your haematocrit with regular blood tests. Please tell us if you take blood thinners (anticoagulants) or have a bleeding disorder.

If a gel may suit you: testosterone gel can transfer to other people through skin contact and can be harmful to women and children. You would need to cover the area once dry and wash your hands after applying. Please let your prescriber know if you are in close daily contact with a pregnant woman or young children.

About the fertility-sparing options: clomifene and hCG work by encouraging your own body to make testosterone, and can help protect fertility. Whether they are suitable depends on the cause of your low testosterone, which your prescriber will assess.

Do you have a peanut or soya allergy? *

Please note: the Sustanon 250 injection contains peanut (arachis) oil, so it is not suitable if you have a peanut or soya allergy. Your prescriber will choose a different option for you if needed.

Next steps – a few final details. Please give us your current height, weight and a recent blood pressure reading so your prescriber has an up-to-date picture before your review.

Height *

Weight *

Your most recent blood pressure reading *

Ordering tests (optional). Thank you – you have already uploaded recent blood results for this review, so you do not need to order anything now. If you are due a repeat or monitoring blood test, or your prescriber recommends one, you can order it here. Both include a free prescriber consultation.

Order a monitoring / follow-up blood test
Order the TRT home blood-testing kit

Consent

By submitting this consultation I confirm that:

1. The information I have provided is true, accurate and complete to the best of my knowledge.
2. I understand a prescriber will review my answers and that treatment is not guaranteed.
3. I understand testosterone therapy is a long-term treatment that requires ongoing blood-test monitoring.
4. I understand testosterone therapy can reduce fertility and sperm production, sometimes permanently.
5. I will attend for the blood tests and reviews my prescriber recommends.
6. I will not stop or change any medicine prescribed by another clinician without advice.
7. I understand how to use my treatment safely and will read the information provided.
8. I consent to Courier Pharmacy holding and processing my data in line with its privacy policy.
9. I understand I can withdraw from treatment at any time.

Consent *

I agree to the statements above and give my consent for any treatment provided.

Are you registered with a GP in the UK? *

Your doctor's details: please give their name, address and email

(Optional) Do you consent to us accessing your NHS Summary Care Record, or requesting further information on your medical history from your GP?

Summary Care Record

I consent

(Optional) Do you consent to us writing to your GP to share information about this supply and any information we hold about you?

Write to GP

I consent

Product Category

Important

We review all orders to ensure you receive the best treatment possible. If what you ordered is unsuitable, we will refund part or all of your order.

If we decide that what you ordered is unsafe for you, based on the other information you provided, we won’t provide any treatments. However, we may call you and suggest alternatives.

TRT consultation

Conditions

Treatments

Care and policies