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Testosterone replacement tops up the body’s own supply of the hormone when the testicles, or the glands controlling them, are not making enough. The hormone then acts on androgen receptors in muscle, bone, brain and sexual tissue.
Testosterone replacement is authorised in the EU, and a licensed doctor can prescribe it after a medical review when it is clinically appropriate for you.

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What it is

Testosterone replacement is an authorised medicine in the EU. It is one of the options a doctor may consider for sexual health, alongside the PDE5-inhibitor tablets and topical alprostadil covered elsewhere in this library.
Only authorised where deficiency is confirmed. Following an EU-wide review that opened on 10 April 2014 and closed with the CMDh position of 8 January 2015, product information was changed to state that testosterone should only be used when an abnormally low hormone level has been confirmed by signs and symptoms and by appropriate laboratory tests. The EMA states that restoring levels in healthy older men is not an authorised use — so it is not prescribed simply on request.

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What the studies reported

In TRAVERSE, a first cardiovascular death, non-fatal heart attack or non-fatal stroke occurred in 182 men on testosterone (7.0%) and 190 on placebo (7.3%) — hazard ratio 0.96, 95% CI 0.78 to 1.17, meeting the trial’s non-inferiority criterion (Lincoff et al., N Engl J Med 2023). TRAVERSE also reported a higher incidence of atrial fibrillation, acute kidney injury and pulmonary embolism in the testosterone group than in the placebo group.
These results come only from men aged 65 and over whose low testosterone was confirmed by blood tests. They say nothing about men with normal testosterone levels, and the trial authors state the study was too small to draw conclusions about the risks of treatment.
Every NCT identifier links to its ClinicalTrials.gov record (NCT03518034 for TRAVERSE). A readout is not the same as peer-reviewed publication, and results are grouped by source and evidence grade so journal data and manufacturer announcements cannot be confused. Sources: EMA — Testosterone-containing medicines referral (nationally authorised; indication and monitoring wording); EMA — No consistent evidence of an increased risk of heart problems with testosterone medicines.

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Who it is not suitable for

Testosterone replacement is not prescribed for men with normal testosterone levels who simply want a boost — the EMA is explicit that this is not an authorised use. It is considered only once low levels are confirmed by symptoms and by laboratory testing, and the doctor also weighs the cardiovascular signal seen in TRAVERSE (higher atrial fibrillation, acute kidney injury and pulmonary embolism) before proposing it.

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Other sexual health options a doctor may consider

Where testosterone replacement isn’t appropriate, or the concern is erectile function rather than deficiency, a doctor may instead consider:

Sildenafil (Viagra)

Phosphodiesterase-5 inhibitor. The doctor assesses it after ruling out cardiovascular contraindications.

Tadalafil 10/20mg

Long-acting PDE5 inhibitor, available in low doses for daily use or higher doses on demand.

Vardenafil 5/10/20mg

Alternative within the same class, sometimes better tolerated depending on the patient’s profile.

Avanafil 50/100/200mg

Faster-acting PDE5 inhibitor, an option for selected patients based on medical judgement.
Vitaros (alprostadil cream) is a topical option considered for patients who don’t respond to PDE5 inhibitors or have contraindications to them. A licensed doctor decides case by case — we never prescribe without evaluation.

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Common questions

No. The EMA is explicit that restoring levels in healthy older men is not an authorised use. Testosterone replacement is considered only once low levels are confirmed by symptoms and by laboratory testing.
In TRAVERSE, a first cardiovascular death, non-fatal heart attack or non-fatal stroke occurred in 182 men on testosterone (7.0%) and 190 on placebo (7.3%) — meeting the trial’s non-inferiority criterion. TRAVERSE also reported a higher incidence of atrial fibrillation, acute kidney injury and pulmonary embolism in the testosterone group. These results come only from men aged 65 and over whose low testosterone was confirmed by blood tests.
Following an EU-wide review that opened on 10 April 2014 and closed with the CMDh position of 8 January 2015, product information was changed to state that testosterone should only be used when an abnormally low hormone level has been confirmed by signs and symptoms and by appropriate laboratory tests.
A doctor may consider sildenafil, tadalafil, vardenafil, avanafil or Vitaros (alprostadil cream), depending on your history and what the doctor decides is clinically appropriate. See Vitaros for the topical alprostadil option.
The questionnaire covers symptoms, cardiovascular history, current medication and allergies. A registered doctor reviews the case personally and decides whether treatment is appropriate, which one, and at what dose.

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How Hi-Doctor handles it

The questionnaire covers symptoms, cardiovascular history, current medication and allergies — see how eligibility works and how safety checks run. Sexual health is offered as a one-off consultation; the cost is set out on pricing. The medicine itself, if a doctor prescribes one, is paid separately at a pharmacy.

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Start a consultation

Sexual health consultation

Answer the sexual health questionnaire and a registered doctor reviews it. They decide whether treatment is appropriate, which one, and at what dose — and declining is a normal outcome. See what it costs and how the review works.
This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.