TRT Dosing Protocols: Finding Your Optimal Dose

Why Dosing Matters More Than You Think

Two men can take the exact same dose of testosterone and have wildly different blood levels. One might hit 800 ng/dL. The other might land at 1,200 ng/dL. The reason: individual differences in metabolism, SHBG levels, body composition, and how efficiently their body processes the hormone.

This is why cookie-cutter dosing fails and why the best TRT providers treat dosing as an ongoing optimization process rather than a one-time decision.

Common Starting Doses

The Standard Starting Point

Most TRT providers start men on 100-150 mg of testosterone cypionate per week. This is conservative enough to assess your response without overshooting and aggressive enough to produce meaningful changes in blood levels and symptoms.

Starting higher (180-200 mg/week) is sometimes appropriate for men with very low baseline levels, high SHBG, or higher body weight. But for the average man beginning TRT, 120-150 mg/week hits the sweet spot for a starting dose.

Dose Ranges by Goal

These are generalizations. Your SHBG, body fat percentage, and individual metabolism all influence where you actually land.

Injection Frequency: The Biggest Variable

How often you inject matters as much as how much you inject. Here are the most common protocols, from least to most frequent.

Once Weekly

Protocol: Full weekly dose in one injection Example: 150 mg every Monday

This was the standard for years and many providers still prescribe it. The problem: with an 8-day half-life for testosterone cypionate, once-weekly injections create significant peaks and troughs. You might feel great on Tuesday and Wednesday, then notice energy and mood declining by Friday and Saturday.

Pros: Simple, fewer injections Cons: Larger hormonal fluctuations, higher estrogen spikes, more side effects

Twice Weekly (Most Popular)

Protocol: Weekly dose split into two equal injections Example: 75 mg Monday / 75 mg Thursday

This has become the gold standard at most modern TRT clinics. Splitting the dose cuts the peak-to-trough variation roughly in half. Less fluctuation means more stable energy, mood, and libido throughout the week. It also reduces estrogen spikes because you’re never flooding your body with a large bolus of testosterone.

Pros: Good balance of stability and convenience Cons: Two injection days per week

Three Times Weekly

Protocol: Weekly dose split into three injections Example: 50 mg Monday / 50 mg Wednesday / 50 mg Friday

Increasingly popular among optimization-focused clinics. Three injections per week provide even more stable levels than twice weekly. Some men report that the jump from two to three injections per week eliminates their need for an aromatase inhibitor because estrogen spikes are further blunted.

Pros: Very stable levels, reduced aromatization Cons: More frequent injections

Every Other Day (EOD)

Protocol: Calculated dose every 48 hours Example: ~43 mg every other day (equivalent to ~150 mg/week)

EOD dosing produces near-steady-state testosterone levels. The peaks and troughs are minimal. This is often recommended for men who are sensitive to hormonal fluctuations or who aromatize heavily.

Pros: Excellent stability, minimal side effects Cons: Alternating schedule can be harder to track

Daily Microdosing

Protocol: Small daily injections Example: ~20 mg daily (equivalent to ~140 mg/week)

The newest trend in TRT. Daily injections with insulin syringes (27-31 gauge) provide the most physiologically stable testosterone levels possible with injections. Blood levels barely fluctuate, mimicking the body’s natural continuous production more closely than any other injectable protocol.

Research from the Journal of the Endocrine Society has shown that daily subcutaneous injections of testosterone cypionate produce stable serum levels with less hematocrit elevation compared to less frequent dosing.

Pros: Most stable levels, lowest side effect profile, minimal aromatization Cons: Daily commitment, more supplies used

How to Know If Your Dose Is Right

Bloodwork Timing

This is crucial and frequently done wrong. Always draw your blood at trough, which means right before your next scheduled injection. This gives you the lowest point in your cycle and allows your provider to make accurate dose adjustments.

If you inject Monday and Thursday, draw blood Thursday morning before injecting.

If your provider draws blood the day after injection, you’re measuring your peak, which will look artificially high and could lead to an unnecessary dose reduction.

Target Levels

Where should your numbers be? Experienced TRT clinicians typically target:

• Total testosterone at trough: 700-1000 ng/dL
• Free testosterone: 15-25 pg/mL
• Estradiol (sensitive): 20-35 pg/mL
• Hematocrit: Below 52%

If your trough is below 600 ng/dL and you still have symptoms, the dose probably needs to go up. If your trough is above 1,100 ng/dL, you may be taking more than necessary.

Symptom Tracking

Numbers matter, but so does how you feel. Track these weekly:

• Energy levels (1-10 scale)
• Mood and motivation
• Libido and sexual function
• Sleep quality
• Workout performance and recovery
• Any side effects (acne, water retention, mood swings)

Some men feel best at 800 ng/dL. Others need 1,000 ng/dL. Your sweet spot is where bloodwork is healthy AND symptoms are resolved.

Ancillary Medications

HCG (Human Chorionic Gonadotropin)

Typical dose: 250-500 IU, 2-3 times per week Purpose: Maintains testicular function, preserves fertility, supports intratesticular testosterone production

HCG mimics LH and keeps the testes from shutting down completely. It also helps maintain intratesticular testosterone and other hormones (like pregnenolone and DHEA) that are produced locally in the testes.

Anastrozole (Aromatase Inhibitor)

Typical dose: 0.25-0.5 mg, 1-2 times per week Purpose: Reduces conversion of testosterone to estradiol

Used less frequently now than five years ago. The modern approach favors optimizing injection frequency and dose first. AIs are reserved for men who still have elevated estrogen despite protocol adjustments.

Warning: Over-suppressing estrogen is worse than having it slightly elevated. Low estrogen causes joint pain, low libido, depression, and poor lipid profiles. If an AI is prescribed, start low and titrate based on bloodwork.

DHEA

Typical dose: 25-50 mg daily Purpose: Supports adrenal function and fills a gap that TRT can create by suppressing intratesticular DHEA production

Gonadorelin

Typical dose: 200-400 mcg subcutaneous, 2-3 times per week Purpose: Alternative to HCG for maintaining LH/FSH signaling. Effectiveness is debated compared to HCG.

Protocol Adjustments: When and How

When to Adjust

• After your 6-week follow-up bloodwork
• If symptoms aren’t resolving despite 8+ weeks on protocol
• If side effects are persistent
• If hematocrit is climbing above 52%
• If estrogen is consistently out of range

How to Adjust

Dose changes should be conservative: 10-20 mg per week at a time. A 20 mg weekly change can shift your blood levels by 100-200 ng/dL. Recheck bloodwork 6 weeks after any adjustment.

If side effects are the primary concern, try increasing injection frequency before decreasing the dose. Splitting the same dose into more injections often resolves issues that look like overdosing but are actually fluctuation problems.

Subcutaneous vs. Intramuscular Injection

Research supports that SubQ injections produce equivalent testosterone levels to IM injections. SubQ has become the preferred method at most online TRT clinics because patients find it more comfortable and it’s easier to self-administer.

The Bottom Line

There is no universally correct TRT dose. Your optimal protocol depends on your body, your bloodwork, and how you respond. The best approach is to start conservative, test at 6 weeks, adjust based on labs and symptoms, and repeat until dialed in.

The most common mistake men make is chasing a specific number rather than optimizing for how they feel. Work with a provider who understands this and who treats you as an individual. That’s how you get TRT right.

This article is for educational purposes only and does not constitute medical advice. Dosing decisions should be made in consultation with a licensed healthcare provider based on your individual bloodwork and clinical presentation.