Testosterone Replacement Therapy (TRT) 101: A Beginner's Guide

Testosterone Replacement Therapy (TRT) is a medical treatment designed to restore testosterone levels in men experiencing low testosterone (low T). If you're new to TRT, understanding key terms, dosing schedules, and ancillary medications is essential to optimizing your treatment. This guide covers the basics of TRT, helping you navigate your journey with confidence.

Key Terms & Definitions

Testosterone Replacement Therapy (TRT): A medical treatment for men with clinically low testosterone levels, typically involving the administration of exogenous (external) testosterone.

Aromatase Inhibitor (AI): A class of drugs that reduces estrogen levels by inhibiting the aromatase enzyme, which converts testosterone into estrogen.

Human Chorionic Gonadotropin (hCG): A hormone that mimics luteinizing hormone (LH), stimulating the testes to produce testosterone and maintain fertility during TRT.

Peak vs. Trough Levels:

• Peak: The highest level of testosterone in the bloodstream, occurring shortly after an injection.
• Trough: The lowest level of testosterone in the bloodstream, typically occurring just before the next scheduled dose.

Estrogen (E2): A hormone derived from testosterone; while necessary in small amounts, excessive estrogen can cause side effects like water retention and gynecomastia (breast tissue growth in men).

Free Testosterone: The biologically active form of testosterone that is not bound to proteins in the blood and is available for use by the body.

Typical TRT Dosing Schedules & Their Rationale

One of the most common questions about TRT is how often injections should be administered. The goal of dosing schedules is to maintain stable testosterone levels while minimizing side effects. Below are the common injection frequencies and their reasoning:

Once Weekly (Every 7 Days)

Pros:

• Fewer injections
• Convenient for patients new to TRT

Cons:

• Large peaks and troughs can lead to fluctuations in mood, energy, and libido
• Higher likelihood of estrogen conversion due to higher peak levels

Common Protocol:

• 100–200 mg of testosterone cypionate or enanthate per week

Twice Weekly (Every 3.5 Days)

Pros:

• More stable testosterone levels, reducing peaks and troughs
• Lower estrogen conversion compared to once-weekly dosing
• Reduced risk of side effects like mood swings and fatigue

Cons:

• Requires more frequent injections

Common Protocol:

• 50–100 mg of testosterone cypionate or enanthate every 3.5 days

Three Times Weekly (Every 2-3 Days)

Pros:

• Even more stable hormone levels
• Further reduced estrogen conversion
• Smoother symptom control

Cons:

• Requires more frequent injections

Common Protocol:

• 40–70 mg of testosterone per injection

Daily (Subcutaneous Injections)

Pros:

• Provides the most stable testosterone levels
• Minimizes peaks and troughs almost entirely
• Subcutaneous injections are easier and less painful than intramuscular injections

Cons:

• Requires daily commitment to injections

Common Protocol:

• 10–20 mg of testosterone cypionate or enanthate per day

Ancillary Medications Used in TRT

In some cases, additional medications may be used alongside testosterone to optimize results and manage side effects. Here are some of the most common ancillary medications:

Human Chorionic Gonadotropin (hCG)

• Used to stimulate the testes to continue producing testosterone and sperm, helping maintain fertility and preventing testicular atrophy.
• Common dosing: 250–500 IU 2-3 times per week

Aromatase Inhibitors (AIs) (e.g., Anastrozole, Letrozole, Exemestane)

• Used to control estrogen levels in men who experience excessive conversion of testosterone to estrogen.
• Overuse can lead to dangerously low estrogen, which may cause joint pain, mood swings, and cardiovascular issues.
• Common dosing: 0.25–0.5 mg of Anastrozole once or twice per week (only when necessary)

Nandrolone (Deca-Durabolin)

• Sometimes prescribed as an adjunct to TRT to help with joint pain and muscle growth.
• Can suppress natural testosterone production if not properly managed.
• Common dosing: 50–150 mg per week, usually in combination with TRT.

Oxandrolone (Anavar)

• A mild anabolic steroid sometimes used in conjunction with TRT to improve body composition and strength.
• Can impact liver function and lipid profiles, so monitoring is necessary.
• Common dosing: 10–25 mg per day in short cycles.

Key Takeaways

• TRT is designed to restore healthy testosterone levels in men with low T, improving energy, mood, libido, and overall well-being.
• Dosing schedules vary, with more frequent injections leading to more stable hormone levels and fewer side effects.
• Ancillary medications like hCG and AIs can be useful but should be used only when necessary and under medical supervision.
• Regular bloodwork is essential to monitor testosterone, estrogen, and other markers to ensure optimal results and minimize risks.

If you're considering TRT, consult with a knowledgeable provider to determine the best protocol for your specific needs. A well-managed TRT regimen can lead to significant improvements in quality of life when approached correctly. At AlphaMD, we are committed to providing the best resources and medical expertise to support you in your TRT journey. Visit AlphaMD.org to learn more and take the first step toward optimizing your health.