This is my story. I am thirty-four years old and in the last five years ago my life has changed forever. These changes were a mixture of the disastrous and the miraculous in roughly equal measures.
Please read on…

1970
I was born. A healthy baby boy, but nobody noticed the undescended right testicle. In fact nobody ever noticed it, even with the usual battery of medical checks throughout childhood. It dawned on me in the end, perhaps at the age of 8 or 9 – and I could feel the undescended testicle through the skin of my abdomen – but I buried my head in the sand for years and did nothing, even though during my teens I read in a couple of medical books about the increased risk of testicular cancer in cases like mine.

1981
Puberty happened completely normally for me. It came quite early too, before my 11th birthday, and all of the usual things happened: the growth spurt, the voice breaking, the hair sprouting in strange places and the sudden urges to stare at my biology teacher’s very well-developed chest. However from the age of about 13 or 14 onwards I started to have difficulty controlling my weight. I was also often quite tired & lethargic, to the point where one or two of my schoolteachers had expressed concerns, and I was certainly lacking confidence with the opposite sex. My first sexual experience was at the age of 20, many years later than I would have liked it to be! I was quiet, shy, socially awkward and bookish.
In my late teens I also began to have a lot of back problems. Nothing specific, just general aches & pains without any real explanation. I had read that tall people were more prone to back problems, so I just put it down to that and learned to live with it.

1991
In 1991, during my time as a student, I noticed quite a sharp ache in my left testicle. Initially I ignored it, assuming it would get better quickly, but after three or four days I was sufficiently concerned to pay a visit to my GP. I realised of course that he would want to carry out an examination, and that without doubt he would notice that the right testicle was undescended. Because of this, I mentioned the fact up front when I visited him. He examined the left testicle and noticed nothing unusual & said that the pain would probably vanish in a few days (and he was right).
Regarding the right testicle, he immediately (and correctly) said that I ought to consider having it removed since there was an increased risk of testicular cancer if I did not. I agreed to visit a urologist for a consultation with a view to undergoing an orchidectomy. I was due to sit my university finals in the summer of 1991 so an operation was scheduled for shortly after this.
I graduated successfully (first class honours in Mathematics from Trinity College in Cambridge) and a few weeks later the operation went ahead. It was a very straightforward operation (apparently) and was completed successfully. On the day before the operation, the surgeon – a consultant urologist – visited me to explain that I had the option to have a prosthetic inserted for cosmetic reasons. He showed me the “small” and the “large” versions of these prosthetics. “How odd”, I thought, “that even the smaller of the two is still quite a lot larger than my own left testicle.” More on that later…

1993-1999 In early 1993 my back problems worsened dramatically. I started to experience severe pain in my lower back which then gradually spread down my left leg as the weeks went on, sometimes reaching as far as my toes. Eventually after various scans a disc prolapse (slipped disc) was diagnosed. The leg pain was of course sciatica, and I also suffered from a severe lack of mobility as well as a little muscle wastage. In time, however, the symptoms eased and after about 18 months had more or less vanished.
Around that time I also started to notice some other symptoms. I was frequently tired & prone to bouts of depression. I was plagued with more general aches & pains. I perspired excessively. I still lacked confidence, both in the office and in social situations, and particularly with the opposite sex. I was very easily flustered under pressure. As time went on, I also sensed a slight drop-off in my sex drive and I noticed that morning erections became pretty rare occurrences. Obtaining a really hard erection was not as easy as it once had been. At the time I put all this down to “getting old” which seems ridiculous looking back – I wasn’t even 30!
I had a fiery temper at times too. Almost always this was aimed at things rather than people, but it was pretty disturbing nonetheless – both for me and for the people around me. In general the cause of my anger was simply frustration at my own inadequacies. I didn’t feel “manly”. I should have been in the prime of my life, ready to take on the world, but I had little energy, no will to compete, and no resilience. The list of my tantrums is embarrassingly long, but examples include: • During a bike ride, becoming so angry because of a puncture that I picked up the bike and hurled it across the road • Later that day, at home, being so frustrated at my inability to mend a simple puncture that I kicked the bike across the yard • While playing tennis, smashing my racket to pieces because of my frustration at my lack of energy & co-ordination
All of these things gradually became worse as the years went by. I steadily became less active, gradually gained weight and tended to spend more & more time feeling tired & lethargic. Just a few minutes of physical activity – gardening, for example – would leave me sweating and exhausted, having to lie down & rest for hours. I had problems in the office too. I found that I cracked under pressure and that I was very thin-skinned. I could not accept criticism in any form – it all seemed like a personal attack. I bore grudges. I was frightened of my owns shadow.
I also found that my concentration was intermittent – sometimes I was razor sharp and very much on top of events; but more often I was in a daze, watching the world whirl around my head.

1999
This was the worst year of all and the start of five years of heartache and anguish.
In the early part of 1999 I suffered another disc prolapse in my back. It gave me little trouble during the day when I was mobile but, when lying still for any length of time, the pain – which was caused by pressure on a nerve around my rib cage – would come right back. Because of this I couldn’t sleeping properly. I would frequently lie awake for hours on end during the night, taking painkillers to numb the ache, with work problems racing around my mind. I was usually exhausted by the time I reached the office in the morning. I was also extremely stiff & sore because of the back injury – on most days I could not stand up straight for the first half an hour after rising. Add to this a great deal of pressure in the office during the day, and with the benefit of hindsight it seems obvious that I was heading for a crash.
A long weekend with my partner in Sweden in June proved to be pivotal. I had just completed a very stressful project in the office and managed to escape for a few days of peace & quiet, fresh air and exercise, hundreds of miles from the office. One would think this would be the perfect getaway.
I hated every minute. I was unable to relax. At the slightest sign of a problem (e.g. arriving at the tourist information shop to find it closed for lunch) I would freeze. I would sink into such a state of depression that I could not even speak or move. I would just sit or lie on the floor and stare into space. The weekend was a disaster.
On returning home I visited my GP and asked for his help. He could see that I was suffering from depression, anxiety, stress, etc. and suggested that I try Prozac for a while. I did this, and it actually proved to be quite successful in treating the depression – my moods lifted, and I felt more cheerful and confident. It wasn’t all good news though – my sex drive all but vanished, I was sweating profusely, and I found that my mind was racing and that my attention span could be measured in seconds.
Now for the next thread of this story: my partner & I had for some time been trying to start a family, without success. In September 1999 we saw an infertility specialist to seek his advice. Following that appointment, a sperm test revealed what I had feared: a very low sperm count, coupled with very poor motility. The implication of this was that the chances of a natural conception were very low indeed. As well as the sperm test, a series of blood tests were carried out. Most of the results were normal, but the specialist spotted a very low testosterone level – 5.5 nanomoles per litre – which, he suggested, was rather lower than it should be. The conversation went thus:
Q: If we fix the testosterone deficiency, will it cure the infertility?
A: No.
Q: OK. But apart from that, a deficiency of testosterone sounds like it could be serious. Does it need treatment in its own right?
A: Well, I’m not sure, but I don’t think so. But if you’re concerned, I’ll refer you to a urologist I know well. He knows a lot more about the subject.

So, the scene was set.
The back problem was still there, the workplace stress was still there, but this was all now compounded by having to deal with two new problems: infertility and an untreated (and at the time utterly baffling) hormone imbalance. Thank goodness for Prozac, I say (with some hesitation) – this was an awful lot to deal with simultaneously, but I seemed to just about hang on in there.

I have to make a confession here. I am the worst kind of armchair medical expert. No sooner had I got home from the hospital, having learned of my testosterone deficiency, than I was logging onto the internet to “do my homework”. Imagine my stunned surprise when I stumbled across a site listing the symptoms of low testosterone and found that I had the lot! There’s seems little point in listing them here because I’ve pretty much listed them all already. I did an awful lot of research in the weeks that followed, convinced that I really was onto something. Was I about to put the gradual decline of the last 8 years behind me and fight back?
I had something of a wait before seeing the urologist, but after seeing my test results he was quite happy to prescribe testosterone replacement therapy. He did give me a few (accurate) warnings:
(i) That it could harm my fertility (not an issue in this instance)
(ii) That it may lead to testicular shrinkage
(iii) That “negative feedback” may well set in, i.e. that the body’s own production of testosterone would be reduced when the presence of the extra from the patches was sensed.
After some consideration I decided to press ahead regardless, and on the evening of 23rd December 1999 I put my first 5mg testosterone patch onto my left arm. Funny – within an hour or two I noticed how lively & cheerful I felt. Very talkative, articulate, alert, confident, wide awake. How can that be? Oh well. Bedtime.
I slept very soundly indeed that night and woke up with more energy than I had in years. I stepped straight out of bed and was ready for action. I remember thinking to myself (and saying to my partner): “is this what normal people feel like?” I went for a long walk with my partner and her family that day (Christmas Eve). Nobody could keep up with me! Up hill, down dale, I just kept on going.
I also noticed that my appetite had reduced. I had always had a very healthy appetite, with a tendency to crave carbohydrates and “stodge”. Suddenly I found I was eating rather less and also leaning towards fruit, vegetables, salads, etc. My sex drive perked up a little too. Not drastically, since it was never noticeably low, but enough to be noticeable. I also noticed a drastic improvement in my back as the weeks went on. It felt a lot stronger & more supple. The girdle of muscles around the abdomen & lower back is riddled with testosterone receptors, and any deficiency in testosterone levels starves these receptors with the result that the muscles weaken & lose tone. This is probably the reason for my back trouble over the years – weak muscles which weren’t able to support my back properly & to allow me to keep good posture.

2000
I continued to feel very well for about a month, but then I gradually noticed the effects tailing off and some of the original symptoms reappearing. I remembered what I had been told about negative feedback, so I paid another visit to the urologist who readily agreed to double the dosage to two 5mg patches per day.
This improved matters but after about two months the same thing began to happen.
The urologist suggested that the patches may not be potent enough and suggested testosterone pellet implants instead. He wanted to implant 600mg of pellets which he suggested would last around six months. Now that’s just over 3mg per day, rather on the low side compared to the daily production of typically 7mg-10mg naturally in the testicles.
Not convinced by what I had heard, I consulted a Harley Street specialist. After a physical examination he told me that my remaining testicle was rather smaller than average. A series of blood tests (early morning, testosterone around 8 nanomoles per litre, higher than previously but still very deficient) he also recommended pellet implants, but at a dosage of 1600mg instead of 600mg. To me that sounded closer to the mark, so I agreed to give it a try.
The procedure was virtually painless. I had some fairly minor bruising for a few days but then I experienced total relief from my symptoms thereafter. I was very impressed indeed. The only downside was the cost: typically £600 each time the procedure is carried out. The default dosage interval for pellets tends to be six months, but for me this interval was too long – around four months after the insertion the old symptoms began to return, a sign that the pellets were almost used up. The consultant’s theory on this – which seems plausible – was that because I was rather younger than most TRT patients, I metabolise the testosterone more quickly than most, which is why the pellets dissolve faster than expected.
Feeling much more confident and with the depression seeming to have lifted, I decided the time was right to stop taking Prozac. I believed that the testosterone itself was a much more effective (and more natural) antidepressant.
In April 2000 my partner & I finally were married, and towards the end of the year we were approved for adoption, having chosen this course over alternatives such as IVF, donor insemination, etc.

2001
In the summer of 2001 we met our two children for the first time, and two weeks after that they came to live with us permanently. It all seems like a blur now. To anyone considering adoption: do it by all means, but for goodness’ sake go into it with your eyes open. It will put you under immense pressure. It will test every weakness in your relationship, however small, over and over and over. I can’t directly compare of course, but I suspect adoption is an even bigger shock than natural childbirth and, if I’m honest, not one I was really prepared for (in spite of the extensive training we underwent). Often more than one child arrives at a time (as in our case), with no period of adjustment, and usually carrying some fairly serious emotional baggage (happy, secure children in stable homes with loving parents aren’t put up for adoption!).
Hormonally I was doing reasonably well, but the stress was putting my relationship with my wife under enormous pressure. I also found that I was increasingly prone to coughs, colds and sore throats – a sure sign for me of being run down and under stress.
Reluctantly I started to take Prozac again.

2002
In the summer of 2002 my marriage came to an end. I moved out of the family home, and my wife & children stayed behind. Rather perversely and unexpectedly, if I put the enormous emotional turmoil to one side for a moment, physically I felt great. My testosterone levels were good, I felt fit and strong, and a lot of the (probably stress-related) niggling health problems I’d suffered from suddenly vanished. And I do mean suddenly – this was almost an overnight change.
A couple of months after the separation, I decided to stop taking Prozac for the second time. The agitation, the restlessness, the sweating and the loss of my sex drive had all happened again. I felt very odd indeed after a few months. I gradually reduced the dosage and within about a month had weaned myself off the stuff altogether without too many problems.
I haven’t taken Prozac since then, and I have no plans to. In some ways I blame Prozac for ending my marriage. For several months I had a feeling in the back of my mind that things were going horribly wrong but Prozac seemed to allow me to push any worries to the back of my mind. A good drug for ostriches, perhaps.
In October 2002 I moved to a rented flat in south-east London and tried to restart my life.

2003
In the mid-2003 my divorce was finalised.
Around the same time a new form of testosterone replacement was launched in the UK: Testogel. This treatment form had been available since 2000 in the USA where it is know as Androgel). I moved to a new job in April 2003 and my new medical insurers wouldn’t cover pre-existing conditions, so for cost reasons alone I decided to give Testogel a try rather than sticking with the pellet implants. On one 5mg sachet daily I was noticing some benefit but not, to my mind, enough compared to the pellets. After a short period therefore I doubled the dosage and I found this to be far more effective. A subsequent blood test showed a slightly above average testosterone level on a 10mg dosage. I was happy.
Better still, my GP agreed to prescribe Testogel on the NHS, which meant that the cost of a year’s treatment dropped from around £1,600 using pellets to about £75 with the gel.
Why am I in This Position Anyway?
Cryptorchidism (undescended testicles) seems to be on the increase in male infants. Opinions vary on the reason for this trend – some say it’s a genetic problem; others that it could be related to an increase in environmental oestrogens (we’ve all heard the anecdotes about fish in polluted rivers spontaneously changing sex); the use of certain oestrogenic drugs in pregnant women (DES etc.) in the late 1960s and early 1970s to reduce the risk of miscarriage; and so on.
What happened to me in early adulthood though, and why? I went through puberty quite normally and at a fairly early age, so at that time perhaps all was well hormonally. I’ve heard two suggested causes for my steep decline during my 20s:
(i) That the remaining testicle could have somehow been damaged during the orchidectomy operation (carried out at the age of 21);
(ii) That it was instead damaged subsequently by the silicon prosthetic?
In some ways this question is academic. I am where I am. Finding or not finding an explanation for what happened in the past will have no bearing on where I go from here, and my remaining testicle has little function now, so arguably there’s no reason to dwell on it.
Over time the prosthetic has gradually hardened. The texture – reasonably natural at the time of insertion – is now quite odd. Had I known this might happen (and no, I wasn’t warned about it), I don’t think I would have agreed to have it put in. Again, there’s little point in dwelling on this.

Let’s Bring the Story up to Date
I’m still using Testogel and I’m pretty happy with it overall. In some ways it compares favourably with pellets:

Arguably a daily regime mimics the body’s natural production more closely, although opinion is divided on how important this is in practice

No bruising from the implantation procedure

A huge cost advantage (for me, that is – whether or not it would be true for others depends on their circumstance)

If the time interval between successive implants is too long then it’s likely that there will be a period when testosterone levels fall and symptoms reappear (although a sympathetic doctor will prescribe another form of TRT to “bridge the gap” for a short time).

In other ways the pellets are preferable:

Very consistent dosage from day to day

No hassle rubbing on gel

No boxes of medicine cluttering up my bathroom

No need to mess around with prescriptions every month

Some people find extra hair gradually appears where the gel is applied
In terms of the day-to-day relief from my original symptoms, there is very little to choose between the two. Most candidates for TRT won’t go far wrong with either if the dosage is assessed properly. The same cannot always be said, I fear, for the other treatment forms (oral capsules, patches, injections).

In January 2004 I moved out of my rented flat and bought a much larger flat just a couple of miles from the office. I think this was a pivotal point in my recent life. My commute to the office was suddenly slashed from around an hour to about fifteen minutes. I had much more space at home and a lot more free time. A friend of mine has moved in with me as a flatmate/lodger and I am very much enjoying her company. I did not enjoy living alone at all – I had never done it before and after 18 months of it I had had enough.
I’m pleased and relieved to say that I am seeing my children regularly, even though they now live almost 300 miles from London. They are doing well and I have a very close relationship with them in spite of the physical separation.
I have sold my car at last and am about to buy a motorbike.
I’m enjoying my job. I’m learning a lot. I get on very well with my boss, my colleagues and my clients. I’m becoming more and more confident in my ability as each month goes by. I’m earning a very good salary indeed and in material terms I want for very little. There is pressure at times, but these days I have a skin thick enough to deal with it.
I’m enjoying living in London. I’m settled into my new flat now, and have found some very nice pubs nearby (let’s face it, these things matter!). London was initially rather bewildering for me when I moved here in late 2002 but I am now much more comfortable here. One has of course to adapt sometimes in order to deal with some of the more frustrating aspects of London (traffic, noise, litter, petty crime, etc.), but the flipside of the coin is that there are probably opportunities in my professional and personal life here that I would not find anywhere else on the planet.
I’m feeling healthy. I am drinking less and have improved my diet. I believe I have lost a little weight recently. I feel confident, alert and cheerful. More to the point, I feel like a man. This is still something of a novelty to me!
The stress of the divorce was a huge weight on my shoulders and finally I can feel it lifting. I can even sense the change in my body language.
I feel very strong too.
I feel very strong physically. I’m still young, with plenty of testosterone at my disposal. I am tall and very well built, and I feel ready to knock over brick walls and rescue damsels in distress from the bad guys at a moment’s notice.
I also feel very strong mentally. This is because the struggle of the last two years has taught me that I possess resilience far greater than I had ever imagined, and that gives me a healthy gung ho attitude and the courage to plough on head first into my new life in the knowledge that I can (and I’m sure I will) take a few hard knocks here & there and emerge smiling at the end of it. I also believe that without testosterone replacement, the resilience that I referred to would simply not have been there. So I’m sticking with it.
I think the future looks very bright.

Epilogue
I wrote this story in the hope that it would strike a chord with others who find themselves in my situation. Spotting a problem, diagnosing it, finding the right form of treatment, getting the dosage right and taking care of all the broader lifestyle issues is not easy. If you have read the full text of my story you will see that although I’m in a pretty good position now, I have gone through an awful lot of change and upheaval to get here.
You may be reading this having suspected that you have a testosterone deficiency. Or perhaps this has already been confirmed but you are struggling to find a form of treatment that really works for you.
Either way, I hope you gain some inspiration from this story and from the others in this part of Nick’s site. I had to spend a lot of money to put myself in front of the real experts in this field; and I had to spend hundreds of hours educating myself. I had to absorb large amounts of information and then present intelligent, carefully reasoned arguments to my doctors and specialists in the most articulate way I could – in order to get the treatment and advice that I needed. Nevertheless, every penny and hour spent on this has been worthwhile for me and if I had my time again I would do exactly the same.
Having accumulated this knowledge I (very much like Nick) feel that I have a duty to share this with others in my position in order to help them. If you would like to put any questions to me then just email Nick on the address given on the site and he will forward your emails to me. I promise that I will try to help.
Alan, 26 June 2004.