Think you might be suffering from low testosterone?

Average testosterone levels in men have more than halved over the past 50 years. The reason for this is not clear, but may be related to environmental toxins, obesity and diabetes.

Typical symptoms of low testosterone in men include some or all of the following:

• Sexual function: Reduced interest in sex and erectile dysfunction.
• Well-being: Lack of motivation, tiredness, poor sleep, depression and reduced self-confidence.
• Physical changes: Loss of muscle and athletic performance, increased body fat, hot flushes and thinning of the bones.

Testing

These symptoms could be caused by many other conditions, so the first thing to do is have a blood test in the early morning (which is more accurate) to check your testosterone levels. If your doctor wants to rule out other possible causes, additional tests may be advised, such as a full blood count, liver and kidney function tests, thyroid function tests, etc.

Testosterone levels can vary significantly from day to day, so if the result is not clear, a second test is often done on another occasion to confirm the levels. Analysis of total testosterone gives an indication of your levels, but free testosterone, or preferably bioavailable testosterone, is more accurate, as it takes into account the part of the hormone that is bound to proteins and therefore inactive.

Testosterone deficiency levels are:

Total	<300-350 ng/dL
Free	<6.5-9 ng/dL
Bioavailable	<1.1-1.3 ng/mL

If your testosterone levels are low, you may also be tested for LH, FSH and prolactin (other hormones involved), as well as having a blood count and a PSA test for prostate cancer.

If your testosterone levels are clearly normal, you should be assessed by your doctor to look for other possible causes of your symptoms.

Treatment

Before starting treatment, you need a general heart and blood pressure check and a rectal examination of the prostate to ensure there is no prostate cancer (which could be stimulated by the TRT).

In Spain, testosterone is available in two forms: a gel applied to the skin or an injection.

I usually suggest starting with the gel, as if you have any side effects, you can stop immediately, and it is out of your system in a day or two.

Some patients say they find the injections more effective. They are normally given into the muscle, typically every 2-4 weeks, according to the manufacturer’s recommendation. However, if the effects wear off before the next injection, it is possible to give smaller doses more frequently to obtain a steadier level in the body.

There is also a longer-acting version of injectable testosterone that lasts 10 to 14 weeks.

Benefits

Different effects of TRT may appear at different times.

Improvement in sexual drive, mood and quality of life starts within 3-6 weeks, whereas erectile function may take up to 6 months.

Changes in body fat, muscle mass and strength may take 3-4 months to become evident and continue to improve over the first year.

The best response is achieved with a combination of TRT and lifestyle changes, including exercise, diet, reducing alcohol consumption and smoking, and, if needed, additional medication such as tadalafil.

Monitoring

After three months, you should have another blood test to check the testosterone level. If using injectables, do the test halfway between injections to determine the average level. This, combined with your symptoms, determines whether the dose is right for you. The level should lie at the middle to upper end of the normal range. Don’t be tempted to push the level beyond the upper limit, as this carries risks to your health.

You must also check your blood count because TRT can stimulate an overproduction of red blood cells, which, if too high, carries a risk of stroke. If your haematocrit level is above 50%, you may need to reduce the dose. Above 54%, you may need to have 500 mL of blood removed (venesection) to quickly reduce the haematocrit.

A repeat rectal examination is done to check that the prostate has not grown or developed any nodules.

If all is well, a review six months later and then yearly is advised.

Side effects and risks

A small proportion of men experience acne or worsening of sleep apnoea.

Some men develop breast tenderness or swelling due to the conversion of testosterone to the female hormone oestrogen. Normally, this can be managed with oestrogen blockers.

Testicles tend to shrink as they are no longer needed to produce the body’s own testosterone.

Caution is required if there is a history of prostate problems or cardiovascular disease.

Fertility is an often-overlooked consideration. TRT reduces the sperm count. Even after stopping TRT, it may take many months to recover, and, rarely, infertility can be permanent.

If you are planning to have children in the future, you can discuss various options with your doctor, such as HCG injections (which stimulate your natural testosterone production) or sperm banking to safeguard fertility for the future.

How much does it cost?

Prices as of July 2026.

The initial consultation with a doctor at Atlantic Clinic is €90. Follow-up consultations are €60.

Examples of analysis costs:

Total testosterone	€21
Bioavailable testosterone	€65
Full blood count	€11
PSA	€23

We also offer analysis packages for check-ups. Find out more on our Analysis page.

Final thoughts

If you are weighing up the pros and cons of TRT, remember that low testosterone, if not corrected, carries its own health risks, apart from those mentioned above, such as diabetes, heart disease, strokes and reduced lifespan.

 

Dr Anthony Crichton-Smith | 10 July 2026

Recent news from the UK has highlighted a concerning outbreak of meningitis B (MenB) in Kent, England. While outbreaks of this kind remain rare, they serve as an important reminder of how serious this infection can be—and how valuable vaccination is in protecting yourself and your family.

At Atlantic clinic, we are already speaking with many British patients who either travel regularly to the UK or have children studying there. Here’s what you need to know.

A recent outbreak in the UK

In March 2026, health authorities identified a cluster of meningitis B cases centred around Canterbury in Kent. At the time of writing, there have been over 20 confirmed cases and several additional probable cases, with two tragic deaths reported.

The outbreak has mainly affected teenagers and young adults, particularly students, and has been linked to close-contact settings.

UK health officials responded quickly with antibiotics, contact tracing, and an expanded vaccination campaign targeting those at highest risk.

Although the situation is being brought under control, experts emphasise that meningitis can spread rapidly and unpredictably, and vigilance remains essential.

What is meningitis B?

Meningitis B is a serious bacterial infection caused by Neisseria meningitidis. It can lead to:

• Meningitis (inflammation of the lining of the brain)
• Sepsis (blood poisoning)

These conditions can develop quickly and may be life-threatening if not treated urgently.

While rare, MenB is the most common strain of meningococcal disease in the UK.

How is it spread?

Meningitis B is not highly contagious, but it spreads through close, prolonged contact, such as:

• Living in the same household
• Kissing
• Sharing drinks, cigarettes, or vapes

This is why outbreaks are often seen in schools, universities, and social settings.

Symptoms to watch for

Early symptoms can be non-specific, but may include:

• Fever
• Headache
• Vomiting
• Neck stiffness
• Sensitivity to light
• Confusion
• A rash that does not fade when pressed

Symptoms can worsen rapidly, so urgent medical attention is essential if meningitis is suspected.

Who is most at risk?

Higher-risk groups include:

• Babies and young children
• Teenagers and young adults (especially students)
• People living in shared accommodation
• Anyone in close contact with a confirmed case

Many adults and teenagers in the UK were never routinely vaccinated against MenB, as the vaccine was only introduced into the infant schedule in 2015.

The role of vaccination

The meningitis B vaccine provides important protection against this potentially life-threatening infection.

During the current outbreak, UK authorities have:

• Offered vaccination to students and close contacts
• Expanded eligibility to additional age groups in affected areas

This reflects the key role vaccination plays in controlling outbreaks and preventing severe illness.

Why this matters if you live in Spain

Even if you live on the Costa del Sol, or elsewhere in Spain, this issue is highly relevant if:

• You travel regularly to the UK
• Your children attend school or university there
• You have family members in affected areas

Meningitis can spread through travel and social contact, so protection is not just a local issue.

Meningitis B vaccination in Marbella

At Atlantic clinic, we offer the meningitis B vaccine for both children and adults.

We commonly see:

• Parents vaccinating teenagers before university
• Families preparing for travel to the UK
• Adults seeking added protection after hearing about recent outbreaks

Vaccination is a simple and effective step that can provide reassurance—especially during periods of increased risk.

For those never vaccinated, the complete course is 2 doses of the vaccine at least 1 month apart.

For those previously vaccinated, but at-risk, a single booster vaccine can be given.

The cost of each vaccine is 162€.

Final thoughts

The current UK outbreak is a reminder that while meningitis is uncommon, its impact can be severe and sudden.

If you or your family have connections to the UK, it may be worth considering vaccination—particularly for teenagers and young adults.

If you would like personalised advice or to book a meningitis B vaccine, our team at Atlantic Clinic is here to help.

 

For more information or appointments, please contact our clinic directly.

Call us (+34) 952 81 7425 or send a message (+34) 616 83 0988.