Further information and resources are available on our Hormone replacement webpage and
British Society for Sexual Medicine guidelines on adult testosterone deficiency

Gender Dysphoria Programme

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
TestosteroneAim for a target total testosterone (TT) level of 15-30 nmol/l to achieve optimal response.
Testosterone Enantate250mg/ml amp: £87.73 (3 x 1ml)
For maintenance treatment: 250mg Testosterone Enantate intramuscularly every three to six weeks, according to individual requirement.
Serum testosterone levels should be measured before start of treatment and occasionally during the treatment at the end of an injection interval. Serum levels below normal range would indicate the need for a shorter injection interval. In case of high serum levels an extension of the injection interval may be considered.
Testosterone Undecanoate
as Nebido®
250mg/ml amp: £87.11 (4ml)The injection interval should be within the recommended range of 10 to 14 weeks. Careful monitoring of serum testosterone levels is required during maintenance of treatment. It is advisable to measure testosterone serum levels regularly. Measurements should be performed at the end of an injection interval and clinical symptoms considered. These serum levels should be within the lower third of the normal range. Serum levels below normal range would indicate the need for a shorter injection interval. In case of high serum levels an extension of the injection interval may be considered.
Testim®1% gel 50mg/5g single dose container £30.50 (30 x 5g)The recommended starting dose of TESTIM is testosterone 50mg (1 tube)/per day.
Dose titration should be based on serum testosterone levels or the persistence of clinical signs and symptoms related to testosterone deficiency. To ensure proper serum testosterone levels are achieved, early morning serum testosterone should be measured before applying the next dose, approximately 7-14 days after initiation of therapy. Currently there is no consensus about age specific testosterone levels. The normal serum testosterone level for young eugonadal men is generally accepted to be approximately 10.4 – 34.6 nmol/L. However, it should be taken into account that physiologically testosterone levels are lower with increasing age. If serum testosterone concentrations are below the normal range, the daily testosterone dose may be increased from 50mg (one tube) to 100mg (two tubes) once a day.
Testavan®20mg/g 85.5g pump: £25.22The recommended starting dose of Testavan is 23 mg testosterone (one pump actuation) applied once daily. To ensure proper dosing, serum testosterone levels should be periodically measured and dose titrated to maintain eugonadal serum testosterone levels.
The serum testosterone level should be measured 2-4 hours after dosing approximately 14 days and 35 days after starting treatment or after a dose adjustment. If the serum testosterone concentration is below 17.3 nmol/L the daily Testavan dose may be increased by 1 pump actuation. If the serum testosterone concentration exceeds 36.4 nmol/L the daily Testavan dose may be decreased by 1 pump actuation.
Testogel®16.2mg/g 88g (20.25mg per actuation) pump: £31.11The recommended dose is two pump actuations of gel (i.e. 40.5 mg of testosterone) applied once daily at about the same time, preferably in the morning. The daily dose should be adjusted by the doctor depending on the clinical or laboratory response in individual patients, not exceeding four pump actuations or 81 mg testosterone per day. The adjustment of posology should be achieved by increments of one pump actuation of gel.
The dose should be titrated based on the pre-dose morning testosterone blood levels. Steady state blood testosterone levels are reached usually by the second day of treatment with TESTOGEL 16.2 mg/g. In order to evaluate the need to adjust the testosterone dosage, blood testosterone levels should be measured in the morning before application of the product, after the steady state is reached. Testosterone blood levels should be assessed periodically. The dose may be reduced if the testosterone blood levels are raised above the desired level. If the levels are low, the dosage may be increased stepwise, to a daily administration of 81 mg of testosterone (four actuations of gel) per day.
Tostran®2% gel (10mg per application) multidose container £28.63 (60g)The recommended starting dose of Tostran is 3 g gel (60 mg of testosterone) applied once daily at approximately the same time each morning. Dose titration should be based on both serum testosterone levels and the existence of clinical signs and symptoms related to androgen deficiency. It should be taken into account that physiological testosterone levels decline with increasing age.
5α-reductase inhibitor
Finasteride5mg tablets: £1.05 (28)Alternative to alpha-blockers particularly in men with significantly enlarged prostate. Also licensed for use with doxazosin in tha management of benign prostatic hyperplasia.