Tongkat Ali vs. TRT: Costs, Results & Which Is Right for You

If you're a British man dealing with low testosterone symptoms, you've probably considered two main options:

Option A: Testosterone Replacement Therapy (TRT)—the medical route with injections, gels, or patches.

Option B: Natural approaches like Tongkat Ali—the supplement route without prescriptions.

Both get discussed online, often by people with strong opinions and questionable objectivity. So let's cut through the noise and look at what each option actually offers, what it costs, and who it's best suited for.

This isn't about declaring a winner. It's about helping you understand which approach—or which combination—might make sense for your specific situation.

Testosterone Replacement Therapy is exactly what it sounds like: replacing your body's testosterone production with external testosterone.

How it works: You receive testosterone through injections (typically every 1-3 weeks), daily gels applied to the skin, or patches. This external testosterone raises your blood levels directly.

What it does: Bypasses your body's production system entirely. Your testosterone levels become determined by what you're taking, not what your body produces.

The trade-off: Because external testosterone is present, your body reduces or stops its own production. The testes essentially go dormant for testosterone production.

Tongkat Ali works completely differently—it's not replacing anything.

How it works: The active compounds in Tongkat Ali appear to work through multiple mechanisms: reducing cortisol (which suppresses testosterone), supporting the release of testosterone from binding proteins, and potentially signalling your body to produce more.

What it does: Supports and optimises your body's natural testosterone production systems rather than replacing them.

The trade-off: Effects are more modest than TRT, and not everyone responds equally. But your body's own production system stays intact and active.

When properly dosed and monitored, TRT typically raises testosterone to optimal ranges (15-30 nmol/L or higher):

• Testosterone increase: Direct control—levels can be brought to whatever target is chosen
• Timeline: Effects begin within weeks, full benefits in 3-6 months
• Consistency: Very predictable when properly managed
• Symptom improvement: Studies show significant improvements in energy, mood, libido, body composition

NHS vs. Private TRT:

• NHS TRT (when prescribed): Typically free or prescription charge
• Private TRT clinics: £100-200+ per month for treatment plus monitoring

Getting it prescribed is the challenge. The NHS has strict criteria:

• Testosterone typically needs to be below 8-12 nmol/L on multiple tests
• Symptoms must significantly impact quality of life
• Other causes must be ruled out

If prescribed:

• Medication: Free (or standard prescription charge)
• Monitoring: Covered by NHS
• Wait times: Varies, can be several months for endocrinology referrals

Reality check: Many men with "borderline" low testosterone (10-15 nmol/L) don't qualify for NHS treatment despite experiencing symptoms. The threshold for treatment is set at the lower end of "normal."

More accessible but significantly more expensive:

• Initial consultation: £150-300
• Blood tests: £100-200 (required regularly)
• Medication: £50-150/month depending on type
• Ongoing monitoring: £50-100/month
• Total first year: £1,500-3,000+
• Ongoing annual cost: £1,200-2,500+

Considerably more affordable:

• Quality Tongkat Ali: £25-40/month
• Optional blood tests: £50-100 (before/after)
• Gym membership: £20-50/month (you should be training anyway)
• Total first year: £400-700

Before deciding anything, know your actual numbers:

• Total testosterone (morning test, 8-10am)
• Free testosterone
• SHBG (sex hormone binding globulin)
• Basic health markers (liver function, blood count)

You can do this through your GP or private testing services (Medichecks, Thriva, etc.).

If testosterone is below 8 nmol/L: Seek medical evaluation. This level typically warrants TRT consideration regardless of other factors.

If testosterone is 8-15 nmol/L with symptoms: Natural optimisation makes sense as a first approach. Give it 8-12 weeks with proper lifestyle changes and quality supplementation.

If testosterone is above 15 nmol/L: Your symptoms may have other causes. Investigate sleep, thyroid, stress, and other factors before assuming it's testosterone-related.

Regardless of which path you choose, address:

• Sleep quality and duration
• Regular resistance training
• Stress management
• Body composition
• Alcohol consumption

These factors affect both natural testosterone and TRT effectiveness.

Based on your numbers, severity, budget, and preferences, choose:

• Natural optimisation first (if borderline levels)
• Medical evaluation for TRT (if clinically low)
• Private TRT consultation (if NHS route isn't viable)

Whatever you choose, track your progress:

• Subjective symptoms (energy, mood, libido)
• Objective measures (retest testosterone after 8-12 weeks)
• Adjust approach based on results

TRT is generally safe when properly monitored, but it's not without concerns:

Common effects:

• Acne or oily skin
• Fluid retention
• Mood changes during adjustment
• Testicular shrinkage (your body stops producing its own)

Serious concerns requiring monitoring:

• Polycythaemia (blood thickening)—requires regular blood tests
• Cardiovascular effects—research is mixed, requires cardiac consideration
• Prostate monitoring—regular PSA tests recommended
• Fertility impact—TRT suppresses sperm production (often reversible when stopped)

The commitment: TRT is typically a long-term or permanent decision. Many men stay on it indefinitely because their natural production has been suppressed.

Generally well-tolerated, with a different risk profile:

Common effects:

• Occasional restlessness or sleep disruption (usually with evening dosing)
• Mild digestive upset in some users
• Increased energy that some find uncomfortable initially

Documented concerns:

• Rare cases of liver stress reported in medical literature
• Not appropriate for pregnant/breastfeeding women
• Should be avoided with certain medications (blood thinners, hormone therapies)

What's different: You can simply stop taking it if issues arise. Your body's natural systems remain intact throughout.

Let's address the elephant in the room.

Many British men feel failed by the NHS approach to testosterone. Common frustrations include:

• The threshold problem: You can be at 10-11 nmol/L, experiencing significant symptoms, and be told you're "normal." Technically true by NHS standards, but not helpful when you feel terrible.
• The waiting game: Even if you qualify, waiting times for endocrinology can stretch months. Meanwhile, you're still exhausted and struggling.
• The one-size-fits-all approach: NHS TRT, when prescribed, often uses standard protocols that may not be optimised for your individual needs.
• The lack of alternatives: Many GPs aren't familiar with evidence-based natural approaches and may dismiss supplements entirely—even those with legitimate research behind them.

This is why many men end up either paying for private TRT (expensive) or exploring natural options (which the NHS often ignores).

There's no universally "right" choice between Tongkat Ali and TRT. They serve different purposes:

TRT is a medical treatment for clinically low testosterone. It's effective, well-understood, and appropriate when natural production has genuinely failed. But it's a significant commitment with real costs and monitoring requirements.

Tongkat Ali is a natural optimisation tool for men whose testosterone production is suppressed but not destroyed. It's more modest in effects, more affordable, and reversible—making it a sensible first step for many men.

For the majority of UK men experiencing symptoms in their 30s, 40s, and 50s—especially those with borderline-low rather than severely deficient testosterone—starting with natural optimisation makes practical sense. It's lower risk, lower cost, and keeps your options open.

If natural approaches don't deliver sufficient improvement after a proper trial (8-12 weeks with quality products and lifestyle optimisation), then exploring TRT becomes a reasonable next step with more information about your individual response.

The worst approach? Doing nothing while feeling progressively worse. Whatever path you choose, taking action beats resignation.