TRT Netherlands: the four routes and what they cost

TRT is ordinary medical care in the Netherlands. The condition is that a doctor has established a testosterone deficiency. TRT stands for testosterone replacement therapy. Testosterone is prescription only and comes from the pharmacy.

In practice four routes lead there. They differ enormously in who is watching alongside you. Those four are rarely laid out side by side.

That figures. Every party ranking highly for this search sells one of those routes. So you rarely see the whole picture. Below they are all four, bill included.

Which routes exist in the Netherlands?

You reach treatment with testosterone through four doors. Those are your GP, a hospital specialist, a private clinic or an online provider. The first two are regular care and fall under your basic insurance. You pay for the last two yourself.

Thuisarts explains plainly what a GP does with fatigue and reduced libido. That is a useful first step. The preparations themselves appear with dosing and contraindications in the Farmacotherapeutisch Kompas.

Is testosterone therapy reimbursed?

Registered testosterone preparations sit in the basic package. The condition is a prescription for an established indication. That does not mean you pay nothing. Pharmacy medication counts towards your deductible.

In 2026 that mandatory deductible is 385 euro per year. The cabinet plans to halve it to 165 euro from 2027. Whether that goes ahead is not yet settled.

GP care sits outside the deductible. The blood work your GP orders does count towards it. So do consultations with a specialist.

If you go to a private or online provider, you normally pay everything yourself. What your insurer actually does is in your own policy terms. Those differ per company and per year.

What happens at the GP?

Your GP starts with your symptoms rather than with a drug. Fatigue, lower sex drive, worse sleep and a short fuse are common complaints. Those have dozens of possible causes. Blood work follows, usually in the morning and usually twice.

Two measurements are standard because testosterone swings by the day and by the hour. The Endocrine Society noted in 2018 that one low result is not enough.

What strikes me every time: men often arrive with a result and a preferred outcome. A GP looks first at sleep, weight, alcohol and stress. That feels like a delay, when it is simply the order of operations.

What gets drawn then is covered in our piece on blood values before you start TRT.

Why do men choose a private or online clinic?

Speed and certainty, mostly. A private clinic can move within weeks. A referral to an internist often takes longer. That is a legitimate trade, as long as you know what you are trading.

What you trade is the wide view. A provider who only supplies testosterone rarely looks seriously at other causes. Sleep apnoea, thyroid and alcohol produce the same complaints.

Picture two men with the same result of 9.1 nmol/l. In one, a sleep study turns up apnoea as the culprit. In the other the internist finds nothing else and a deficiency remains.

With an online provider, watch three things. Is there a Dutch branch? Is a BIG-registered doctor involved? Is blood monitoring part of the package?

If that last one is missing, you miss exactly the values that move during this treatment. Which values those are is covered in monitoring testosterone therapy. Our guide to TRT and testosterone therapy goes wider.

What gets monitored during treatment?

Testosterone from outside changes more than your testosterone value. It also stimulates the production of red blood cells. Your blood can thicken as a result, which pushes the haematocrit up.

That is why doctors keep following that value. The Endocrine Society lists haematocrit as a standing check during treatment. In men over fifty, PSA is usually added.

The risks therefore sit not in the first month but in the years after. Treatment without monitoring is the real risk, rather than the treatment itself.

To know where you stand now, a testosterone panel measures more than testosterone alone. A separate SHBG test shows how much testosterone is actually available.

What does it cost if you pay yourself?

At a private or online provider you pay roughly three things. Those are the first consultation, the blood work and the drugs. Follow-up checks come on top.

Rates differ sharply per provider and change each year. So always ask for a full overview before you start.

The cost most often underestimated is the repeat monitoring. Treatment with testosterone is not a one-off purchase. It is a course that keeps running as long as you use it.

That makes comparing routes harder than it looks. A cheap first consultation says little about a whole year. So ask for the annual cost, monitoring included.

What can you do before knocking anywhere?

You can have your testosterone measured to know where you stand. You then take that result to your GP. It does not change the route. It does make the conversation more concrete than a story about tiredness alone.

Draw blood in the morning if you can. A testosterone test gives you that value. The marker pages on total testosterone and free testosterone explain what the numbers mean.

If you do not recognise yourself in the picture, start with signs of low testosterone. Routes without external testosterone exist too, including clomiphene.

My advice stays what it is for any treatment you will use for years. Start with the doctor who also looks at the other causes. Not with the party selling one solution.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

References

• Bhasin S, et al. Testosterone therapy in men with hypogonadism. Journal of Clinical Endocrinology and Metabolism, 2018. PMID 29562364
• Basaria S. Male hypogonadism. The Lancet, 2014. PMID 24119423
• Luther PM, et al. Testosterone replacement therapy: clinical considerations. Expert Opinion on Pharmacotherapy, 2024. PMID 38229462
• Zorginstituut Nederland, deductible under the Health Insurance Act. 2026 amount: 385 euro. Accessed 2026.
• Farmacotherapeutisch Kompas, testosterone monographs. Accessed 2026.