TRT in Europe: The Definitive Guide

What is TRT in Europe?

TRT in Europe is prescribed testosterone for men whose bodies make too little of it, obtained through a public health system or a private doctor. There is no single European route. EU law sets the basics, and each country decides who may prescribe, which products are sold, who pays and how strictly testosterone is controlled. [1], [2]

EU law sets the criteria for prescription-only medicines, and testosterone is prescription-only in every register checked: Germany, France, Spain, Italy, Ireland, Sweden and Denmark. Most products are authorised country by country rather than by the European Medicines Agency, so a brand can be sold and paid for in one country and missing next door. Checked September 2026. [1], [22], [3], [4], [11], [23], [24], [25], [2]

The EU's 2014 safety review set a shared frame: low testosterone (hypogonadism) must be confirmed by signs, symptoms and lab tests, and raising testosterone in healthy older men is not an authorised use. [2]

Testosterone is not on the United Nations lists of internationally controlled drugs, so each country decides on extra controls: France lists it as a Liste I medicine, Italy restricts who can prescribe it, and Sweden, Denmark and Norway cover it with doping laws. [26], [3], [9], [18], [19], [20]

This guide covers Germany, France, Spain, Italy, the Netherlands, Ireland and the Nordic countries (Norway is in the European Economic Area, not the EU). The UK has its own guide: TRT in the United Kingdom.

How do you get TRT in Europe?

The route has the same shape everywhere: symptoms plus two low morning blood tests, a check for fixable causes, a first prescription from a doctor your country allows, then follow-up tests. What changes is who may prescribe first and who pays. [5], [6]

1. Symptoms and two morning blood tests. The European Association of Urology (EAU) asks for a fasting total testosterone test between 07:00 and 10:00, repeated on at least two occasions when it is below 12 nmol/L. The European Academy of Andrology (EAA) asks for fasting tests before 11 am on two different days, and Denmark's guideline recommends mass spectrometry, a more precise lab method. [5], [6], [10]
2. A search for causes. Both European guidelines put weight loss, lifestyle change, stopping medicines that lower testosterone and treating other illnesses first. [5], [6]
3. A first prescription from the right doctor. In France, the first prescription must come from a specialist in endocrinology, diabetology, nutrition, urology, gynaecology or reproductive medicine and andrology; after that, any doctor can renew it. In Italy, testosterone is a restricted prescription written by hospital centres or by an endocrinologist, urologist or andrologist. Denmark's guideline (advice, not law) says specialists with andrology expertise should do the work-up and start treatment. We found no official specialist-only rule for Germany, Spain, the Netherlands, Ireland or Sweden. Checked September 2026. [3], [8], [9], [10]
4. Public or private payment, then each supply. Public systems charge co-payments, deductibles or yearly caps, and some pay only for certain products or diagnoses (see cost). We found no official figures for private costs. Each supply comes from a pharmacy, and in Ireland and Italy every supply needs a new prescription (see prescription validity). [7], [14], [15], [23], [9]
5. Follow-up blood tests. The EAU checks testosterone and hematocrit (the share of the blood made up of red cells) at 3, 6 and 12 months, then every year. See what is monitored. [5]

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How to get a testosterone prescription in Europe

The common route in five steps, and where countries differ. Checked September 2026.

1. 1.Symptoms + two morning tests

   Fasting total testosterone, 07:00–10:00 (EAU) or before 11 am (EAA), repeated if below 12 nmol/L

2. 2.Look for causes first

   Weight, lifestyle, medicines that lower testosterone, other illness

3. 3.First prescription

   From a doctor your country allows

4. Where countries differ at step 3
   • France: Listed specialists start; any doctor renews
   • Italy: Hospital centres or endocrinologist, urologist, andrologist (RNRL)
   • Denmark: Guideline: specialist start (advice, not law)
   • Germany, Spain, the Netherlands, Ireland, Sweden: No specialist-only rule found
5. 4.Public or private payment

   Co-payments, deductibles or caps; some products or diagnoses only

6. Where countries differ at step 4
   • Italy: Nota 36: below 12 nmol/L + symptoms + specialist plan
   • Everywhere: co-payments, deductibles or yearly caps; amounts in the cost section.
7. 5.Follow-up tests

   Testosterone and hematocrit at 3, 6 and 12 months, then yearly (EAU)

Checked September 2026. Rules differ by country and change often.

What does it take to qualify for TRT in Europe?

Symptoms plus repeated low morning tests, with the line at about 12 nmol/L. The table shows each European clinical guideline and payment rule, with US guidelines for comparison. Checked September 2026.

[5], [6], [7], [10], [12], [27], [28]

Most European bodies land at about 12 nmol/L, with deficiency much more likely below 8 nmol/L. Denmark gives no single number because lab methods differ, the Netherlands relies on clinical features plus two low results, and Italy uses 12 nmol/L to decide who the health service pays for. US guidelines draw lower lines. European labs report nmol/L; 1 nmol/L is about 28.8 ng/dL, and the testosterone unit converter does the arithmetic. [5], [6], [10], [12], [7]

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Where guidelines draw the line for low testosterone

Total testosterone below which each body supports a diagnosis, with symptoms.

Each line runs from 200 ng/dL (7 nmol/L, left) to 400 ng/dL (14 nmol/L, right); the shaded part is 264–350 ng/dL, where the guidelines' lines fall. A dashed circle means an approximate line.

Endocrine Society (2018)

Below 264 ng/dL (9.2 nmol/L), standardized assays

CUA (Canada, 2021)

Below 10 nmol/L (about 290 ng/dL)

AUA (US, 2018, reconfirmed 2024)

Below 300 ng/dL (10.4 nmol/L)

Endocrine Society statement (July 2026)

“Near 300 ng/dL”

EAU · ICSM · BSSM (Europe 2026 · international 2024 · UK 2023)

Below 12 nmol/L (about 350 ng/dL)

Every guideline also requires symptoms, and all but the CUA call for at least two morning tests; none diagnoses from a number alone.

Is TRT given for age-related decline in Europe?

No. The EU's 2014 review calls it an unauthorised use, the Dutch formulary says there is "no place" for testosterone in natural ageing, and the EAU advises against it for thinking, vitality or strength in ageing men. Age itself rules no one in or out: a man of any age with confirmed low testosterone and symptoms can be treated. [2], [12], [5]

What does public cover require?

Checked September 2026.

• Italy has the clearest rule. Under AIFA Nota 36, the health service pays only for primary or secondary hypogonadism below 12 nmol/L with typical symptoms (such as low sexual desire, weak bones, low muscle strength, belly fat or mood changes), on a specialist centre's treatment plan, and only for the products it lists. [7], [11]
• Spain funds its listed products for testosterone replacement in male hypogonadism "when the deficiency has been confirmed by clinical data and biochemical tests" (our translation). [29]
• Germany's statutory insurance excludes testosterone used to increase sexual desire as a lifestyle use; we found no official statement on diagnosed hypogonadism either way. [30]
• The Netherlands has reimbursed Nebido since 1 October 2022; "conditions apply" to Nebido and Androgel, and we did not read them. [31], [32]
• France, Ireland and the Nordic countries publish cover by product (see cost); we found no written testosterone-specific eligibility criteria.

Which testosterone products are sold in Europe?

Long-acting undecanoate injections and daily transdermal gels (absorbed through the skin) are the most widely listed; the rest depends on the country. "Marketed" in a register means authorised and on the market, not in stock at every pharmacy. Checked September 2026.

[3], [33], [13], [4], [34], [29], [11], [35], [12], [32], [23], [36], [24], [37], [25]

Of the registers checked, only Spain sells testosterone cypionate, the ester most US men use, funded since 1 May 2018. In the other countries checked, the injections are undecanoate, enanthate, propionate or the Sustanon 250 ester mix; we did not check injections in Germany, Sweden, Denmark, Finland or Norway. [4], [29]

What doses do the product labels give?

The product label (in Europe, the SmPC) sets the starting schedule; prescribers adjust it using blood tests and symptoms. Each schedule below comes from one national source, named in its line, and the same product can have a different schedule in another country. Checked September 2026.

• Nebido (undecanoate 1,000 mg/4 mL; French label): 1,000 mg by intramuscular injection (into a muscle) every 10 to 14 weeks; the first gap can be as short as 6 weeks. See the undecanoate injection guide. [38]
• Sustanon 250 (Dutch national formulary): usually 250 mg (1 mL) once every 3 weeks. See the Sustanon 250 guide. [12]
• Testosterone Desma 250 mg/mL (enanthate; French label): 250 mg every 2 or 3 weeks; for maintenance, 250 mg every 3 or 6 weeks depending on the patient. See the enanthate guide. [39]
• Androtardyl 250 mg/mL (enanthate; French label): 250 mg every 2 to 4 weeks. [40]
• Propionate (Spanish and Italian labels): Spain's Testex label gives 25 mg two to four times a week, and Italy's Testovis label 50 mg twice a week. See the propionate guide. [41], [42]

Check your pack's strength before converting a dose to a volume: Spain's Testex Prolongatum 250 mg/2 mL holds 125 mg per mL, not the 200 mg per mL common in the US, so the same milligrams fill a different volume. The TRT dose calculator converts milligrams to milliliters and syringe units for your concentration; the cypionate guide covers that ester. [4]

Which products are no longer sold?

• Oral testosterone undecanoate capsules. France's Pantestone is no longer listed, and none appeared in the Spanish, Italian or Dutch registers. The oral testosterone guide covers the US capsules. [13], [4], [11], [12]
• Fortigel (France). Authorisation withdrawn. [3]
• Sustanon 250 (Ireland). Its Irish licence was withdrawn on 4 December 2008. [36]
• Enclomiphene (never approved). The EU refused to authorise it in 2018. See the enclomiphene guide. [43]

What does TRT cost in Europe?

It depends on the country and the product: public systems charge a co-payment, reimburse a share, count medicines toward a deductible, or cap what you pay. These are official figures; there are none for private care. Checked September 2026.

[14], [44], [45], [30], [3], [33], [46], [47], [48], [49], [29], [11], [7], [15], [32], [16], [50], [51], [24], [37], [52], [25], [53], [54]

The biggest differences are by product, not only by country. In France the generic undecanoate injection is reimbursed while the same medicine sold as Nebido is paid in full; in Italy only three products are paid by the health service. Spain's percentages changed on 14 May 2026, so older price tables are out of date. [3], [11], [47]

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What you pay for prescribed medicines, country by country

Official 2026 rules, each in its own currency. A guide to each system, not a price comparison.

GermanyPer item + yearly cap

€5–10 per item

10% of the price. Yearly cap 2% of income (1% if chronically ill)

No reference-price group for testosterone

FranceShare reimbursed

65% reimbursed

Generic undecanoate and enanthate injections, plus a €1.02 dispensing fee

Nebido, Androgel and Testavan not reimbursed

SpainShare by income + cap

40–60%

Working age, by income. Pensioners under €100,000: 10%, cap €8.23–€18.52 a month

Rates since 14 May 2026

ItalyPaid list (class A)

3 products

Paid by the health service under Nota 36; others paid by the patient (class C)

Testovis, Tostrex (single 60 g pack), Testavan

NetherlandsYearly deductible

€385

Reimbursed medicines count toward it

Nebido reimbursed since Oct 2022, with conditions

IrelandMonthly cap

€80 a month

Drugs Payment Scheme, per person or family. Medical card: €1.50 an item, up to €15 a month

Listed products for men not confirmed

Sweden12-month cap

SEK 3,800

Full price up to SEK 2,000, then discounts

Testogel 16.2 mg/g, Tostrex, Testavan in the scheme

DenmarkYearly cap

DKK 4,850

What adults pay toward subsidised medicines

Tostran listed with a subsidy price

FinlandYearly ceiling

€636.12

Medicine ceiling for the year

Testosterone products not checked

NorwayYearly cap

NOK 3,278

Patient charges, including blue-prescription medicines

Not confirmed whether testosterone qualifies

Caps cover all prescribed medicines, not only testosterone. Official figures only; no private prices. Checked September 2026.

What are the rules on testosterone in Europe?

Prescription-only everywhere checked, with extra rules in some countries: limits on who prescribes, and doping laws in the Nordic countries and Germany. Checked September 2026.

[22], [55], [56], [57], [58], [3], [59], [4], [60], [9], [61], [23], [62], [63], [24], [18], [25], [64], [19], [65], [20], [66]

How long is a testosterone prescription valid?

We found official rules on prescription renewal for only two countries. In Ireland, Nebido and the gels are prescription-only and the register entries say the prescription "may not be renewed", so each supply needs a new one. In Italy, testosterone is a restricted prescription that is renewed for each supply. We did not check how long a testosterone prescription stays valid in Germany, France, Spain, the Netherlands, Sweden, Denmark, Finland or Norway, so ask your prescriber or pharmacist. Checked September 2026. [23], [9]

Will a prescription from one EU country work in another?

Usually yes, if the product is sold where you are. EU law says a named-patient prescription from one EU country must be dispensable in another, restricted only where necessary to protect health or when there are justified doubts that it is genuine. Germany treats prescriptions from the EU, the EEA and Switzerland as German ones if they carry the required details. Checked September 2026. [17], [67]

Three limits matter:

• It does not change who pays. The law says recognition "shall not affect the rules on reimbursement", so you may pay the full price abroad. [17]
• A pharmacist can refuse for ethical reasons, and the rule excludes "special medical prescription" medicines (narcotics and psychotropic drugs); we found no country that puts testosterone in that category. [17], [1]
• The prescription needs set details: your full names and date of birth; the prescriber's full name, qualification, phone or email with the international prefix, work address with country, and signature; the medicine's common name, form, strength, quantity and dosage; and the date. [68]

Cross-border electronic prescriptions through the EU's MyHealth@EU service are being rolled out country by country. [69]

Can you get TRT online in Europe?

Sometimes. Germany's model code for doctors allows care entirely at a distance, including prescribing, only in individual cases when it is medically justifiable. Denmark's patient-safety authority says digital care follows, as a starting point, the same rules as care in person. France's specialist rule applies however you see the doctor. For Italy, Spain, the Netherlands, Ireland and Sweden we found no rule written for testosterone. Checked September 2026. [70], [71], [3]

A doctor prescribing remotely still needs the same diagnosis: symptoms and repeated morning blood tests. [5]

Can you travel in Europe with testosterone?

Yes, with your prescription and the original package, within each country's limit. Most countries here that publish a limit allow about 3 months' supply of a prescribed medicine; Norway allows only 30 days because testosterone is on its doping list. Checked September 2026. [58], [59], [60], [63], [66]

A Schengen certificate is a 30-day form for carrying medicines your home country controls as narcotic or psychotropic drugs. Testosterone is not one under the international treaties, so it depends on your home country's law; Ireland's certificate, for example, covers only its Schedule II and III drugs. [72], [61], [26], [63] The traveling with testosterone guide covers packing, customs and time zones in full.

Is testosterone allowed in sport?

No. The World Anti-Doping Agency (WADA) prohibits testosterone at all times, and its 2027 list, in force from 1 January 2027, keeps the ban. Athletes need a therapeutic use exemption (TUE), which WADA grants only for low testosterone with a clear physical cause, not one linked to age or weight. Germany's national anti-doping agency says the requirements for a testosterone exemption are very high. Checked September 2026. [21], [73], [74], [75]

Is it legal to buy testosterone without a prescription?

No. Pharmacies may supply testosterone only on a prescription, and possessing it without one is an offence under the Swedish and Danish doping laws; Germany's Anti-Doping Act targets possession for doping in sport. Checked September 2026. This guide gives no advice on buying without a prescription. [76], [4], [23], [18], [64], [56]

TRT country by country

What stands out in each country beyond the tables above, and what we could not confirm. Checked September 2026.

Germany

Testosterone is prescription-only and is not a narcotic under Germany's narcotics law (Betäubungsmittelgesetz); the law that applies beyond prescribing is the Anti-Doping Act, which targets possession for doping in sport. We found no specialist-only rule, and pharmacies must accept prescriptions from other EU and EEA countries and Switzerland. We did not verify which testosterone brands are marketed in Germany or whether statutory insurers state a policy on hypogonadism. [22], [55], [56], [67], [30]

France

Testosterone is a Liste I medicine started by listed specialists (andrology-qualified doctors were added in January 2022) and renewable by any doctor. Reimbursement covers the generic undecanoate injection and the two enanthate injections; Nebido and the gels are paid in full, and oral Pantestone is no longer listed. [3], [8], [46], [13]

Spain

Every testosterone product in Spain's register is prescription-only, so claims that it is sold over the counter are wrong. Spain funds a licensed cypionate alongside undecanoate injections and gels, and its co-payment bands changed on 14 May 2026. We could not confirm whether any product needs specialist approval. [4], [29], [47]

Italy

Italy combines three restrictions: a restricted prescription from hospital centres or named specialists, a new prescription for each supply, and public payment only under Nota 36 for three products. Nebid, the undecanoate generics, Sustanon 250, Testoviron and Testogel are paid by the patient. [9], [7], [11]

Netherlands

The national formulary lists undecanoate injections, Sustanon 250 and several gels, and rules out testosterone for low testosterone from natural ageing. Nebido has been reimbursed since October 2022, with conditions, and counts toward the €385 deductible. We could not confirm whether a family doctor may start treatment. [12], [31], [15]

Ireland

Ireland markets Nebido and five gel products, each a prescription that "may not be renewed", and has not licensed Sustanon 250 since 2008. We could not confirm which testosterone products the health service payment schemes list for men. [23], [77], [36]

Nordic countries

• Sweden. Prescription required, and the doping law bans possessing or using testosterone except for medical or scientific purposes. Gels are in the high-cost protection scheme. [24], [37], [18]
• Denmark. Import and possession are lawful only on a doctor's prescription, and the national guideline recommends a specialist start. It estimates that more than 5,000 men in Denmark were on testosterone in 2022. [64], [10]
• Finland. We did not verify which products are sold or how the doping offence applies; the yearly medicine ceiling is in the cost table. [53]
• Norway (EEA, not EU). Testosterone and its esters are on the national doping list, which limits travelers to 30 days' supply. [20], [66]

Is TRT safe, and what have European regulators found?

For men with confirmed low testosterone, European regulators judge the benefits to outweigh the risks, and the risks that remain, such as a rising hematocrit, are why treatment is monitored. The EU's 2014 review found "no consistent evidence of an increased risk of heart problems" in men who lack the hormone, and a 2025 EU safety review left the balance of benefits and risks unchanged. [2], [78]

The 2025 review recommended three new warnings: a rare lung reaction to injection oil, pulmonary oil microembolism (POME); an interaction with SGLT2 inhibitor medicines; and gel transfer to pets. National label dates vary, so your leaflet may not show them yet. The French Nebido label (updated January 2026) already says to watch the patient during and immediately after each injection. [78], [38]

The largest heart-safety trial, TRAVERSE, followed 5,204 men at high heart risk. Among the 5,198 who used the study gel at least once, heart attack, stroke or cardiovascular death occurred in 182 of 2,596 men on testosterone gel (7.0%) and 190 of 2,602 on placebo (7.3%) (hazard ratio 0.96, 95% CI 0.78 to 1.17). That met the trial's test for ruling out a large increase in risk: the top of the range had to stay below 1.5. Some problems were more common on testosterone, in rates among about 2,600 men in each group: atrial fibrillation 3.5% vs 2.4%, acute kidney injury 2.3% vs 1.5% and pulmonary embolism 0.9% vs 0.5%. The trial tested only a daily gel, men used it for an average of 21.7 months, and about 61% stopped their study gel early. [79], [80], [81], [82] The TRT and heart health guide covers it in full.

The label changes the FDA requested in June 2026 concern US labels only, were still pending in September 2026, and do not change European labels. [83]

Who should be especially cautious?

• Men who want children soon. The EAU says not to use testosterone in men who want to father children; TRT and fertility explains why and what the alternatives are. [5]
• Men with prostate or breast cancer. Locally advanced or spreading prostate cancer and male breast cancer rule testosterone out under the EAU guideline. [5]
• Men with a high hematocrit or heart failure. A hematocrit of 54% or more and uncontrolled heart failure rule it out; a starting hematocrit of 48–50%, severe urinary symptoms and a family history of blood clots call for caution. The EAA also advises against it soon after a major heart event or stroke. [5], [6]
• Drug-tested athletes. See sport. [21]
• Under-18s. Testosterone for teenagers belongs only in specialist care.
• Women. This guide is for men. Testosterone for women uses different products and doses; see testosterone therapy for women.

Which medicines interact with testosterone?

The interaction European regulators added most recently is with SGLT2 inhibitors, diabetes and heart medicines such as empagliflozin and dapagliflozin: together with testosterone they can push hemoglobin and hematocrit higher. Bring a complete list of your medicines and supplements to your pharmacist or prescriber, and see the TRT hematocrit guide for what raises red blood cells. [78]

What is monitored once you start TRT?

Testosterone and hematocrit at about 3, 6 and 12 months, then yearly, with a prostate check before starting. This summary is for preparing questions, not a personal testing plan. Checked September 2026.

[5], [6], [12], [38]

The TRT blood work guide explains when to draw each test; the hematocrit and prostate guides go deeper.

Common questions about TRT in Europe

Is TRT legal in the EU?

Yes, with a prescription. Testosterone is a prescription-only medicine in every European register checked, and prescribed treatment is legal everywhere covered here. Extra rules apply in some countries: Italy restricts who can prescribe, and Sweden, Denmark and Norway control testosterone under doping laws. Checked September 2026. [1], [9], [18], [19] See the rules.

Is TRT covered by health insurance in Europe?

Often, but not for every product. Italy pays only under Nota 36 and only for three products, France reimburses some injections but not Nebido or gels, Spain funds its listed products with an income-based co-payment, and the Netherlands reimburses Nebido with conditions. Germany excludes testosterone used to increase sexual desire. Checked September 2026. [7], [11], [3], [29], [31], [30] See what it costs.

Do you need a specialist to start TRT in Europe?

In France and Italy, yes. France requires a listed specialist for the first prescription (any doctor can renew), and Italy restricts prescribing to hospital centres and endocrinologists, urologists and andrologists. Denmark's guideline recommends a specialist start. We found no specialist-only rule for Germany, Spain, the Netherlands, Ireland or Sweden. Checked September 2026. [8], [9], [10] See the steps.

Is testosterone cypionate available in Europe?

Yes, in Spain. Testex Prolongatum (cypionate 100 mg/2 mL and 250 mg/2 mL) is marketed and funded by the Spanish health system. In the other registers checked, injections are undecanoate, enanthate, propionate or the Sustanon 250 mix. Check the concentration, because Spain's is not the US 200 mg/mL. Checked September 2026. [4], [29], [11], [12] See the products.

Which European countries sell Sustanon 250?

Of the countries checked, Italy and the Netherlands list Sustanon 250 as marketed. Ireland's licence was withdrawn in 2008, and it was not listed in the French or Spanish registers. The Dutch formulary gives a usual schedule of 250 mg every 3 weeks. Checked September 2026. [11], [12], [36], [3], [4] See the Sustanon 250 guide.

Glossary

Plain explanations of the medical, legal and payment terms used in this guide. Underlined terms in the text link here.

Andrologist

A doctor who specializes in male reproductive health, including testosterone and fertility. In France and Italy andrology-qualified doctors are among those allowed to start testosterone.

Atrial fibrillation

An irregular, often fast heart rhythm that raises the risk of stroke. It was more common on testosterone than placebo in the TRAVERSE trial.

Clinical guideline

Recommendations written by a medical society or health system, based on its review of the evidence and expert judgment. Different guidelines can reach different conclusions.

Co-payment

The part of a prescription's cost that you pay yourself when the health system pays the rest, for example Germany's €5 to €10 per item.

Confidence interval (CI)

The range in which a study's true result probably lies, given how many people were studied. If the range for a hazard ratio includes 1, the study cannot show a difference between the groups.

Deductible (eigen risico)

An amount you pay each year before your insurance starts paying. In the Netherlands it is €385 in 2026, and reimbursed medicines count toward it.

EAA

The European Academy of Andrology, whose 2020 guideline on low testosterone in men is endorsed by the European Society of Endocrinology.

EAU

The European Association of Urology, which publishes Europe's most widely used guideline on male hypogonadism, updated yearly (2026 edition).

Endocrinologist

A doctor who specializes in hormones and the glands that make them.

Hazard ratio

A measure comparing how often an event happens over time in two groups. A hazard ratio of 1 means no difference. In TRAVERSE the ratio for heart attack, stroke or cardiovascular death was 0.96, with a 95% confidence interval of 0.78 to 1.17; because that range includes 1, the trial did not find a difference between gel and placebo.

Hematocrit

The share of the blood made up of red blood cells. Testosterone therapy can raise it, which is why it is checked.

Hypogonadism (low testosterone)

When the testes make too little testosterone. Primary hypogonadism starts in the testes; secondary hypogonadism starts in the brain signals that control them.

Intramuscular (IM)

Injected into a muscle. Nebido, Sustanon 250, enanthate and cypionate injections are given this way.

Liste I (France)

A French category of prescription-only medicines. Every testosterone product sold in France is on it.

Marketing authorisation

A regulator's permission to sell a medicine. Most testosterone products in Europe are authorised by each country rather than by the European Medicines Agency.

MyHealth@EU

The EU service that lets an electronic prescription from one EU country be used in a pharmacy in another. Countries are joining it one at a time.

nmol/L and ng/dL

Two units for blood testosterone. Europe mostly uses nanomoles per liter (nmol/L), the US nanograms per deciliter (ng/dL); 12 nmol/L is about 350 ng/dL.

Nota 36 (Italy)

The Italian medicines agency's rule for when the national health service pays for testosterone: confirmed hypogonadism below 12 nmol/L with typical symptoms and a specialist's treatment plan.

Placebo

A dummy treatment with no active ingredient, used as a comparison in studies.

Prescription-only medicine

A medicine a pharmacy may supply only against a prescription. EU law sets the criteria; each country applies them.

Product label (prescribing information)

The official document approved by a medicines regulator for a product, describing its approved uses, doses, warnings and monitoring. In Europe it is called the summary of product characteristics.

PSA (prostate-specific antigen)

A protein made by the prostate and measured in a blood test. It is checked before and during testosterone therapy.

Pulmonary embolism

A blood clot that travels to the lungs, usually from a vein in the leg. It needs urgent treatment.

Pulmonary oil microembolism (POME)

A rare reaction in which tiny droplets of the oil in an injection reach the lungs. The French Nebido label, for example, asks for the patient to be watched during and just after each injection.

Reimbursement

When a health system or insurer pays all or part of a medicine's price. In France, for example, some testosterone injections are reimbursed at 65%.

RNRL (Italy)

Italy's restricted prescription category for testosterone: only hospital centres or named specialists (endocrinologists, urologists, andrologists) may write it, and each supply needs a new one.

Schengen certificate

A form, valid for 30 days, that lets a resident of a Schengen country carry medicines their home country controls as narcotic or psychotropic drugs. Whether testosterone needs one depends on the home country.

SGLT2 inhibitor

A group of diabetes, heart and kidney medicines, such as empagliflozin (Jardiance) and dapagliflozin (Forxiga), that make the kidneys remove sugar in urine. They raise hematocrit on their own.

SHBG (sex hormone-binding globulin)

A blood protein that carries testosterone. When SHBG is unusually high or low, total testosterone can mislead, so free testosterone is calculated as well.

SmPC (summary of product characteristics)

The official European product label for health professionals, setting out a medicine's approved uses, doses, warnings and monitoring.

Therapeutic use exemption (TUE)

Permission from an anti-doping body for an athlete to use a banned medicine for a genuine medical need. For testosterone, WADA grants it only for low testosterone with a clear physical cause.

Total testosterone

All the testosterone in a blood sample, both the part bound to proteins and the free part. It is the main test for diagnosing low testosterone.

Transdermal

Absorbed through the skin, as with testosterone gels and patches.

TRT (testosterone replacement therapy)

Prescribed testosterone, by injection, gel or other forms, for men with low testosterone.

WADA

The World Anti-Doping Agency, which publishes the list of substances banned in sport. Testosterone is prohibited at all times.

How this guide was researched

This guide is built from a thorough review of the sources cited throughout it: EU and national laws, medicines registers and price databases, health-service payment rules, product labels, European and US clinical guidelines, anti-doping rules and a large clinical trial. We also read the questions people ask in public online forums about getting TRT in Europe, to make sure the guide answers them.

The guide cites 83 sources: 75 laws, regulators' pages, medicines registers, payment rules, product labels and anti-doping rules, 5 clinical guidelines, and 3 papers and records from one large clinical trial. Each type of source answers a different question. Laws and registers show what is allowed and sold. Guidelines show how doctors are told to diagnose and monitor. Trials show what was measured. Every numbered citation links to its entry below, labeled by source type.

How this guide was made

Research and drafting were AI-assisted. Every cited source was checked against the original, and the guide was reviewed and edited by Doserly before publication. It has not had an independent clinical review, and Doserly does not currently have medical reviewers. Doserly makes a medication and health-tracking app and runs Doserly Academy, both of which are promoted in this guide. Read our editorial policy for how guides are researched, updated and corrected.

This guide is for educational purposes. It summarizes what the reviewed sources report so the rules are easier to understand; it is not medical or legal advice. Rules, prices and product lists change often, so check with your doctor, pharmacist or health service before you rely on them.

Explore the sources