Am I eligible to start treatment if I have an existing condition?

Most health conditions do not stop you starting TRT. Some need a letter from your GP or specialist first, and a few mean we cannot treat you. Our doctors make the final decision at your consultation, so tell us about any condition or medication when you sign up.

We cannot treat you if you:

• are under 18
• are not physically living in the UK. We treat patients in England, Scotland, Wales, Northern Ireland, the Isle of Wight and the Isle of Man, but not Jersey, Guernsey, Ireland, the British Overseas Territories or overseas forces addresses.
• have active prostate, breast or liver cancer, or classic Hodgkin lymphoma
• have severe or untreated heart failure, or untreated high blood pressure above 180/100
• have sleep apnoea that is untreated, or that is moderate to severe
• have had a stroke in the last 6 months
• have cirrhosis, or end-stage COPD, emphysema or another lung condition that needs home oxygen
• have essential thrombocythaemia, a haematocrit of 0.54 or above, or a ferritin level above 1000 or below 10
• have a moderate to severe learning disability, cognitive impairment or dementia
• have blood results that are significantly outside the normal range

We are also not set up to provide transgender hormone care, which follows different clinical protocols.

Conditions that need a letter or specialist input first

• A heart condition such as a previous heart attack or cardiomyopathy: a letter from your cardiologist.
• Kidney disease at stage 3b or above: a letter from your kidney specialist.
• Prostate cancer in remission: sign-off from your urologist. Breast cancer in the last 5 years: a letter from your surgeon or oncologist. Other cancers: your oncology history. Testicular cancer in remission is not a barrier.
• Severe urinary symptoms with an enlarged prostate: prostate cancer must be ruled out first.
• If you carry the BRCA2 gene: specialist input, and a decision you make with full information.
• A pituitary condition, raised prolactin, Addison's disease, previous brain surgery, or newly diagnosed hyperthyroidism that is not yet treated: input from your GP or endocrinologist. A raised TSH on its own is not a barrier, but we will ask you to see your GP about it.
• A previous DVT or blood clot in the lung: your clinic letters.
• A stroke or TIA more than 6 months ago: when it happened and how it is being treated.
• A BMI under 17: a referral from your GP.
• A significant mental health condition: your psychiatrist's view on how stable it is.
• Newly diagnosed diabetes: evidence from your GP of the diagnosis and how it is controlled.
• If you have taken testosterone, steroids, SERMs or peptides yourself: a 3 to 6 month break and repeat blood tests.
• If you are trying for a baby, or plan to in the next 6 months: TRT can affect fertility, so we involve a fertility doctor. We also have non-TRT options a doctor can discuss with you.

Not a barrier

Diabetes that is under control, high blood pressure controlled with medication, stable atrial fibrillation or an ICD, blood thinners as long as the reason for them is not on the lists above, haemochromatosis with ferritin in range, a single kidney, Gilbert's syndrome, Crohn's or colitis, rheumatoid arthritis, testicular cancer in remission, HIV, controlled epilepsy, osteoporosis, Parkinson's, gout, stable thyroid disease, an enlarged prostate without severe symptoms, treated sleep apnoea, a high BMI or high cholesterol.

If you are in the armed forces or the police, you need written approval from your medical or commanding officer before treatment starts.

Not sure where you fit? Email trt@manual.co with the condition and any medication you take, and our clinical team will tell you what we need.