TRT treats confirmed hypogonadism: compatible symptoms and low testosterone on appropriately repeated morning tests. In Spain testosterone is prescription-only and authorised products include gels and injections. A doctor decides whether treatment is indicated and arranges monitoring of testosterone, haematocrit and, where appropriate, prostate health.
How is the decision to use TRT made?
There is no single route. Assessment may start in primary care, urology, endocrinology, andrology or a private medical service, including telemedicine. What matters is a genuine medical assessment rather than a box-ticking process.
Explain what is happening
Sexual symptoms, energy, strength, body changes, sleep, mood, medicines, opioids or anabolic steroids, medical conditions and testicular or pituitary history are reviewed.
Confirm testosterone
The EAU recommends morning total testosterone, generally between 07:00 and 10:00 and fasting, with a low result repeated on another day. Infection, illness, poor sleep or major weight change can distort the result.
Understand the cause
LH, FSH, SHBG, calculated free testosterone, prolactin and other tests may be used according to the clinical pattern.
Review safety and fertility
Haematocrit, fertility plans, prostate issues, urinary symptoms, recent cardiovascular disease and other factors are considered before treatment.
Make a shared decision and prescribe
If the diagnosis is well supported and there is no reason to delay, a doctor can prescribe an authorised medicine. Private prescriptions in Spain can be issued electronically and dispensed in pharmacies.
Follow up
TRT does not end with the prescription. Symptoms, testosterone, haematocrit and, depending on age and risk, prostate health are reviewed.
Sources: EAU 2026 · AEMPS CIMA · Royal Decree 1718/2010.
Can the whole process be done online?
Part or all of the assessment can be done by telemedicine if the service identifies the patient, takes an adequate history, reviews blood tests, answers questions and arranges follow-up. Being online does not change the diagnostic criteria.
A serious service should explain what information it needs, which tests are missing, why treatment may be accepted or declined, how you contact a doctor and how follow-up will work. Be cautious of anyone promising testosterone before seeing your symptoms and blood results, or selling "optimisation" of a normal level.
What forms of testosterone are available in Spain?
Authorised testosterone in Spain includes gels and injections. All require a prescription. Choice depends on preference, response, haematocrit, cost, availability and ease of follow-up.
Transdermal gel
Usually applied daily. It gives relatively steady levels and allows gradual dose adjustment. Another person can absorb it through skin contact, so handwashing, clothing and washing the application site before close contact matter.
Shorter-interval injections
Some injectable preparations are given at intervals of weeks and can produce more noticeable peaks and troughs between doses. The exact schedule depends on the authorised product and the individual plan.
Long-acting injection
Testosterone undecanoate is a long-acting intramuscular preparation. Product information determines the loading and maintenance intervals and the injection must be given as directed.
There are also shorter-acting injectable preparations. The exact product and schedule should follow the authorised Spanish product information and the prescriber's plan.
Who should not use testosterone?
Contraindications depend on the product. Product information includes known or suspected prostate or male breast cancer and allergy to the active ingredient or excipients; some injectable products have additional contraindications such as current or previous liver tumours.
A doctor may also delay or avoid TRT if low testosterone has not been confirmed, there are no compatible symptoms, near-term fertility is a priority, haematocrit is already high, a pituitary or testicular cause needs investigation first, or prostate or cardiovascular issues need specific assessment.
What is treatment trying to achieve?
The aim is to improve symptoms attributable to hypogonadism and keep testosterone in an appropriate physiological range, not to reach the highest possible number. Sexual symptoms often respond more consistently than fatigue or motivation.
If testosterone normalises but symptoms do not improve, the diagnosis should be reconsidered rather than automatically increasing the dose.
What monitoring is needed after starting?
Monitoring depends on formulation and individual risk. Symptoms and adverse effects, testosterone and a full blood count with haematocrit are commonly reviewed. The EAU considers haematocrit above 54% to require intervention. PSA and prostate assessment are added when appropriate for age and risk.
Timing of testosterone measurement depends on the product. For gels, some product information recommends measurement before a dose and some a few hours after application; long-acting undecanoate is measured just before the next injection. A "high" or "low" result without dose timing can mislead.
When should you seek urgent help during TRT?
- Call 112 for chest pain, sudden breathlessness or collapse.
- Seek same-day assessment for new pain, warmth or swelling in one leg.
- Tell the clinician immediately if coughing, breathlessness, sweating, chest discomfort or dizziness occurs during or just after a long-acting undecanoate injection.
- Seek medical advice if a person who has had skin contact with testosterone gel, particularly a child or woman, develops signs of androgen exposure such as increased body hair or acne.
What should TRT not be?
It should not be a route to testosterone without a diagnosis, a way to maintain supraphysiological levels or a treatment for unexplained fatigue without considering other causes. This site does not sell testosterone or recommend a particular commercial provider.