TRT – How to dial in your protocol

Intro

There’s no one size fits all approach to TRT and it’s actually quite rare that your first TRT protocol will completely dial you in.

Check out my other post to determine whether or not you are a good candidate for TRT.

Often there’s a period of trial and error whereby doses need to be adjusted, administration frequency needs to be changed and for some people even the testosterone ester swapped.

This post will serve as a good guideline and help you find your ideal dosage, frequency and ester. To give you all the benefits that TRT has to offer with none (or as few) of the potential side effects as possible.

Finding your dose

Dosage can vary a lot and I’ve seen it range from as little as 80mg, to as high as 250mg per week.

So what determines the dosage you should use?

Well, it should be the minimum amount possible to get full symptom relief.

Everyone responds to things differently and testosterone is no different – The way you metabolise testosterone can be impacted by:

• Age
• Genetics
• The carrier oil of the testosterone itself
• Bodyfat levels
• Lifestyle (physically active people have more androgen receptors to use the exogenous testosterone)

I recommend that guys start with 100mg per week, for most men this will bring their total testosterone between 650-1000 ng/dl and more importantly, with a much higher proportional free testosterone due to exogenous testosterone lowering SHBG (sex hormone binding globulin).

For many guys 100mg is likely enough to treat hypogonadism and get symptom relief.

However, if you don’t see symptom relief or just partial relief, you can increase the dose but wait 6 weeks before doing so, this is to allow the longer esters of testosterone (enanthate/cypionate) to fully saturate and reach peak serum concentration levels in the blood.

How to adjust dosage with enanthate & cypionate

Here’s an example of how you would go about finding the sweet spot with your TRT protocol.

Start a diary and assess at the end of every week how you feel, score your mood, energy and libido out of 10.

100mg per week, wait 6 weeks, assess how you feel.

If symptoms have improved, great. Increase dose by 20mg.

120mg per week, wait another 6 weeks, assess how you feel.

Maybe you get further symptom relief, increase dose by another 20mg.

140mg per week, wait another 6 weeks, assess how you feel again.

Now you’re feeling really good, increase it again by 20mg.

160mg, wait 6 weeks, assess how you feel.

You could start to get high estrogen issues here, but you didn’t at 140mg.

So guess what? 140mg is your dose that you get symptom relief and feel good, without estrogen issues.

Adjusting dosage with the propionate ester would follow the same process but you could adjust the dose every 2 weeks due to the much shorter half-life.

If you are using TRT to treat hypogonadism due to age or another factor, your primary goal should be symptom relief. So ideally you want to use as little as possible to achieve that result.

More isn’t always better

Of course higher testosterone has many benefits including enhanced athletic performance, decreased recovery time and making it easier to improve body composition.

It also comes with drawbacks that you need to be aware of.

Blood pressure

Such drawbacks include an overactive renin angiotensin aldosterone system. Which makes your body hold onto more minerals causing the kidneys to have to work harder than usual.

Over time this increases blood pressure and resting heart rate, causing the heart to have to work harder than it should, chronically this can lead to left ventricular hypertrophy which increases the risks of stroke and heart disease.

Things like omega 3 fish oils, daily cardio and in some cases an angiotensin receptor blocker (ARB) like telmisartan can mitigate the risks and keep aldosterone and blood pressure under control.

But if your goal is just symptom relief, why run the testosterone that high anyway to the point where blood pressure could become an issue.

Estrogen

In a perfect world you won’t need any estrogen control with TRT, but everyone is different and we all convert testosterone to estrogen at different rates via aromatization.

Using higher doses of testosterone makes it more likely that you’ll need some type of estrogen control.

Using myself as an example, if I exceed 175mg of testosterone a week, my estrogen starts to creep up resulting in extra water retention that increases blood pressure and causes libido and mood instability.

It also means having to use more drugs to control the side effects of other drugs, which can become a vicious cycle – The few variables the better.

I’ve heard of some guys that are able to take up to 300mg per week without any estrogen control. These are known as low aromitizers and are certainly outliers, most guys seem to start having issues with estrogen beyond the 200mg range.

Bodyfat also contributes to estrogen conversion. The more bodyfat you carry, the greater rates of estrogen conversion you will have and it’s not uncommon for some men that have had issues with high estrogen to drop a load of bodyfat and all of a sudden, they no longer need additional estrogen management.

High estrogen can also be the cause of acne and gyno if it gets out of hand, so proper management is crucial to keeping it under control.

Administration & frequency

The most common and best way to administer testosterone is via injection, I knew a guy that put TRT off for years because he was scared to inject himself.

So he suffered symptoms of low testosterone for years because he couldn’t get over that one hurdle. It can seem scary, but trust me when I say that it’s one of those things that once you do it once you’re like… wow I can’t believe that’s all it was and I was scared this whole time.

You can use a 29g insulin pin and go subcutaneous or shallow intramuscular. 90% of the time you don’t even feel it. It’s like a 1/10 on the pain scale.

Ideally, testosterone is shot daily but if you really hate injections twice a week is fine for the longer esters but you may experience more peaks and valleys in serum concentration and as a result may have estrogen issues that otherwise could have been avoided with daily shots.

If you don’t mind doing shots, you can also just use testosterone propionate for TRT. There’s anecdotal reports of guys feeling better having more libido on propionate over enanthate/cypionate. It will also allow you to make more rapid adjustment in dosage too due to the shorter half life.

Cream is another option but I don’t recommend it, it’s messy, requires application multiple times a day and if you have a partner it can take the spontaneity out of intimacy because you won’t be able to have sex with testosterone cream on your genitals.

Managing estrogen

If you’re a high aromatizer and do end up requiring estrogen management, maybe because you need to push testosterone up high enough to get symptom relief to the point where you are getting excessive estrogen. Then there’s a few things you can do.

Check out this post all about estrogen management.