Department of Men’s health

Low testosterone produces symptoms that are real, common and easily attributed to age: fatigue, low mood, loss of drive, loss of muscle. It also has causes that replacement alone does not address. Diagnosis here requires two morning measurements by mass spectrometry, the reference method, and investigation of the secondary causes — pituitary disease, obesity, sleep apnoea and the effects of medication — before replacement is considered, since treating the cause is often better than replacing the hormone. Where replacement is indicated it is prescribed to restore a physiological range, and its effect on fertility is discussed with you before it begins.

Testosterone replacement is a long-term commitment, and it is not commenced without an agreed schedule for monitoring it. Testosterone and haematocrit are measured at three, six and twelve months and annually thereafter, alongside prostate-specific antigen, lipids and liver function, with bone density at interval. Where the blood thickens, as it can on treatment, venesection is performed here. The schedule is held in your record and kept by your consultant, so that treatment is confirmed to be working and safe rather than assumed to be.

The department assesses male fertility, investigates the causes of difficulty in conceiving, and counsels you on what the results mean. Semen analysis and sperm DNA fragmentation are complemented by endocrine profiling, scrotal ultrasound and, where no sperm are found, investigation of azoospermia and genetic assessment with genomic specialists. Treatment itself is referred to a named fertility specialist, with your assessment complete, your records sent ahead and your consultant remaining involved.

Fertility preservation before treatment that may affect fertility, before testosterone replacement, or as a matter of choice. Samples are collected in a private suite, analysed, frozen and stored under licence, and transferred to any licensed clinic you choose when they are needed, with the arrangements made by the Institute.

Recovery from anabolic steroid use is a medical matter, and it is provided here on the same confidential basis as any other consultation. The department assesses the endocrine axis and the cardiovascular, hepatic and haematological effects of use, assesses fertility, and supervises withdrawal and the recovery of the body’s own hormone production, which can take months and is safer managed than left to happen. Monitoring continues until recovery is confirmed by measurement.

Erectile dysfunction is investigated for its cause rather than treated symptomatically, because it is frequently the first sign of vascular disease, and sometimes of endocrine or neurological disease, years before either presents in any other way. The department undertakes vascular, endocrine and neurological investigation, and full cardiovascular assessment with [Cardiovascular medicine] where the picture warrants it. Premature and delayed ejaculation and Peyronie’s disease are assessed and treated, and psychosexual consultation is available as part of the same care.

Prostate testing is undertaken with its limitations explained before it begins, because a raised prostate-specific antigen is more often benign than not, and the value of the test lies in how it is interpreted. PSA is measured with free PSA and density, and read alongside examination and, where indicated, multiparametric magnetic resonance imaging on the Siemens MAGNETOM Sola, which is now the reference investigation before any biopsy is considered. Lower urinary tract symptoms are assessed and treated, surveillance is by the same consultant, and referral for biopsy is made only where imaging supports it.

Many of the conditions on this page have a metabolic cause. Low testosterone, erectile dysfunction and fatigue are frequently the visible signs of insulin resistance, arterial disease or fatty liver, and treating those is often what resolves the symptom. The department measures each of them directly using advanced diagnostics and our doctors design personal care plans around your needs.

Osteoporosis in men is under-diagnosed, and in roughly half of cases is secondary to another condition, most often low testosterone, medication or alcohol. The department measures bone density on the GE Lunar iDXA, investigates secondary causes where loss is found, and assesses lean mass and sarcopenia on the same platform, with grip strength tested as the simplest and among the most predictive measures of physical decline. A personal care plan is designed against the measurement, and the measurement is repeated at the interval at which it could have changed.

Breast tissue enlargement in men is common, frequently distressing, and investigated here for its cause before any treatment is considered: endocrine, hepatic and drug-related assessment identifies the reason in most cases, and treating it often resolves the condition. Medical management is provided where appropriate, and where surgery is the right course the patient is referred to a named surgeon, with the investigation complete.