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Frequently asked questions about TRT
Testosterone Replacement Therapy (TRT) is a medical treatment for men with a confirmed deficiency in testosterone. Natural testosterone levels can decrease due to age, stress, illness or lifestyle, which may lead to symptoms such as fatigue, low libido and reduced muscle strength. TRT replenishes this deficiency through injections, gels or other methods. In the Netherlands, TRT can only be prescribed when there is a clinically proven deficiency confirmed by blood tests. In this guide, you’ll learn how TRT works, what the benefits and risks are, which tests are required and what the approximate costs are.
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How does TRT work in the Netherlands?
In the Netherlands, a TRT programme is only available under medical supervision. It starts with your GP, who will assess your symptoms and arrange a morning blood test to measure your testosterone levels. If the results show consistently low values and clear symptoms, you are usually referred to an endocrinologist, urologist or specialised clinic. The specialist will determine whether testosterone replacement is necessary and create a treatment plan. During treatment, your testosterone levels are regularly monitored to ensure they remain stable and to check for possible side effects. TRT can be administered in different forms, such as injections (e.g. Nebido), gels or patches. Self-medication with testosterone is prohibited in the Netherlands and can lead to serious health risks, including hormonal imbalance and cardiovascular problems.
What is the effect of TRT on your body?
Testosterone affects almost every system in the body. In men with a deficiency, TRT can lead to increased energy, a more stable mood and improved physical performance. Many men notice, after a few months, an increase in muscle mass and strength, a reduction in body fat and better recovery capacity. Mentally, TRT can also have positive effects, such as improved focus, greater motivation and a stronger libido. Not every man responds in the same way; the degree of improvement depends on the severity of the deficiency and overall health. TRT is most effective in men with objectively low testosterone levels and clear symptoms.
Significant results through TRT
- Increase of your muscles and strength
- Improvement of your mood and motivation
- Higher bone density and improved energy levels
- Improvement of libido and stamina
When is TRT medically required?
Testosterone treatment is only appropriate in cases of a proven deficiency and corresponding symptoms. The diagnosis of hypogonadism is made when both blood tests and the symptom profile support it. Guidelines from the Endocrine Society and the Dutch Society for Endocrinology (NVE) recommend considering TRT only when total testosterone levels are below 8 nmol/L. Levels between 8 and 12 nmol/L require additional testing, such as free testosterone and SHBG. LH and FSH levels are also measured to determine whether the issue originates in the testes or the pituitary gland. It is important that the diagnosis is confirmed with at least two morning measurements, as testosterone levels fluctuate throughout the day. TRT should only be started when there is a clear deficiency and persistent symptoms.
Tests before and during the treatment
Before starting TRT, several medical tests are carried out. In addition to measuring testosterone levels, LH, FSH, SHBG and prolactin are also assessed. In older men, or when prostate issues are suspected, PSA levels are checked. Other important tests include a full blood count (haematocrit), liver and kidney function, glucose levels, lipid profile, and in some cases an MRI scan to detect possible pituitary abnormalities. This comprehensive screening ensures that TRT can be started safely.
During treatment, regular monitoring is required. Blood levels are usually checked again after three months and then every six to twelve months. This allows the doctor to adjust the dosage and intervene promptly if any abnormalities occur. Monitoring is essential, as TRT can increase the production of red blood cells and affect PSA levels.
Possible risks and side effects
When used correctly and under medical supervision, TRT is generally safe — but it remains a hormonal treatment with potential side effects. In the short term, acne, fluid retention or mood swings may occur. Some men experience increased irritability or a slight rise in blood pressure. Over the longer term, TRT can reduce sperm production, which may temporarily affect fertility. It can also make the blood thicker by increasing the haematocrit level, which must be monitored to reduce the risk of thrombosis.
It also remains important to monitor the prostate, especially in men over fifty. TRT is not recommended in cases of active prostate or breast cancer. Current scientific consensus (Mayo Clinic, Endocrine Society, NHS) indicates that TRT is safe for men with a medical indication and proper monitoring, but self-administration without supervision can be dangerous.
Cost and reimbursement
The cost of testosterone therapy in the Netherlands varies depending on the type of treatment and where it is provided. A consultation with your GP is fully covered by basic health insurance and does not count towards your deductible. However, blood tests and specialist consultations are subject to the deductible. Medication costs differ: testosterone gels typically range from €30–100 per month, while injections such as Nebido average €150–300 per year. Private clinics often charge additional fees for consultations, laboratory tests or comfort services.
When TRT is medically indicated and prescribed by a doctor, most health insurers will reimburse the treatment either partially or in full. Non-medical or cosmetic use is not eligible for reimbursement. It is advisable to check with your health insurer in advance to confirm the exact coverage.
Natural ways to support your testosterone level
Not every testosterone deficiency requires medication straight away. In many cases, a healthy lifestyle can help improve natural testosterone production. Regular strength training, maintaining a healthy weight, getting enough sleep and reducing stress are all proven ways to support hormonal balance. Nutrition also plays a role: foods rich in zinc, vitamin D and healthy fats contribute to maintaining healthy testosterone levels.
Although some supplements are marketed as “natural boosters”, scientific studies (Harvard Health, Voedingscentrum) show that the evidence for their effectiveness is limited. They may offer some support, but they do not replace medically indicated TRT. However, lifestyle adjustments are an important first step towards greater energy and vitality for any man experiencing hormonal symptoms.
Conclusion
TRT can significantly improve quality of life in men with a proven testosterone deficiency. The treatment is safe and effective when carried out under professional supervision, with regular monitoring and a clear medical indication. Self-medication or purchasing testosterone online without medical oversight is risky and strongly discouraged.
At IKARIA Clinics, we help men experiencing hormonal imbalance, fatigue and vitality issues through thorough blood testing and personalised guidance. This ensures that every treatment is tailored to your unique hormonal profile and overall health.
