NHS vs private TRT: how testosterone treatment works and what each costs

The two prices side by side

Testosterone replacement on the NHS costs the standard prescription charge. In England that is £9.90 per item on 22 October 2026. Prescriptions are free in Wales for anyone registered with a Welsh GP and free for everyone in Northern Ireland. The charges by nation guide covers Scotland and the other exemptions.

Private treatment is priced as a monthly plan. Pages fetched on 22 October 2026 showed £59.99 a month at Manual for oral treatment, £99 to £169 at Voy and £28 membership plus £10 to £60 medicine at Leger Clinic. The TRT cost guide lists every figure.

The saving between a 12-month prepayment certificate at £114.50 and Leger Clinic's year one estimate of £1,477 is £1,362.50. Against twelve single charges at £118.80 the gap is £1,358.20.

How the NHS pathway works

NHS guidance for GPs in Bath and North East Somerset, Swindon and Wiltshire, published September 2025, sets out the steps. Your GP arranges a fasting blood test between 8am and 10am for testosterone, SHBG, albumin, LH, FSH, prolactin, PSA and a full blood count. A second morning sample at least one week apart is needed before any diagnosis.

The guidance states the thresholds. Total testosterone below 8 nmol/L on both samples "is consistent with hypogonadism". A result between 8 and 12 nmol/L "could represent hypogonadism" and is assessed in secondary care, where a trial of treatment may be considered. Above 12 nmol/L the person "is not hypogonadal". The GP refers to endocrinology when total testosterone is below 12 nmol/L. Before any referral the GP completes a prostate check.

The specialist starts treatment. The guidance says "for commencement of prescribing, a letter from the specialist must be sent to the GP" with the dose, preparation and next review date. The Doncaster shared care protocol from December 2025 adds that transfer to the GP "would not be expected before 3 months of treatment" and only once the dose is settled. The GP then prescribes under shared care.

NHS Dumfries and Galloway's referral guidance for Scotland uses slightly different bands. Below 7 nmol/L androgen deficiency is likely and referral follows once illness and medicines are ruled out. Between 7 and 11 nmol/L is equivocal and referral depends on symptoms. Above 11 nmol/L deficiency is unlikely and no referral is made.

What the NHS prescription costs

Testosterone is Class C and Schedule 4 Part 2 on the GOV.UK controlled drugs list. The Doncaster protocol says primary care should issue no more than a 30-day supply per prescription. In England each prescription is one item at £9.90, so a year of monthly scripts is £118.80. Gel, injections and capsules are each one item. If the specialist adds a second medicine, that is a second item.

A 12-month prescription prepayment certificate costs £114.50 and covers every item. It beats twelve single charges by £4.30 and covers any other prescription you have in the year. Men aged 60 or over and those with a medical exemption certificate pay nothing.

Monitoring under NHS shared care is also free. The Doncaster protocol lists a full blood count, kidney, liver, PSA and testosterone at 6 months, 12 months and then yearly.

How the private pathway works

A private clinic replaces the GP, the referral and the specialist with its own prescriber. Voy charges £33.95 for a first finger-prick test, £49.95 to £119.95 for a venous confirmation test and £79.95 for a video consultation. The Men's Health Clinic charges £280 for a 60-minute new patient consultation plus £149 to £169 for its blood panel. Numan bundles the first tests and consultation into a single charge of up to £149.

Private clinics set their own criteria. The NHS pages cited do not govern them. A private prescription for testosterone still has to come from a registered prescriber and be dispensed by a GPhC registered pharmacy, because the medicine is prescription only and a controlled drug.

Moving between the two

The Men's Health Clinic prices a consultation for men transferring from the NHS at £280. Voy charges £70 for a transfer consultation from another provider. Leger Clinic lists a switch consultation from £59.

The reverse move, from private to NHS, is not a transfer. NHS guidance requires a specialist letter before a GP prescribes. A GP practice may ask you to go through the NHS referral from the start, with the same two morning samples. The private results may help the GP decide whether to refer.

Steps if you want the NHS to assess you

1. Book a GP appointment and describe the symptoms. Ask for a morning testosterone test.
2. Attend the blood test fasting, between 8am and 10am.
3. If the result is below 12 nmol/L, a second sample is taken at least one week later.
4. The GP completes a prostate check and refers to endocrinology.
5. The specialist starts treatment. After about three months on a stable dose, prescribing moves to your GP.
6. In England, buy a prepayment certificate if you expect twelve or more items in the year.

Mistakes that cost money

Paying a private clinic for two months of treatment while an NHS referral is already in progress, then paying £280 for a transfer back.

Paying £9.90 per item in England when a £114.50 certificate would cover the year. The certificate pays for itself at the twelfth item.

Buying a private venous test at £49.95 to £119.95 when a GP has already agreed to arrange the same test free.

Where the figures come from

The England prescription charge is from the NHS website. The Wales and Northern Ireland positions are from the Welsh Government and nidirect. The diagnostic thresholds, the two-sample rule and the specialist letter requirement are from NHS clinical guidance published in September 2025 and December 2025, and Scottish referral guidance from NHS Dumfries and Galloway. Private prices were read from each clinic's own page on 22 October 2026. The Dose Club gives no medical advice. Whether treatment is right for you is a decision for a prescriber.