So, have men on testosterone replacement therapy (TRT), encountered similar difficulties?
The numbers of men on TRT compared with women on HRT is very small. In addition, there are a variety of different testosterone treatments available, which further helps dilute any problems with availability of one particular brand. The bigger struggle men have been finding with hormone therapy is not so much the availability of the medicine, but getting treatment in the first place.
In comparison with menopause where diagnosis is based solely on symptoms, low testosterone in men is only diagnosed by confirmation of either a low total or free testosterone. The problem, however, comes in determining what testosterone level is low enough to provide a formal diagnosis?
The British Society of Sexual Medicine (BSSM), which provides official guidance on target reference ranges for testosterone levels in men, states that men with a total testosterone of < 12nmol/l or a free testosterone < 0.225nmol/l are classed as having “low testosterone”.
However, most NHS clinics use much lower cut off points; often 6-8nmol/l and sometimes even lower than that. Most of the time, men have their blood tests done and are simply told their results are “normal”.
So why are levels in the NHS so much lower than the national BSSM guidance? This may be down to financial reasons, failure to update local reference ranges, or a lack of provision to provide for male hormonal deficiencies.
Overall, it is probably multifactorial, but in practice this means that hundreds, perhaps thousands of men are being told everything is fine, when actually their testosterone levels are low.