TRT Gone Wrong: 3 Rookie Mistakes Guys Keep Making

Let’s be real: starting testosterone replacement therapy (TRT) is a big step — and when it’s done right, it can be life-changing. More energy. Better mood. Sharper focus. A return to feeling like yourself again.

But here’s the thing: even well-intentioned men can sabotage their TRT results without realizing it. A few small mistakes can lead to big frustrations — from emotional ups and downs to physical side effects that make you wonder, “Wait… am I doing this wrong?”

Don’t worry. We’ve got you. Here are 3 of the most common TRT mistakes men make — and how to avoid them like a pro.

🚫 Mistake #1: Injecting Too Infrequently

The problem:
Some men start with bi-weekly or even once-a-week injections thinking, “That’s less hassle, right?” Unfortunately, this often leads to rollercoaster hormone levels — highs right after injection, followed by sluggish crashes a few days later.

The fix:
Consider splitting your dose into twice-weekly injections. This can help maintain more stable testosterone levels, reduce side effects like mood swings or irritability, and even improve how you feel day-to-day.

Pro tip: Subcutaneous (subQ) injections are often easier and less painful than intramuscular ones, and work just as well for many guys.

🌊 Mistake #2: Ignoring Estrogen Management

The problem:
Testosterone doesn’t work alone — your body naturally converts some of it into estrogen via a process called aromatization. That’s normal. But too much estrogen can lead to things like water retention, moodiness, or even sensitive nipples (yep, it happens).

The fix:
Don’t panic and jump to using an aromatase inhibitor (AI) right away. Estrogen isn’t the enemy — it’s essential for mood, libido, and even cardiovascular health. Instead, monitor your symptoms and work with a knowledgeable provider (like AlphaMD) to track your estrogen (E2) levels alongside your testosterone.

Heads up: Chasing "perfect" lab numbers can be a trap. Go by how you feel just as much as what’s on paper.

📉 Mistake #3: Not Testing (or Testing at the Wrong Time)

The problem:
Lab work is key to tracking your progress — but timing matters. Testing too far from your injection can give a misleading picture, showing low T when levels are actually fluctuating.

The fix:
For accurate results, do bloodwork midway between your last injection and your next one. If you inject every 3.5 days, test on Day 3. This gives a more realistic snapshot of your average levels — not just a post-injection spike or a pre-injection dip.

Bonus: Make sure you’re testing Total T, Free T, Estradiol (E2, sensitive), SHBG, and hematocrit at minimum.

✅ Wrapping it Up

TRT is a tool — and like any tool, it works best when you know how to use it. By avoiding these common mistakes, you're setting yourself up for smoother sailing and better long-term results.

At AlphaMD, we help you dial in your TRT protocol with real medical guidance, personalized care, and no BS.