A common starting dose is 100mg per week of testosterone cypionate or enanthate. However, this varies based on individual factors:

• Some men respond well to 80-100mg/week
• Others may need 120-150mg/week to reach optimal levels
• Body weight, SHBG levels, and injection frequency all affect dosing

Injection frequency depends on your SHBG levels and personal response:

• Once weekly: Works for some men with normal-high SHBG
• Twice weekly (every 3.5 days): Most common, provides stable levels
• Three times weekly (M/W/F): Better for lower SHBG individuals
• Every other day (EOD) or daily: Best for very low SHBG (under 20)

Target levels vary by individual goals and symptom relief:

• Mid-normal range: 500-700 ng/dL (works for many men)
• High-normal range: 700-1000 ng/dL (some men feel best here)
• Supraphysiological: Above 1000 ng/dL (not recommended for TRT)

The goal is symptom relief, not just a number. Some men feel great at 600 ng/dL while others need 900 ng/dL.

Both methods are effective, with pros and cons:

Subcutaneous (SubQ):

• Less painful, smaller needles (27-30 gauge)
• Slightly slower absorption, more stable levels
• Easier to self-administer
• May cause small lumps at injection site for some

Intramuscular (IM):

• Traditional method, well-studied
• Faster absorption
• Larger needles (23-25 gauge)
• Less risk of injection site reactions

For 200mg/mL testosterone concentration with U-100 insulin syringes:

• Each unit = 2mg of testosterone
• 20mg dose = 10 units
• 40mg dose = 20 units
• 50mg dose = 25 units
• 100mg dose = 50 units

Formula: Divide your dose in mg by 2 to get units

Very minimal differences:

• Both are long-acting esters with similar half-lives
• Cypionate: Half-life ~8 days
• Enanthate: Half-life ~7 days
• Can be used interchangeably at the same dose
• Some men report feeling slightly different between the two, but this is uncommon

Testosterone propionate is a short-acting ester:

• Half-life: ~1-2 days (requires daily or EOD injection)
• More stable blood levels with frequent dosing
• Typical dose: 10-20mg daily
• Can be mixed with cypionate/enanthate for smoother levels

Conversion: 50mg cypionate every 3 days ≈ 14mg propionate daily

Timeline varies by symptom:

• 1-2 weeks: Increased energy, better sleep
• 3-4 weeks: Improved mood, motivation
• 4-6 weeks: Libido improvements
• 6-8 weeks: Body composition changes begin
• 3-6 months: Full benefits, muscle gain, fat loss

According to research by Dr. Shalender Bhasin:

• 125mg weekly is the minimum dose for significant fat-free mass gains
• Lower doses (50-100mg) may normalize testosterone but produce minimal body composition changes
• This dose produces trough levels around 500-700 ng/dL
• Provides best balance of benefits and minimal side effects

For three times weekly injections:

• Monday/Wednesday/Friday: Creates a "low point" on Sunday before Monday injection
• Sunday/Tuesday/Thursday: More evenly spaced
• Every other day (EOD): Most consistent levels but schedule rotates weekly

Choose based on your SHBG and how you feel. Men with very low SHBG (under 20) often do better with EOD or daily.

There's no one-size-fits-all answer, but general guidelines:

• 20-30 pg/mL: Many men feel best here
• 30-50 pg/mL: Acceptable for most, some prefer higher E2
• Above 50 pg/mL: May cause side effects in some men
• Below 20 pg/mL: Often too low, can cause joint pain, low libido

Use AIs only if you have high E2 symptoms:

• High E2 symptoms: Water retention, gynecomastia, emotional, erectile dysfunction
• First try: Lowering testosterone dose or increasing injection frequency
• If AI needed: Start with lowest dose (0.125mg anastrozole twice weekly)
• Avoid: Prophylactic AI use without symptoms or lab confirmation

Start low and adjust based on symptoms and labs:

• Starting dose: 0.125mg twice weekly (or 0.25mg once weekly)
• Typical range: 0.125-0.5mg twice weekly
• Maximum: Rarely need more than 1mg twice weekly
• Timing: Same day as injection or 24 hours after

Anastrozole has a half-life of ~50 hours, so dosing 2x weekly maintains stable levels.

Based on research, there are predictive models:

• Men under 60: E2 (pg/mL) ≈ 0.31 × Total T (ng/dL) - 94
• Men over 60: E2 (pg/mL) ≈ 0.26 × Total T (ng/dL) - 78

For example: Total T of 800 ng/dL → Expected E2 ≈ 30-40 pg/mL

Low Estradiol symptoms:

• Joint pain, cracking joints
• Low libido, erectile dysfunction
• Dry skin, brittle hair
• Anxiety, irritability
• Loss of morning erections

High Estradiol symptoms:

• Water retention, bloating
• Gynecomastia (breast tissue growth)
• Emotional, crying easily
• Erectile dysfunction
• Oily skin, acne

HCG has several benefits on TRT:

• Maintains testicular size: Prevents atrophy
• Preserves fertility: Maintains some sperm production
• Hormone production: Maintains pregnenolone and progesterone
• Improves well-being: Some men report better mood, libido

Common HCG protocols:

• 250-350 IU 3x weekly: Most common for testicular maintenance
• 500 IU twice weekly: Also popular, easier schedule
• 1000 IU weekly: Less frequent but works for some
• For fertility: May need 500 IU 3x weekly or higher

Standard reconstitution process:

• 5000 IU vial: Add 5mL bacteriostatic water (1000 IU/mL)
• For 500 IU dose: Draw 0.5mL (50 units on insulin syringe)
• For 250 IU dose: Draw 0.25mL (25 units)
• Storage: Refrigerate after mixing, use within 60 days

ExcelMale has an HCG calculator tool to help with different vial sizes and desired doses.

Yes, fertility can often be restored:

• Add HCG: 500-1000 IU 3x weekly
• Add FSH: May need HMG or recombinant FSH for sperm production
• Or PCT: Come off TRT and use Clomid/enclomiphene
• Timeline: Can take 6-12 months to restore sperm counts

SERMs can work for some men with secondary hypogonadism:

Clomid (clomiphene):

• Typical dose: 25-50mg every other day
• Increases LH/FSH, raises testosterone
• Maintains fertility
• Side effects: Vision issues, emotional changes, high estradiol

Enclomiphene (pure isomer):

• Fewer side effects than Clomid
• Typical dose: 12.5-25mg daily
• More consistent testosterone increase

Comprehensive baseline panel:

Hormones:

• Total Testosterone (2 tests, morning, fasted)
• Free Testosterone (equilibrium dialysis or calculated)
• Estradiol (sensitive/LC-MS method)
• LH and FSH
• SHBG
• Prolactin
• DHT (optional)

Thyroid:

• TSH, Free T3, Free T4

Metabolic:

• Complete Blood Count (CBC)
• Comprehensive Metabolic Panel (CMP)
• Lipid Panel

Other:

• PSA (prostate)
• Vitamin D
• HbA1c (diabetes screening)

Recommended testing schedule:

• Week 6-8: First check after starting TRT
• 3 months: Verify protocol is optimized
• 6 months: Check all parameters including PSA
• Then annually: Or more frequently if adjusting protocol

Total Testosterone:

• All testosterone in blood (bound + unbound)
• Most commonly tested
• Normal range: 300-1000 ng/dL

Free Testosterone:

• Not bound to SHBG or albumin
• Bioavailable to tissues
• Usually 1-3% of total testosterone
• Better indicator of testosterone activity

Bioavailable Testosterone:

• Free T + albumin-bound T
• Also readily available to tissues

Sex Hormone Binding Globulin (SHBG) binds to testosterone:

• High SHBG (>50): Binds more T, less free T available
• Normal SHBG (20-50): Typical response to TRT
• Low SHBG (<20): More free T, but clears faster from system

SHBG affects protocol:

• Low SHBG: Need more frequent injections (EOD or daily)
• High SHBG: Can usually handle less frequent dosing
• SHBG influences how much testosterone you need

Testing timing recommendations:

• Trough testing (preferred): Right before next injection
• Provides lowest level, ensures you're not going too low
• Most consistent for protocol adjustments
• Standard for clinical practice

Peak testing (occasionally):

• 24-48 hours after injection
• Useful to see total variation
• Not standard for protocol decisions

Hematocrit (HCT) guidelines on TRT:

• Normal: 40-48%
• Borderline: 50-52%
• High: 52-54% (may need intervention)
• Very high: >54% (typically requires action)

Managing high HCT:

• Ensure adequate hydration
• Lower testosterone dose
• Increase injection frequency
• Donate blood (therapeutic phlebotomy)
• Consider naringin supplementation

TRT typically affects cholesterol:

• HDL: May decrease 10-15% (generally mild)
• LDL: Usually minimal change
• Triglycerides: Often improve with TRT
• Total cholesterol: Varies individually

For men, use the sensitive assay:

• LC-MS/MS (Liquid Chromatography Mass Spectrometry): Most accurate for men
• Also called: "Sensitive" or "Ultrasensitive" E2 test
• Avoid: Standard immunoassay (designed for women, less accurate for men)

Lab names vary (Quest uses "Estradiol, Sensitive", LabCorp uses "Estradiol, LC/MS/MS")

TRT-related acne has several causes:

• Increased sebum production from testosterone
• DHT elevation (some men more sensitive)
• Hormonal fluctuations from inconsistent dosing
• High estradiol can contribute

Management strategies:

• More frequent injections (reduce hormone fluctuations)
• Lower dose if T levels very high
• Topical treatments (benzoyl peroxide, salicylic acid)
• Prescription options (tretinoin, isotretinoin for severe cases)
• Consider if E2 is too high or too low

Water retention is often estradiol-related:

Causes:

• High estradiol (most common)
• Starting TRT (temporary, first few weeks)
• Dose too high
• High sodium intake

Solutions:

• Check and manage estradiol levels
• Reduce sodium, increase water intake
• More frequent injections
• Lower dose if needed
• Consider AI if E2 confirmed high with symptoms

TRT and hair loss connection:

• DHT (from testosterone conversion) causes male pattern baldness in genetically predisposed men
• If you're genetically prone, TRT may accelerate existing hair loss
• TRT doesn't cause hair loss if you don't have the genetic predisposition

Prevention/management:

• Finasteride 1mg daily (blocks DHT)
• Dutasteride (stronger DHT blocker)
• Minoxidil (topical growth stimulant)
• RU58841 (topical anti-androgen)

Gynecomastia on TRT:

Causes:

• High estradiol relative to testosterone
• Rapid testosterone increase
• Individual sensitivity to estrogen

Prevention:

• Keep E2 in appropriate range
• Use AI if E2 consistently high
• Consider raloxifene 60mg daily (SERM that prevents breast tissue)

Treatment (if developed):

• Raloxifene 60mg daily for 3-6 months
• Lower E2 with AI or dose adjustment
• Surgery if tissue is fibrous/established

Fatigue on TRT can have multiple causes:

• Estradiol too low: Crashed E2 from too much AI
• Estradiol too high: Can also cause fatigue
• Hematocrit too high: Blood too thick
• Thyroid issues: TRT can affect thyroid
• Sleep apnea: TRT can worsen existing OSA
• Iron deficiency: Especially if donating blood frequently
• Dose too high or too low

TRT and sleep apnea relationship:

• TRT can worsen existing obstructive sleep apnea (OSA)
• Mechanism: Testosterone may affect upper airway muscle tone
• More common in first few months of therapy
• Weight gain from TRT can contribute

Management:

• Get sleep study if experiencing symptoms (snoring, poor sleep, morning fatigue)
• Use CPAP if diagnosed
• Weight loss helps significantly
• Consider if TRT dose needs adjustment

TRT and prostate health:

• Modern research: TRT doesn't increase prostate cancer risk
• May worsen: Existing BPH (benign prostatic hyperplasia) in some men
• Monitor PSA: Check baseline and periodically on TRT
• PSA increases: Small increase common and usually benign

Red flags (see urologist):

• PSA increase >1.4 ng/mL in one year
• PSA >4.0 ng/mL (varies by age)
• Abnormal digital rectal exam

Multiple factors affect libido beyond testosterone:

• Estradiol levels: Too high or too low both kill libido
• Thyroid: Hypothyroidism reduces libido
• Prolactin: Elevated prolactin suppresses libido
• DHT: Some men need adequate DHT for libido
• Dopamine: Consider dopaminergic supplements/medications
• Psychological: Stress, relationship issues, depression
• Time: Can take 3-6 months to fully improve

Additional ED treatment options:

Oral medications:

• Sildenafil (Viagra): 25-100mg as needed
• Tadalafil (Cialis): 5mg daily or 10-20mg as needed
• Vardenafil (Levitra): 10-20mg as needed

Injections (Trimix/Quadmix):

• Most effective option
• Injected into penis 5-10 minutes before sex
• Dose titrated individually
• Available from compounding pharmacies

Other options:

• PT-141 (melanocortin receptor agonist)
• L-citrulline supplementation
• Vacuum erection devices
• Check estradiol, prolactin levels

DHT (dihydrotestosterone) importance:

• Much more potent androgen than testosterone (3-10x)
• Important for libido in some men
• Contributes to erectile quality
• Affects prostate, hair, and skin

Normal DHT levels on TRT:

• Typically 30-85 ng/dL
• Some men feel better with higher DHT
• Can predict DHT from testosterone levels

PT-141 is a melanocortin receptor agonist:

Benefits:

• Works on libido (not just erectile function)
• Acts centrally in the brain
• Effective for many men and women
• Usually dosed 1-2mg subcutaneously

Side effects:

• Nausea (most common, especially first few uses)
• Flushing
• Takes 2-4 hours to work, plan ahead

Elevated prolactin reduces sexual function:

Effects of high prolactin:

• Decreased libido
• Erectile dysfunction
• Reduced ejaculatory volume
• Can lower testosterone production

Normal range: 4-15 ng/mL

Treatment if elevated:

• Investigate cause (prolactinoma, medications, etc.)
• Cabergoline 0.25-0.5mg twice weekly (if appropriate)
• Vitamin B6 (high dose) may help mildly elevated levels

These hormones can decline on TRT:

DHEA:

• Often suppressed by TRT
• Typical dose: 25-50mg daily
• Can convert to testosterone and estrogen
• Monitor levels if supplementing

Pregnenolone:

• Precursor to all steroid hormones
• May improve mood, cognition
• Typical dose: 25-100mg daily
• Generally well tolerated

TRT can affect thyroid function:

• Some men develop hypothyroid symptoms on TRT
• Check TSH, Free T3, Free T4 regularly
• Optimal ranges often differ from "normal" lab ranges

Consider thyroid medication if:

• TSH >2.5 with symptoms
• Free T3 in lower third of range with symptoms
• Reverse T3 elevated (>15 ng/dL)

Options:

• Levothyroxine (T4 only)
• T3/T4 combination (many prefer this)
• NDT (natural desiccated thyroid)

Nandrolone can help joint issues:

Benefits:

• Excellent for joint pain and healing
• Anabolic effects similar to testosterone
• Less androgenic side effects

Dosing:

• 50-100mg weekly for joint benefits
• Usually added to TRT, not replacement

Concerns:

• Can suppress natural production significantly
• Metabolites last many months (problematic for drug testing)
• May affect lipids
• Some men report mental/emotional side effects

These peptides show promise for healing:

BPC-157:

• May accelerate healing of tendons, ligaments, muscles
• Typical dose: 250-500mcg daily subcutaneously
• Usually cycled 4-6 weeks
• Limited human studies but anecdotal support

TB-500 (Thymosin Beta-4):

• Anti-inflammatory and healing properties
• Typical dose: 2-5mg twice weekly
• Often combined with BPC-157

Evidence-based supplements for men on TRT:

Essential:

• Vitamin D3: 2000-5000 IU daily (optimize to 50-80 ng/mL)
• Magnesium: 400-600mg daily (improves sleep, relaxation)
• Fish oil: 2-3g EPA/DHA daily (cardiovascular health)

Beneficial:

• Vitamin K2: 100-200mcg daily (with D3 for calcium regulation)
• Zinc: 15-30mg daily (if deficient, supports testosterone)
• Creatine: 5g daily (muscle, cognition)
• Taurine: 1-3g daily (cardiovascular, may help with HCT)

For specific issues:

• L-citrulline: 6-9g daily (erectile function, blood flow)
• Naringin: 500mg daily (may help reduce hematocrit)
• CoQ10: 100-300mg daily (if on statin or cardiovascular support)

Different options for TRT:

Traditional urologist/endocrinologist:

• Often conservative with dosing
• Insurance may cover
• May only prescribe IM, biweekly injections
• Varying experience with optimization

TRT clinics (Defy Medical, Maximus, etc.):

• Specialize in hormone optimization
• More flexible protocols
• Telemedicine convenient
• Usually cash pay ($150-300/month)
• Provide comprehensive approach

Compounding pharmacies:

• Lower cost for medication
• Custom formulations available
• Popular: Empower Pharmacy, Hallandale, Belmar

Typical vial duration calculations:

Standard 10mL vial at 200mg/mL (2000mg total):

• 100mg/week = 20 weeks
• 120mg/week = 16.6 weeks
• 150mg/week = 13.3 weeks
• 200mg/week = 10 weeks

Smaller 5mL vial at 200mg/mL (1000mg total):

• 100mg/week = 10 weeks
• 150mg/week = 6.6 weeks

Needle recommendations by injection type:

Subcutaneous:

• 27-30 gauge, 1/2 inch
• Insulin syringes work perfectly
• Inject into abdomen, thigh, or upper buttock fat

Intramuscular:

• 23-25 gauge, 1-1.5 inch (depending on injection site and body fat)
• Inject into deltoid, glute, or vastus lateralis (thigh)

Draw needle (if using separate):

• 18-21 gauge for drawing from vial
• Then switch to smaller gauge for injection

Traveling with TRT supplies:

Domestic (US) travel:

• Keep medication in original pharmacy packaging with prescription label
• Carry prescription or doctor's letter
• Can carry in carry-on or checked baggage
• Syringes are allowed with medication

International travel:

• Research destination country's laws (some countries ban testosterone)
• Carry doctor's letter explaining medical necessity
• Keep in original packaging
• Declare at customs if required
• Consider bringing limited supply and timing travel around injections

Handling missed injections:

• Inject as soon as you remember: Don't wait until next scheduled dose
• Don't double dose: Just inject your normal amount
• Resume regular schedule: Continue from when you injected
• One missed dose: Usually not a big deal, might feel slightly off
• Multiple missed doses: May take a week or two to stabilize again